No effect of an early intervention after mild traumatic brain injury on activity and participation: A randomized controlled trial

Matuseviciene, Giedre; Eriksson, Gunilla; DeBoussard, Catharina Nygren

doi:10.2340/16501977-2025

Cited by 16 publications

(32 citation statements)

References 34 publications

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“…Matuseviciene et al offered an early intervention visit to a select group of patients with three PCS at ten days post-injury, but this intervention showed no effect on RTW compared to the control [14]. In that study, 97 of 174 (56%) patients admitted to the hospital with PTA < 1 hour were recruited, compared to 151 of 702 (22%) hospitalised patients with PTA < 24 hour in our study [14]. Wade et al improved the outcome of their early multidisciplinary intervention.…”

Section: Discussionmentioning

confidence: 99%

“…It was not realistic to prolong the inclusion period for more than three years, and our study was unfortunately inadequately powered for the number of patients recruited in the RCT and the primary outcome of RTW. It appears that recruiting an adequate number of patients to achieve statistical power is a common problem in this type of study [13,14]. If we had succeeded in recruiting a significant higher number of patients to the study, we could have achieved a more consistent difference between the groups.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…However, another systematic review found no effect of early interventions focusing on advisement and reassurance after MTBI [13]. Matuseviciene et al tried to avoid this confound by offering an early intervention visit by a rehabilitation specialist compared to providing written information to estimated high-risk patients with three or more PCS after MTBI, but their studies showed no difference in return-to-work (RTW) between interventions [14]. Participation such as RTW is an important goal in rehabilitation because being unemployed affects various dimensions of physical, psychological and social health [15].…”

Section: Introductionmentioning

confidence: 99%

“…According to different cohort studies published, the rate of RTW after one year tends to vary from approximately 55% to 97%, and a systematic review has concluded that the majority of workers seem to RTW within three to six months after MTBI [3,[17][18][19]. Hence, there is still a need for well-designed clinical studies to evaluate the effect of treatments for RTW after MTBI, and it is suggested that further treatment focusing on participation should be individualised [3,4,13,14]. According to other authors additional studies should focus on the timing of the interventions, such as patients with sustainable complaints in the first one to three months after injury [20,21].…”

Section: Introductionmentioning

confidence: 99%

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Multidisciplinary outpatient treatment in patients with mild traumatic brain injury: A randomised controlled intervention study

et al. 2017

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Objective: To evaluate the efficacy of a multidisciplinary outpatient follow-up programme compared to follow-up by a general practitioner for patients being at risk or sick-listed with persistent post-concussion symptoms two months after a mild traumatic brain injury. Design: Randomised controlled trial.Patients: One hundred fifty-one patients, 16-56 years.Methods: Multidisciplinary outpatient rehabilitation with individual contacts and a psychoeducational group intervention at two outpatient rehabilitation clinics compared to follow-up by a general practitioner after a multidisciplinary examination. Primary outcome was sustainable return-to-work first year post-injury. Secondary outcomes were post-concussion symptoms, disability, the patient's impressions of change and psychological distress.Results: Days to sustainable return-to-work was 90 in the intervention and 71 in the control group (p=0.375). The number of post-concussion symptoms were fewer in the intervention (6) compared to the control group (8) at 12 months (p=0.041). No group differences were observed for disability (p=0.193), patients impression of change (p=0.285) or psychological distress (p=0.716).2 Conclusion:The multidisciplinary outpatient follow-up programme focusing on better understanding and reassurance of favourable outcome for mild traumatic brain injury did not improve return-to-work, but may have reduced the development of post-concussion symptoms.Additional studies should focus on which factors exhibit a direct impact on return-to-work.

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Section: Discussionmentioning

confidence: 99%

Section: Strengths and Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Multidisciplinary outpatient treatment in patients with mild traumatic brain injury: A randomised controlled intervention study

et al. 2017

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“…Whether intensified follow-up could help dealing with this uncertainty towards recovery is largely uninvestigated. Two recent papers reported on the effect of an information intervention aimed at high-risk patients (≥three complaints 10 days after injury), in which the authors conclude that the intervention had no effect on activity or participation nor on PTC level after three months [24,25]. Since we found no differences in the average number of complaints between our two groups after two weeks, it might be argued that the identification of at-risk patients based on number of complaints is not appropriate for assessing the need for outpatient follow-up.…”

