An Intervention Program to Reduce to the Risk of Persistent Symptoms After Concussion
An Intervention Program to Reduce to the Risk of Persistent Symptoms After Concussion
This study investigates how well a new therapy program prevents persistent symptoms (e.g.,
 headaches, fatigue, irritability, etc.) after concussion. The program involves examining
 beliefs about concussion and learning healthy coping strategies, and is completed with the
 first three months post-injury.
Although the majority of patients with mild traumatic brain injury (MTBI) experience complete
 recovery within three months, a sizeable group continues to report frequent and severe
 symptoms such as headaches, fatigue, difficulty concentrating, forgetfulness, and
 irritability, in what is labeled persistent post-concussion syndrome (PCS). Persistent PCS is
 associated with vocational, recreational, and social disability. Early education and
 reassurance (treatment as usual) is effective in general, but appears insufficient for this
 subgroup.

 Recent research has identified risk factors for persistent PCS, including inaccurate illness
 beliefs, maladaptive coping behaviour, and emotional distress. The present study will
 evaluate the additive efficacy of a cognitive-behavioural therapy protocol designed to modify
 these risk factors, over and above treatment as usual.

 Participants with MTBI will be recruited within six weeks of injury. Those identified as
 being at-risk for persistent PCS based on evidence-based criteria will receive treatment as
 usual and then be randomly assigned to receive either no further intervention or
 cognitive-behavioural therapy. We hypothesize that the group receiving cognitive-behavioural
 therapy will have fewer PCS symptoms and be less disabled at follow-up. We also hypothesize
 that compensation-seeking status will mitigate this improvement and that illness beliefs,
 coping behaviour, and emotional distress will mediate this improvement. A blinded rater will
 conduct the baseline and outcome assessments.
Inclusion Criteria:

 -  Incurred head trauma within six weeks of study entry

 -  Meet American Congress of Rehabilitation criteria for MTBI, documented by the
 referring/treating physician

 -  Subjective report at least one symptom attributable to head trauma

 -  English as preferred language for communication

 -  Considered at-risk for persistent PCS based on prognostic model from Whittaker et al.
 (2007)

 Exclusion Criteria:

 -  Medical documentation of skull fracture or acute intracranial abnormality on
 neuroimaging, consistent with "mild-complicated" TBI

 -  Self-reported history of a neurological disorder (including prior MTBI within the past
 six months)