Interdisciplinary Rehabilitation for Persisting Post-Concussion Symptoms after Mtbi: N=15 Single Case Experimental Design

Background: Despite clinical guidelines recommending an interdisciplinary approach to persisting post-con-cussion symptom (PPCS) management, evaluations of interdisciplinary interventions remain scant. Objectives: This pilot study aimed to explore the feasibility and preliminary efficacy of an interdisciplinary intervention for PPCSs. Method: A single-case experimental design with randomisation to multiple baselines (2, 4, or 6 weeks) was repeated across 15 participants (53% female) with mild traumatic brain injury (mean age 38.3 years, SD 15.7). The 12-week treatment incorporated psychology, physiotherapy, and medical interventions. Feasibility out -comes included recruitment and retention rates, adverse events, treatment adherence and fidelity. Patient-cen-tred secondary outcomes included the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), assessed 3 times per week during the baseline and treatment phases, and at the 1-and 3-month follow-ups. Other sec-ondary outcomes included measures of mood, sleep and fatigue, physical functioning, health-related quality of life, illness perceptions, and goal attainment. Changes in PPCSs were evaluated using systematic visual analysis and Tau -U. Clinically significant changes in secondary outcomes were explored descriptively. Results: 16/26 individuals assessed for eligibility were enroled (61% recruitment rate); 15 completed the post-treatment follow-ups, and 13 completed the 1-and 3-month follow-up assessments (81% retention rate). High treatment adherence and competence in delivering treatments was observed. Moderate-large effect sizes for reducing PPCSs were observed in 12/15 cases, with 7/15 reaching statistical significance. Improvements were maintained at the 1-and 3-month follow-ups and were accompanied by reductions in fatigue, sleep difficulties, and mood symptoms, and changes in illness perceptions. All participants had clini-cally significant improvements in at least 1 outcome, with 81% of individual therapy goals achieved. Conclusions: This pilot study provided preliminary support for a subsequent randomised controlled trial (RCT), with satisfactory recruitment, retention, treatment compliance, and treatment fidelity. Improvement was evident on participant outcomes including symptom reduction and goal attainment, suggesting that pro-gressing to a phase-II RCT is worthwhile. Findings highlight the potential benefit of individualized interdisci-plinary treatments. (c) 2023 The Authors. Published by Elsevier Masson SAS. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)