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van Ierssel JJ, Galea O, Holte K, Luszawski C, Jenkins E, O'Neil J, Emery CA, Mannix R, Schneider K, Yeates KO, Zemek R. How completely are randomized controlled trials of non-pharmacological interventions following concussion reported? A systematic review. JOURNAL OF SPORT AND HEALTH SCIENCE 2024; 13:537-547. [PMID: 37619783 PMCID: PMC11184319 DOI: 10.1016/j.jshs.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/20/2023] [Accepted: 07/12/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE The study aimed to examine the reporting completeness of randomized controlled trials (RCTs) of non-pharmacological interventions following concussion. METHODS We searched MEDLINE, Embase, PsycInfo, CINAHL, and Web of Science up to May 2022. Two reviewers independently screened studies and assessed reporting completeness using the Template for Intervention Description and Replication (TIDieR), Consensus on Exercise Reporting Template (CERT), and international Consensus on Therapeutic Exercise aNd Training (i-CONTENT) checklists. Additional information was sought my study authors where reporting was incomplete. Risk of bias (ROB) was assessed with the Cochrane ROB-2 Tool. RCTs examining non-pharmacological interventions following concussion. RESULTS We included 89 RCTs (n = 53 high ROB) examining 11 different interventions for concussion: sub-symptom threshold aerobic exercise, cervicovestibular therapy, physical/cognitive rest, vision therapy, education, psychotherapy, hyperbaric oxygen therapy, transcranial magnetic stimulation, blue light therapy, osteopathic manipulation, and head/neck cooling. Median scores were: TIDieR 9/12 (75%; interquartile range (IQR) = 5; range: 5-12), CERT 17/19 (89%; IQR = 2; range: 10-19), and i-CONTENT 6/7 (86%; IQR = 1; range: 5-7). Percentage of studies completely reporting all items was TIDieR 35% (31/89), CERT 24% (5/21), and i-CONTENT 10% (2/21). Studies were more completely reported after publication of TIDieR (t87 = 2.08; p = 0.04) and CERT (t19 = 2.72; p = 0.01). Reporting completeness was not strongly associated with journal impact factor (TIDieR: rs = 0.27; p = 0.01; CERT: rs = -0.44; p = 0.06; i-CONTENT: rs = -0.17; p = 0.48) or ROB (TIDieR: rs = 0.11; p = 0.31; CERT: rs = 0.04; p = 0.86; i-CONTENT: rs = 0.12; p = 0.60). CONCLUSION RCTs of non-pharmacological interventions following concussion demonstrate moderate to good reporting completeness, but are often missing key components, particularly modifications, motivational strategies, and qualified supervisor. Reporting completeness improved after TIDieR and CERT publication, but publication in highly cited journals and low ROB do not guarantee reporting completeness.
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Affiliation(s)
| | - Olivia Galea
- The Centre for Health, Activity and Rehabilitation Research, University of Otago, Dunedin 9016, New Zealand
| | - Kirsten Holte
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada; Alberta Children's Hospital Research Institute; University of Calgary, Calgary, AB T2N 1N4, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Caroline Luszawski
- Alberta Children's Hospital Research Institute; University of Calgary, Calgary, AB T2N 1N4, Canada; Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Elizabeth Jenkins
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - Jennifer O'Neil
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON K1H 8M5, Canada; Bruyère Research Institute, Ottawa, ON K1N 5C8, Canada
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada; Alberta Children's Hospital Research Institute; University of Calgary, Calgary, AB T2N 1N4, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Rebekah Mannix
- Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Kathryn Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada; Alberta Children's Hospital Research Institute; University of Calgary, Calgary, AB T2N 1N4, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada; Alberta Children's Hospital Research Institute; University of Calgary, Calgary, AB T2N 1N4, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Roger Zemek
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada; Departments of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
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Moser N, Gargoum S, Popovic MR, Kalsi-Ryan S. Effectiveness of Non-Pharmacological Therapy on Physical Symptoms in Patients With Persistent Concussion Symptoms: A Systematic Review. J Neurotrauma 2024. [PMID: 38149605 DOI: 10.1089/neu.2023.0474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023] Open
Abstract
