Dizziness, Headaches Posttraumatic, Mild Traumatic Brain Injury, Neck Pain
Conditions
Brief summary
Given the rising rates of concussion in youth ages 10-19 and the significant proportion of young people who remain symptomatic for months following concussion, research evaluating the efficacy of multifaceted treatment options following concussion is imperative. Studies examining the efficacy of treatment strategies following concussion in children and adults are surprisingly limited, and most focus on one treatment approach, have small sample sizes, are not randomized controlled trials, and focus on individuals with prolonged recovery (months). There is a need for a multifaceted treatment trial to examine the early implementation of treatment approaches that may reduce prolonged recovery while considering the heterogeneous presentation of symptoms and patient preferences in the sub-acute stage following concussion. Randomized controlled trials that consider a multifaceted transdisciplinary approach to treatment in the early period following concussion are needed to raise the bar regarding evidence-informed management following concussion
Detailed description
The primary objective of this RCT is to examine if up to 6-weeks of symptom-specific (1. headache, 2. dizziness and/or neck pain) treatment initiated in the acute/sub-acute stages following concussion in 13-19 year-old participants recruited acutely (within 2 weeks) following concussion are superior to up to 6 weeks of a multimodal, non-symptom specific treatment program. Treatment will cease once participants are cleared to return to unrestricted physical activity by a sports medicine physician, and will therefore last up to 6 weeks. We have two primary outcomes: 1. Post-Concussion Total Symptom Score (PCSS /132) on the SCAT5 following treatment of up to six sessions 2. Days from injury to physician clearance to return to unrestricted physical activity (e.g., physical education, sport, recreational activities)
Interventions
PROCEDURESymptom-specific Headache Treatment
Greater Occipital Nerve Block
OTHERSymptom-specific Dizziness &/or Neck Pain Treatment
Cervicovestibular Physiotherapy Treatment
BEHAVIORALMultimodal Concussion Treatment
Lite combination of headache advice, general physiotherapy exercises, mindfulness, visualization, and relaxation
Sponsors
University of Calgary
Canadian Institutes of Health Research (CIHR)
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
This is a single-blind randomized controlled superiority trial with three treatment groups. Trial participants will be screened for headache and neck pain/dizziness based on symptom ratings on the Sport Concussion Assessment Tool 5 (SCAT5) Post-Concussion Symptom Scale (PCSS) (rating 0-2 mild, 3-4 moderate, 5-6 severe /6). Patients will be allocated to one of three treatments based on symptom severity: 1. Headache treatment 2. Neck pain / Dizziness treatment 3. Multimodal treatment All participants will receive standard of care education and exercise recommendations based on BCTT and sub-symptom threshold tolerance at baseline
Eligibility
Sex/Gender
ALL
Age
13 Years to 19 Years
Healthy volunteers
No
Inclusion criteria
* 13 - 19 years of age at the start of treatment * Diagnosed by the study physician with a concussion as per the 5th International Consensus Statement on Concussion in Sport1 * Glasgow Coma Scale 13-15 if recorded * Loss of consciousness \< 30 minutes if present * Post-traumatic amnesia \< 24 hours if present * Diagnosis within 2 weeks of injury * Moderate-severe symptoms of dizziness, neck pain, headaches, or sleep disturbance at \> one week and \< three weeks post injury reported on the PCSS (3-6 on 0-6 Likert scale for at least one of three symptoms) * Patients can have a history of migraine or a family history of migraine
Exclusion criteria
* Inability to communicate orally and/or in writing in English language * Significant developmental delay or intellectual disability * No access to smartphone or computer * Red flags or other clinical indication suggesting that further medical investigation is warranted (e.g., neurological scan - reflexes, dermatomes, myotomes, long tract signs, CN II-XII, Cerebellar Scan * Unresolved Benign Paroxysmal Positional Vertigo (BPPV) (Dix-Hallpike and Roll Test) * Inability to participate in physical activity for a reason other than concussion * Orthopedic or other injury precluding ability to participate * Medical history of neurological conditions: seizures (febrile SZ will be allowed), stroke, previous moderate/severe TBI, CNS cancers, SCI * Psychotic disorder * Inability to provide informed consent * History of surgery in the occipital region * Uncontrolled rheumatologic, inflammatory, or neurologic disorders (eg MS); Fibromyalgia/chronic fatigue syndrome; coagulopathy; immunosuppression * Active cancer * Herpes zoster infection in last 6 months * Pregnancy * Steroid injection to the greater or lesser occipital nerve infiltration in past 3 months * Previously enrolled in the trial
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in symptoms | Collected at 6 weeks from the start of treatment | Change from baseline in symptom burden, measured by the Post-Concussion Symptom Score (PCSS /132) on the SCAT5 (Sport Concussion Assessment Tool - 5th Edition) at 6 weeks following initiation of treatment. Options for scores are: none (0), mild (1), moderate (2), or severe (3) in 22 symptom categories, for a total score of 0 (no symptoms) to 132 (severe symptoms in all categories) |
| Return to unrestricted physical activity | Measured until 3 months from the start of treatment | Days from injury to physician clearance to return to unrestricted physical activity (e.g., physical education, sport, recreational activities) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in symptoms on the Buffalo Concussion Treadmill Test | Measured at 6 weeks from the start of treatment | Change in overall symptoms \[visual analogue scale (VAS) 0-10\] from rest prior to the Buffalo Concussion Treadmill Test (BCTT) to age-predicted 80% maximum heart rate on the BCTT at 6-weeks. 0 indicates 'Feeling Good' up to 10 'Worst I have ever felt'. |
| Changes in symptom-specific ratings | Measured at 6 weeks from the start of treatment | Symptom-specific PCSS \[Post-Concussion Symptom Score (PCSS /132)\] ratings of headache, dizziness/neck pain, and sleep disturbance \[0-6 Likert scale; from no symptoms (0), to moderate (3), to severe (6)\] |
| Change in quality of life rating | Measured at 6 weeks from the start of treatment | Pediatric Quality of Life Inventory V4.0 (PedsQL) at 6-weeks. Likert scale: never a problem (0) to sometimes (2) to almost always (4). Total symptom scores from 0/94 up to 94/94. Higher scores indicate poorer quality of life |
| Change in resilience | Measured at 6 weeks from the start of treatment | Resilience at 6-weeks using the short, 10-item Connor-Davidson Resilience Scale (CD-RISC). Respondents rate items on a 5-point Likert scale, ranging from 0 (not true at all) to 4 (true nearly all the time) for a score range of 0-40. A higher score indicates higher resilience |
Countries
Canada
Contacts
PRINCIPAL_INVESTIGATORCarolyn Emery, PhD
University of Calgary
Outcome results
None listed