Novel interdisciplinary intervention, GAIN, vs. enhanced usual care to reduce high levels of post-concussion symptoms in adolescents and young adults 2–6 months post-injury: A randomised trial

Thastum, Mille Moeller; Rask, Charlotte Ulrikka; Næss‐Schmidt, Erhard Trillingsgaard; Tuborgh, Astrid; Jensen, Jens Søndergaard; Svendsen, Susanne Wulff; Nielsen, Jørgen Feldbæk; Schröder, Andreas

doi:10.1016/j.eclinm.2019.11.007

Cited by 27 publications

(103 citation statements)

References 32 publications

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“…The present MRI study was embedded in a larger RCT (Thastum et al., 2019) carried out at Aarhus University Hospital in Central Denmark Region from February 2015 to March 2018. Recruitment for the MRI study was paused from the beginning of September 2016 to the end of December 2016 due to reduced staff resources.…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…Potential patients from the cohort study ( n = 183) and general practitioners ( n = 173) initially filled out a survey and was then screened for eligibility to the RCT (Thastum et al., 2019). Of these 181 patients was found eligible and consented to be assessed by a neurologist and a psychiatrist (Thastum et al., 2019). Of these 112 patients were included in the RCT and randomly assigned (1:1) to GAIN or EUC; further details on the study design and randomization process have been provided previously (Thastum et al., 2019).…”

Section: Methodsmentioning

confidence: 99%

“…Of these 181 patients was found eligible and consented to be assessed by a neurologist and a psychiatrist (Thastum et al., 2019). Of these 112 patients were included in the RCT and randomly assigned (1:1) to GAIN or EUC; further details on the study design and randomization process have been provided previously (Thastum et al., 2019). At the clinical assessment of the RCT and before randomization, eligible patients ≥18 years were also informed about the present MRI study and asked to participate.…”

Section: Methodsmentioning

confidence: 99%

“…Up to 15% of those who experience mild traumatic brain injury have long‐term post‐concussion symptoms (PCS) 3 months later (McCrea et al., 2009; Snell et al., 2009). The causes of long‐term PCS include biological, psychological, and social factors (Hou et al., 2012), and randomized controlled trials (RCTs) in this patient group suggest that treatments which combine cognitive and behavioral strategies may reduce symptom burden and functional impairment (Rytter et al., 2019; Thastum et al., 2019). We recently conducted an RCT in young patients with long‐term PCS to compare the intervention “Get going After concussIoN” (GAIN) with Enhanced Usual Care (EUC) and found that GAIN resulted in a significantly larger reduction of PCS (Thastum et al., 2019).…”

Section: Introductionmentioning

confidence: 99%

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Microstructural changes in the brain after long‐term post‐concussion symptoms: A randomized trial

Næss‐Schmidt

Blicher

Thastum

et al. 2020

J of Neuroscience Research

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A recent randomized controlled trial in young patients with long-term post-concussion symptoms showed that a novel behavioral intervention "Get going After con-cussIoN" is superior to enhanced usual care in terms of symptom reduction. It is unknown whether these interventional effects are associated with microstructural brain changes. The aim of this study was to examine whether diffusion-weighted MRI indices, which are sensitive to the interactions between cellular structures and water molecules' Brownian motion, respond differently to the interventions of the above-mentioned trial and whether such differences correlate with the improvement of post-concussion symptoms. Twenty-three patients from the intervention group (mean age 22.8, 18 females) and 19 patients from the control group (enhanced usual care) (mean age 23.9, 14 females) were enrolled. The primary outcome measure was the mean kurtosis tensor, which is sensitive to the microscopic complexity of brain tissue. The mean kurtosis tensor was significantly increased in the intervention group (p = 0.003) in the corpus callosum but not in the thalamus (p = 0.78) and the hippocampus (p = 0.34). An increase in mean kurtosis tensor in the corpus callosum tended to be associated with a reduction in symptoms, but this association did not reach significance (p = 0.059). Changes in diffusion tensor imaging metrics did not | 873 TRILLINGSGAARD NAESS-SCHMIDT eT AL.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Microstructural changes in the brain after long‐term post‐concussion symptoms: A randomized trial

Næss‐Schmidt

Blicher

Thastum

et al. 2020

J of Neuroscience Research

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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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Association of Posttraumatic Headache With Symptom Burden After Concussion in Children

et al. 2023

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ImportanceHeadache is the most common symptom after pediatric concussion.ObjectivesTo examine whether posttraumatic headache phenotype is associated with symptom burden and quality of life 3 months after concussion.Design, Setting, and ParticipantsThis was a secondary analysis of the Advancing Concussion Assessment in Pediatrics (A-CAP) prospective cohort study, conducted September 2016 to July 2019 at 5 Pediatric Emergency Research Canada (PERC) network emergency departments. Children aged 8.0-16.99 years presenting with acute (&lt;48 hours) concussion or orthopedic injury (OI) were included. Data were analyzed from April to December 2022.ExposurePosttraumatic headache was classified as migraine or nonmigraine headache, or no headache, using modified International Classification of Headache Disorders, 3rd edition, diagnostic criteria based on self-reported symptoms collected within 10 days of injury.Main Outcomes and MeasuresSelf-reported postconcussion symptoms and quality-of-life were measured at 3 months after concussion using the validated Health and Behavior Inventory (HBI) and Pediatric Quality of Life Inventory–Version 4.0 (PedsQL-4.0). An initial multiple imputation approach was used to minimize potential biases due to missing data. Multivariable linear regression evaluated the association between headache phenotype and outcomes compared with the Predicting and Preventing Postconcussive Problems in Pediatrics (5P) clinical risk score and other covariates and confounders. Reliable change analyses examined clinical significance of findings.ResultsOf 967 enrolled children, 928 (median [IQR] age, 12.2 [10.5 to 14.3] years; 383 [41.3%] female) were included in analyses. HBI total score (adjusted) was significantly higher for children with migraine than children without headache (estimated mean difference [EMD], 3.36; 95% CI, 1.13 to 5.60) and children with OI (EMD, 3.10; 95% CI, 0.75 to 6.62), but not children with nonmigraine headache (EMD, 1.93; 95% CI, −0.33 to 4.19). Children with migraine were more likely to report reliable increases in total symptoms (odds ratio [OR], 2.13; 95% CI, 1.02 to 4.45) and somatic symptoms (OR, 2.70; 95% CI, 1.29 to 5.68) than those without headache. PedsQL-4.0 subscale scores were significantly lower for children with migraine than those without headache only for physical functioning (EMD, −4.67; 95% CI, −7.86 to −1.48).Conclusions and RelevanceIn this cohort study of children with concussion or OI, those with posttraumatic migraine symptoms after concussion had higher symptom burden and lower quality of life 3 months after injury than those with nonmigraine headache. Children without posttraumatic headache reported the lowest symptom burden and highest quality of life, comparable with children with OI. Further research is warranted to determine effective treatment strategies that consider headache phenotype.

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Novel interdisciplinary intervention, GAIN, vs. enhanced usual care to reduce high levels of post-concussion symptoms in adolescents and young adults 2–6 months post-injury: A randomised trial

Cited by 27 publications

References 32 publications

Microstructural changes in the brain after long‐term post‐concussion symptoms: A randomized trial

Microstructural changes in the brain after long‐term post‐concussion symptoms: A randomized trial

Nonpharmacological Treatment of Persistent Postconcussion Symptoms in Adults

Association of Posttraumatic Headache With Symptom Burden After Concussion in Children

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