Novel interdisciplinary intervention, GAIN, vs. enhanced usual care to reduce high levels of post-concussion symptoms in adolescents and young adults 2-6 months post-injury: A randomised trial

Mille Moeller Thastum; Charlotte Ulrikka Rask; Erhard Trillingsgaard Næss-Schmidt; Astrid Tuborgh; Jens Sondergaard Jensen; Susanne Wulff Svendsen; Jørgen Feldbæk Nielsen; Andreas Schröder

doi:10.1016/j.eclinm.2019.11.007

Novel interdisciplinary intervention, GAIN, vs. enhanced usual care to reduce high levels of post-concussion symptoms in adolescents and young adults 2-6 months post-injury: A randomised trial

EClinicalMedicine. 2019 Dec 16:17:100214. doi: 10.1016/j.eclinm.2019.11.007. eCollection 2019 Dec.

Authors

Mille Moeller Thastum¹, Charlotte Ulrikka Rask², Erhard Trillingsgaard Næss-Schmidt³, Astrid Tuborgh², Jens Sondergaard Jensen¹, Susanne Wulff Svendsen³, Jørgen Feldbæk Nielsen³, Andreas Schröder¹

Affiliations

¹ The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus, Denmark.
² Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital, Psychiatry, Denmark.
³ Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Aarhus, Denmark.

Abstract

Background: Evidence for effective interventions to prevent long-term sequelae after concussion is sparse. This study aimed to test the efficacy of Get going After concussIoN (GAIN), an interdisciplinary, individually-tailored intervention of 8 weeks duration based on gradual return to activities and principles from cognitive behavioural therapy.

Methods: We conducted an open-label, parallel-group randomised trial in a hospital setting in Central Denmark Region. Participants were 15-30-year-old patients with high levels of post-concussion symptoms (PCS) 2-6 months post-concussion (i.e., a score ≥20 on the Rivermead Post-concussion Symptoms Questionnaire (RPQ)). They were randomly assigned (1:1) to either enhanced usual care (EUC) or GAIN+EUC. Masking of participants and therapists was not possible. The primary outcome was change in RPQ-score from baseline to 3-month FU. All analyses were done on an intention-to-treat basis using linear mixed-effects models. This trial is registered with ClinicalTrials.gov, number NCT02337101.

Findings: Between March 1, 2015, and September 1, 2017, we included 112 patients. Patients allocated to GAIN+EUC (n=57) reported a significantly larger reduction of PCS than patients allocated to EUC (n=55) with a mean adjusted difference in improvement of 7·6 points (95% confidence interval (CI) 2·0-13·1, p=0·008), Cohen's d=0·5 (95% CI 0·1-0·9). Number needed to treat for prevention of one additional patient with RPQ ≥20 at 3-month FU was 3·6 (95% CI 2·2-11·3). No adverse events were observed.

Interpretation: Compared with EUC, GAIN+EUC was associated with a larger reduction of post-concussion symptoms at 3-month FU.

Funding: Central Denmark Region and the foundation "Public Health in Central Denmark Region - a collaboration between municipalities and the region".

Keywords: Brain concussion; Cognitive behavioural therapy; Graded exercise therapy; Illness perceptions; Intervention; Mild traumatic brain injury; Post-concussion syndrome; Rivermead Post-Concussion Symptoms Questionnaire.

Associated data

ClinicalTrials.gov/NCT02337101