This systematic review provides a comprehensive overview on the effectiveness of rehabilitation on physical symptoms in patients of all ages with persistent concussion symptoms. PubMed, MEDLINE®, Cochrane library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Embase were searched from January 1, 2012 to September 1, 2023 using terms related to physical post-concussion symptoms. Eligible articles were critically appraised using the Scottish Intercollegiate Guidelines Network (SIGN) and the Quality Assessment Tool. The Grading of Recommendations Assessment, Development, and Evaluation system was applied to rate the quality of evidence. Thirty-two articles were included. Preliminary evidence suggests that transcranial magnetic stimulation improves symptoms in adults, specifically headaches. Young adults reported a significant decrease in physical symptoms following sub-symptom aerobic training as well as cervical spine manual therapy. Tentatively, adults demonstrated improvements in headache symptoms following neurofeedback sessions, and progressive muscle relaxation resulted in a decrease in monthly headaches. Multimodal therapy in adults produced significant change in physical symptoms when compared with usual care. However, no further reduction in physical symptoms was observed when adult patients received a program of care that afforded cervicovestibular rehabilitation with symptom-limited exercise compared with a symptom-limited exercise program alone. Cognitive behavioral therapy demonstrated inconsistent findings for its effects on physical symptoms, specifically headaches. Veterans had a significant change in post-concussive symptoms, specifically headaches, following 3-month use of an interactive smartphone application as compared with standard care. Finally, in a pediatric population, the use of melatonin did not produce any changes in physical persistent concussion symptoms as compared with placebo. Preliminary evidence suggests that various forms of rehabilitative therapies can improve persistent physical concussive symptoms. However, given the methodological limitations in the majority of trials, the results need to be interpreted with caution.
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Affiliation(s)
- Nicholas Moser
- KITE Research Institute-University Health Network, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Ontario, Canada
| | - Shawn Gargoum
- Private clinical practice, Apex Physiotherapy and Chiropractic, Pickering, Ontario, Canada
| | - Milos R Popovic
- KITE Research Institute-University Health Network, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Ontario, Canada
- Institute of Biomedical Engineering, University of Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
| | - Sukhvinder Kalsi-Ryan
- KITE Research Institute-University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
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Cole WR, Tegeler CL, Choi YS, Harris TE, Rachels N, Bellini PG, Haight TJ, Gerdes L, Tegeler CH, Roy MJ. Randomized, controlled clinical trial of acoustic stimulation to reduce postconcussive symptoms. Ann Clin Transl Neurol 2024; 11:105-120. [PMID: 37990636 PMCID: PMC10791035 DOI: 10.1002/acn3.51937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/17/2023] [Accepted: 10/19/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVE Effective interventions are needed to address postconcussive symptoms. We report the results of randomized, sham-controlled trial of Cereset Research™ Standard Operating Procedures (CR-SOP), a noninvasive, closed-loop, allostatic, acoustic stimulation neurotechnology previously shown to improve insomnia. METHODS Military service members, veterans, or their spouses with persistent symptoms (Neurobehavioral Symptom Inventory [NSI] Score ≥23) after mTBI 3 months to 10 years ago, were randomized to receive 10 sessions of engineered tones linked to brainwaves (LB, intervention), or random engineered tones not linked to brainwaves (NL, sham control). The primary outcome was change in NSI, with secondary outcomes of heart rate variability and self-report measures of sleep, mood, and anxiety. RESULTS Participants (n = 106, 22% female, mean age 37.1, 2.8 deployments, 3.8 TBIs) were randomized 1:1 to LB or NL, with no significant differences between groups at baseline. Among all study participants, the NSI declined from baseline 41.0 to 27.2 after (P < 0.0001), with gains largely sustained at 3 months (31.2) and 6 months (28.4). However, there were no significant differences between the LB (NSI declined from 39.9 at baseline to 28.2 post-intervention, 31.5 at 3 months, and 29.4 at 6 months) and NL (NSI declined from 41.5 at baseline to 26.2, 29.9, and 27.3, respectively. Similar patterns were observed for the PCL5 and PHQ-9 and there was no difference in HRV between groups. INTERPRETATION Ten hours of acoustic stimulation while resting in a zero-gravity chair improves postconcussive symptoms. However, linking tones to brain electrical activity did not reduce symptoms more than random tones. REGISTRATION ClinicalTrials.gov - NCT03649958.
