None listed
Conditions
Brief summary
Concussion/mild traumatic brain injury represents a public health concern given its prevalence and potential long-term consequences, with up to 30% of people with concussion experiencing delayed recovery/persisting post-concussion symptoms (PPCSs). PPCSs can interfere with successful return to activities (e.g., school, work, sports) causing significant stress for months to years after injury. PPCSs are multifactorial and interdisciplinary treatments are recommended. Limited options for evidence-based interdisciplinary treatments exist, particularly in rural areas where concussion rates are higher. Our team of international leaders in concussion research, developed and piloted an Interdisciplinary Rehabilitation program for Concussion Recovery (i-RECOveR; ACTRN12620001111965) with positive results. Specialised interdisciplinary treatments such as i-RECOveR, however, are usually limited to urban cities and inaccessible in rural areas. Telehealth can increase access to treatments such as i-RECOveR, although the evidence for telehealth concussion interventions is unestablished. As well as increasing access to treatments such as i-RECOveR, a telehealth model may assist with accessibility issues relating to the injury itself. Our previous research identified the potential benefit of telehealth which included eliminating the need to travel to appointments, which for some individuals with debilitating PPCSs, often exacerbated their symptoms compounding anxiety and fatigue. In an Australian and possibly world first, this study will pilot an 8-week interdisciplinary intervention comprised of coordinated neuropsychology, physiotherapy and medical treatments via telehealth in 12 adults with PPCSs. Concussion symptoms will be assessed as well as treatment goal attainment. There is no comparator group. This research has the potential to establish a feasible, effective, and accessible intervention, increasing the reach of specialised concussion services to those living in rural and remote areas.
Interventions
All participants will receive intervention from a neuropsychologist, physiotherapist, and sports medicine physician. Participants will be posted equipment packs to facilitate physiotherapy treatment via telehealth, including heart rate monitor, paddle pop sticks, laminated pages with numbers and checkers, and a ruler.
All participants will receive an initial 60–90-minute consultation with a neuropsychologist, physiotherapist, and medicine physician. The initial consultations will take place vi
All participants will receive intervention from a neuropsychologist, physiotherapist, and sports medicine physician. Participants will be posted equipment packs to facilitate physiotherapy treatment via telehealth, including heart rate monitor, paddle pop sticks, laminated pages with numbers and checkers, and a ruler. All participants will receive an initial 60–90-minute consultation with a neuropsychologist, physiotherapist, and medicine physician. The initial consultations will take place via telehealth using online video conferencing. Following initial consultations, clinicians will meet via case conference to discuss individualised treatment plans. Participants will be offered up to an additional 7 sessions each of psychological and physiotherapy treatment as required based on the initial interviews. (i.e. A total of 16 sessions of treatment will be offered for physiotherapy and psychology). Treatment sessions will be delivered online via videoconference. Psychological treatment sessions will last between 60-90 minutes at a maximum of once a week. Physiotherapy treatment sessions will last for 45-60 minutes and will be at a maximum of once a week. Participants will also be offered ongoing medical management/review/consultations as required via telehealth over the 8-week program. The psychological intervention will be oriented toward a cognitive-behavioural framework as described by Beck (1979) and will be adapted from previous manuals developed by Ferguson and Mittenberg (1996) and Silverberg et al. (2013) and will comprise of goal setting and review, psychoeducation, activity scheduling, cognitive restructuring, anxiety management training, cognitive compensation intervention and sleep intervention. As part of this therapy, participants will be provided with educational materials adapted from readily available resources (published materials such as the Mild Head Injury Bookelet; https://www.monash.edu/medicine/psych/merrc/resources) as well as provided with material specially designed for this study. Participants will also be assessed by a physiotherapist and will be provided treatment in the following domains as required: ocular, vestibular, cervical, and autonomic system functioning. Physical therapy intervention will be specific to their assessment and may comprise of vestibular rehabilitation, manual therapy, cervical strengthening, proprioceptive training, and a graded exercise program. Examples of ocular retraining include convergence exercises where participants will watch a target as it moves towards them, saccadic retraining where participants quickly move their gaze between targets, and smooth pursuit training where the participant watches a moving target. Examples of vestibular rehabilitation are gaze stabilisation where participants turn their head and focus on a target (this is done to a particular speed predetermined by the physiotherapy assessing the participant), VOR cancellation exercises where participants watch a target move through space by turning their whole body, and motion sensitivity exercises such as, walking, and gaze stabilisation or VOR cancellation. Examples of cervical rehabilitation include cervical strengthening such as deep neck flexor strengthening, and proprioception training with a target and a laser to rehabilitate sensory awareness of the neck. Graded exercise is defined as exercise of the participant's choice that can be safely done for 20 minutes. Exercise will be targeted at a particular heart rate. The starting heart rate will be defined as 85% of the point of failure of the subject on Montreal Virtual Exertion test. Heart rates will increase in line with a decrease in participant's symptoms. This will be assessed and closely monitored by the physiotherapist. Graded exercise will generally be walking, running or stationary bike, however, other modes such as swimming could be introduced if tolerated and preferred by the participant. The physiotherapist will outline an individualised treatment and home program based on the assessment. Equipment used throughout the assessment and rehabilitation include various targets (a paddle pop, sticky labels), balls for motion sensitivity and a heart rate monitor for tracking heart rate. Medical management of persistent post-concussion symptoms will comprise of one consultation (same as initial consultation) with the physician which may include pharmacological management of symptoms as well as advice regarding return to activities (e.g. work, sport, school). Treatment fidelity: Adherence to the manualised CBT intervention will be rated by an independent psychologist who will listen to audio/video recordings of 10% of the sessions. To assess physiotherapy treatment fidelity, 10% of the sessions will be rated by an independent physiotherapist.
Sponsors
Monash University
Study design
Allocation
Non-randomised trial
Intervention model
Other
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
16 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
Eligibility criteria: (a) aged 16 – 70 years, (b) sustained a mTBI classified using the most recent diagnostic criteria developed by the American Congress of Rehabilitation Medicine (ACRM), (c) experiencing more than three post-concussion symptoms assessed by the Rivermead Post-Concussion Questionnaire (RPQ; King et al., 1995), in line with the International Statistical Classification of Diseases definition of pPCSs, (d) experiencing post-concussion symptoms for at least two weeks post-injury, and (e) reside in a Modified Monash Model classification 2-6 in Victoria, Australia.
Exclusion criteria
Current acute psychiatric condition, active substance abuse, significant neurological history, and insufficient English.
Outcome results
None listed