Section: Discussionmentioning

confidence: 99%

Outpatient follow-up after mild traumatic brain injury: Results of the UPFRONT-study

et al. 2017

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Outpatient follow-up after mild traumatic brain injury de Koning, M.E.; Scheenen, M.E.; van der Horn, Harm J.; Hageman, G.; Roks, G.; Yilmaz, T.; Spikman, Jacoba; van der Naalt, Joukje Link to publication in University of Groningen/UMCG research database Citation for published version (APA): de Koning, M. E., Scheenen, M. E., van der Horn, H. J., Hageman, G., Roks, G., Yilmaz, T., ... van der Naalt, J. (2017). Outpatient follow-up after mild traumatic brain injury: Results of the UPFRONT-study. Brain Injury, 31, 1102-1108. DOI: 10.1080/02699052.2017 Copyright Other than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the number of authors shown on this cover page is limited to 10 maximum. Objective: To investigate outpatient follow-up after mild traumatic brain injury (mTBI) by various medical specialists, for both hospitalized and non-hospitalized patients, and to study guideline adherence regarding hospital admission. Methods: Patients (n = 1151) with mTBI recruited from the emergency department received questionnaires 2 weeks (n = 879), 3 months (n = 780) and 6 months (n = 668) after injury comprising outpatient follow-up by various health care providers, and outcome defined by the Glasgow Outcome Scale Extended (GOS-E) after 6 months. Results: Hospitalized patients (60%) were older (46.6 ± 19.9 vs. 40.6 ± 18.5 years), more severely injured (GCS <15, 50% vs. 13%) with more Computed Tomography (CT) abnormalities on admission (21% vs. 2%) compared to non-hospitalized patients (p < 0.01) . Almost half of the patients visited a neurologist at the outpatient clinic within six months (60% of the hospitalized and 25% of the non-hospitalized patients (χ 2 = 67.10, p < 0.01)), and approximately ten per cent consulted a psychiatrist/psychologist. Outcome was unfavourable (GOS-E <7) in 34% of hospitalized and 21% of non-hospitalized patients (χ 2 = 11.89, p < 0.01). Conclusion: Twothirds of all mTBI patients consult one or more specialists within six months after injury, with 30% having an unfavourable outcome. A quarter of non-hospitalized patients was seen at the outpatient neurology clinic, underling the importance of regular follow-up of mTBI patients irrespective of hospital admittance. ARTICLE HISTORY

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Nonpharmacological Treatment of Persistent Postconcussion Symptoms in Adults

Rytter

Graff²,

Henriksen³

et al. 2021

JAMA Netw Open

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IMPORTANCE Persistent (>4 weeks) postconcussion symptoms (PPCS) are challenging for both patients and clinicians. There is uncertainty about the effect of commonly applied nonpharmacological treatments for the management of PPCS. OBJECTIVE To systematically assess and summarize evidence for outcomes related to 7 nonpharmacological interventions for PPCS in adults (aged >18 years) and provide recommendations for clinical practice. DATA SOURCES Systematic literature searches were performed via Embase, MEDLINE, PsycINFO, CINAHL, PEDro, OTseeker, and Cochrane Reviews (via MEDLINE and Embase) from earliest possible publication year to March 3, 2020. The literature was searched for prior systematic reviews and primary studies. To be included, studies had to be intervention studies with a control group and focus on PPCS. STUDY SELECTION A multidisciplinary guideline panel selected interventions based on frequency of use and need for decision support among clinicians, including early information and advice, graded physical exercise, vestibular rehabilitation, manual treatment of neck and back, oculomotor vision treatment, psychological treatment, and interdisciplinary coordinated rehabilitative treatment. To be included, studies had to be intervention studies within the areas of the predefined clinical questions, include a control group, and focus on symptoms after concussion or mild traumatic brain injury. DATA EXTRACTION AND SYNTHESIS Extraction was performed independently by multiple observers. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for data abstraction and data quality assessment. Included studies were assessed using the Assessment of Multiple Systematic Reviews (AMSTAR) tool and the Cochrane Risk of Bias (randomized clinical trials) tool. Meta-analysis was performed for all interventions where possible. Random-effects models were used to calculate pooled estimates of effects. The level and certainty of evidence was rated and recommendations formulated according to the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. MAIN OUTCOMES AND MEASURESAll outcomes were planned before data collection began according to a specified protocol. The primary outcomes were the collective burden of PPCS and another outcome reflecting the focus of a particular intervention (eg, physical functioning after graded exercise intervention). RESULTSEleven systematic reviews were identified but did not contribute any primary studies; 19 randomized clinical trials comprising 2007 participants (1064 women [53.0%]) were separately (continued)

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No effect of an early intervention after mild traumatic brain injury on activity and participation: A randomized controlled trial

Abstract: Patients who report few symptoms early after mild traumatic brain injury are likely to have a good outcome regarding activity and participation. The intervention offered in this study, focusing on reassurance of a good outcome and treatment of comorbidities, had no effect.

Cited by 16 publications

References 34 publications

Multidisciplinary outpatient treatment in patients with mild traumatic brain injury: A randomised controlled intervention study

Multidisciplinary outpatient treatment in patients with mild traumatic brain injury: A randomised controlled intervention study

Outpatient follow-up after mild traumatic brain injury: Results of the UPFRONT-study

Nonpharmacological Treatment of Persistent Postconcussion Symptoms in Adults

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