How does the neck contribute to post-concussion symptoms?

Status

Completed

Phases

Unknown

Study type

Observational

Source

ANZCTR

Registry ID

ACTRN12616001183471

Enrollment

Registered

2016-08-29

Start date

2016-09-05

Completion date

2016-11-11

Last updated

2024-02-27

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

None listed

Brief summary

This research is designed to address two questions. 1. How does the neck contribute to persistent (>10 days) post-concussion symptoms? (With particular attention to headaches, dizziness and/or neck pain). 2. What changes in post-concussion symptoms are observed after treatment of the neck? Concussion (also known as mild traumatic brain injury) is increasingly recognised as an injury with significant consequences. Recent New Zealand research shows that following a concussion nearly half (47.9%) report significant persistent symptoms a year later. Some of these symptoms potentially arise from the neck, as there appears to be significant overlap in ‘post-concussion’ and neck-related symptoms. However, original research to describe the contribution of the neck to post-concussion symptoms is lacking. Participants for a prospective case-series will be recruited from two existing concussion service providers involved in assessing cases under the Accident Compensation Corporation (ACC) ‘Concussion Service’. Those with a potential neck contribution to their symptoms, and referred to a Physiotherapist with training in manual therapy for further neck assessment and treatment will be eligible for the study. In line with normal practice participants will be excluded if manual neck assessment is inappropriate, if they have other significant neurological conditions, or are under 16 years old. No additional exclusions will apply, ensuring the results are generally relevant. Following patients through their neck assessment and treatment will allow us to describe the contribution of the neck to their symptoms, and outcomes from neck treatment.

Interventions

This study will observe people who have had a concussion presenting to a concussion provider through the New Zealand Accident Compensation Corporation (ACC) Concussion Service, when it is suspected the neck is contributing to their symptoms, at the time they present to a Physiotherapist for neck assessment and treatment. Participants will complete neck Physiotherapy as normal. This will involve a detailed assessment of the neck including movements, palpation and tests. Treatment will be decided by the participant in collaboration with the Physiotherapist and may include hands-on therapy, exercise, education, advice etc. Treatment will typically span several sessions (e.g. 6 sessions), and is expected to be completed within 2 months of their first appointment. Again, this will be decided by the participant along with the Physiotherapist and healthcare team. Standardised outcomes will be measured at the initial Physiotherapy visit, and again at the final Physiotherapy visit. This will involve questionnaires, clinical measures of symptoms and function, clinical findings in the neck, and saliva samples. Descriptive findings, treatment and outcomes will be retrieved from the clinical notes at the end of their neck Physiotherapy treatment.

Eligibility

Sex/Gender

All

Age

16 Years to No maximum

Healthy volunteers

Inclusion criteria

These are: Patients presenting through the ACC Concussion service to APM Limited OR Advantage South concussion assessors with persistent (> 10 days) headaches, dizziness and/or neck pain; subjective history suggesting the neck may contribute to their symptoms*; who accept and follow through with a referral for neck assessment and treatment by a Physiotherapist with postgraduate manual therapy training. *Potential for the neck to contribute to patient’s symptoms will be informed by: 1. Increased neck pain or stiffness since their concussion injury OR 2. Headache consistent with symptoms arising from the neck: headache triggered by neck movement/positioning, or external pressure to the neck/head; restricted neck range of movement; neck, shoulder or arm pain on the same side (Sjaastad, Fredriksen, and Pfaffenrath 1998) OR 3. Dizziness consistent with symptoms arising from the neck: non-rotatory dizziness described as imbalance or unsteadiness; and triggered by neck movements or positions (Reid et al. 2014).

Exclusion criteria

These are: Contraindications to manual therapy for the neck (e.g. fracture, inflammatory joint conditions, and infection); other significant neurological conditions; patients under the age of 16 years.

Outcome results