Mild Traumatic Brain Injury
Conditions
Keywords
Concussion
Brief summary
Mental health problems frequently complicate recovery from mild traumatic brain injury (mTBI) but are under-recognized and under-treated. Our research program aims to identify evidence-based strategies for closing this knowledge-practice gap. Building on a successful pilot trial, the reseachers will evaluate the effectiveness of a clinical practice guideline implementation tool designed to support proactive management of mental health complications after mTBI in primary care.
Detailed description
Goal: To determine if a clinical practice guideline implementation tool, designed to support proactive management of mental health complications, can improve clinical outcomes from mild traumatic brain injury (mTBI). Background: Up to 1 in 4 people who sustain an mTBI develop depression or an anxiety disorder within the first 3 months. Mental health problems triple the risk of long-term disability after mTBI. However, mental health disorders after mTBI are under-detected and under-treated. Canadian clinical practice guidelines for mTBI developed by the Ontario Neurotrauma Foundation (ONF) recommend that family physicians proactively screen and initiate treatment for mental health disorders. Aims: To evaluate the effectiveness of an implementation intervention designed to facilitate timely detection and treatment of mental health complications in primary care. Approach: Triple-blinded (treatment provider, patient, assessor) cluster randomized controlled trial with two arms. The intervention involves collecting screening test results from patients and a complex intervention with two components: sharing the screening test results in an actionable format with their family physician and activating patients for the clinical encounter with the family physician by sharing education materials about mental health problems and treatment options after mTBI. The comparison group is usual care. Hypotheses: The researchers hypothesize that the guideline implementation tool will be associated with lower rates of mental health complications at 26 weeks post-injury, compared to usual care.
Interventions
OTHERGuideline implementation tool
Family physicians will receive a tailored letter with their patient's mental health screening test results and associated mental health treatment recommendations from the Ontario Neurotrauma Foundation guidelines, as well as a list of mental health treatment resources. In addition, the patient will receive a written information package about mental health problems after mTBI and treatment options to discuss with their family physician.
OTHERGeneric information about concussion management
Family physicians will receive a generic letter drawing their attention to Canadian clinical practice guidelines for mild Traumatic Brain Injury (developed by the Ontario Neurotrauma Foundation). Patients will receive instructions about how to access generic education materials about mTBI (from concussion.vch.ca/), which they should have received anyway as part of usual care.
Sponsors
University of British Columbia
Canadian Institutes of Health Research (CIHR)
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 69 Years
Healthy volunteers
No
Inclusion criteria
* Age 18-69 years old, * presentation to emergency department within 72 hours of injury, * probable mTBI diagnosis per emergency department chart review and interview based on World Health Organization Neurotrauma Task Force diagnostic criteria, * fluent in English, * primary residence in British Columbia, * designate a specific family physician or walk-in clinic where they plan to seek follow-up care
Exclusion criteria
* Pre-existing unstable/serious medical condition (e.g., cancer, multiple sclerosis, etc.) * Pre-existing unstable/severe mental illness (e.g., schizophrenia requiring hospital admission in past year)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| MINI version 7.0.2 for DSM-5 | 26 weeks post injury | Structured diagnostic interview |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Rivermead Postconcussion Symptom Questionnaire | 2, 12, 26 weeks post injury | Standardized questionnaire |
| World Health Organization Disability Assessment Schedule 2.0 12-item version | 12 and 26 week post injury | Standardized interview |
Countries
Canada
Contacts
PRINCIPAL_INVESTIGATORNoah Silverberg
University of British Columbia
Outcome results
None listed