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Affiliation(s)
- Wesley R. Cole
- University of North CarolinaChapel HillNorth CarolinaUSA
| | | | - Y. Sammy Choi
- Womack Army Medical CenterFort BraggNorth CarolinaUSA
| | | | - Nora Rachels
- Womack Army Medical CenterFort BraggNorth CarolinaUSA
| | - Paula G. Bellini
- Uniformed Services UniversityBethesdaMarylandUSA
- Henry M. Jackson FoundationRockvilleMarylandUSA
| | - Thaddeus J. Haight
- Uniformed Services UniversityBethesdaMarylandUSA
- Henry M. Jackson FoundationRockvilleMarylandUSA
| | - Lee Gerdes
- Brain State Technologies, LLCScottsdaleArizonaUSA
| | | | - Michael J. Roy
- Uniformed Services UniversityBethesdaMarylandUSA
- Walter Reed National Military Medical CenterBethesdaMarylandUSA
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Tracey AJ, Bateman AG, Baez SE, Covassin T. Effectiveness of interventions for the improvement of mental health and well-being post-concussion: a systematic review. Brain Inj 2023; 37:1135-1158. [PMID: 37256279 DOI: 10.1080/02699052.2023.2219901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 04/28/2023] [Accepted: 05/26/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To identify and assess the effectiveness and quality of interventions targeted at improving mental health, well-being, and psychosocial impairments post-concussion. DATA SOURCES EBSCOHost, SPORTSDiscus, PsychINFO, Medline (Web of Science), PubMed, and Embase databases. REVIEW METHODS This systematic review is reported in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement in exercise, rehabilitation, sport medicine and sports science (PERSiST). Articles were included if they: (1) were randomized controlled trials or repeated measures pre-posttest study designs, (2) reported mild traumatic brain injury (mTBI) or concussion injury, and (3) evaluated interventions targeting mental health, well-being, and psychosocial impairments post-injury. RESULTS Twenty-three studies were included which evaluated interventions targeting mental health, well-being, and psychosocial impairments post-concussion. Interventions included cognitive rehabilitation (n = 7), psychotherapy (n = 7), psychoeducational (n = 3), neurocognitive training (n = 4), neurocognitive training combined with cognitive rehabilitation (n = 1), and psychotherapy combined with cognitive rehabilitation (n = 1). The seven (100%) cognitive rehabilitation intervention studies and four of the five (80%) neurocognitive training intervention studies observed significant improvements in mental health and well-being outcomes. CONCLUSIONS Cognitive rehabilitation and neurocognitive training may be the most effective interventions for mental health and well-being impairments post-concussion. Researchers and clinicians should continue to explore the effectiveness of these interventions, specifically in populations most impacted by concussion (i.e. athletes).
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Affiliation(s)
- Allie J Tracey
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - André G Bateman
- Department of Sociology, Psychology and Social Work, The University of the West Indies, Kingston, Jamaica
| | - Shelby E Baez
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Tracey Covassin
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
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O’Brien KH, Pei Y, Kemp AM, Gartell R, Gore RK, Wallace T. The SUCCESS Peer Mentoring Program for College Students with Concussion: Preliminary Results of a Mobile Technology Delivered Intervention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5438. [PMID: 37107720 PMCID: PMC10138278 DOI: 10.3390/ijerph20085438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 05/11/2023]
Abstract
Concussions are caused by a hit or blow to the head that alters normal brain functioning. The Success in College after Concussion with Effective Student Supports (SUCCESS) program was developed to provide students with psychosocial support and resources-both key components of concussion management-to assist in recovery and return-to-learn following concussion. In this preliminary evaluation of intervention efficacy, SUCCESS was delivered through a mobile application connecting mentors (students who have recovered from concussion and successfully returned to school) with mentees who were currently recovering. Mentor-mentee pairs met virtually through the app, using chat and videoconferencing features to share support, resources, and program-specific educational materials. Results from 16 mentoring pairs showed that mentee symptoms (V = 119, p = 0.009) and academic problems decreased (V = 114.5, p = 0.002), while academic self-efficacy increased (V = 13.5, p = 0.009) following mentoring. As expected, mentor measures were stable, indicating that providing mentoring did not exacerbate previously resolved concussion complaints. Virtual peer mentoring provided through a mobile application may be a feasible intervention to support academic success and psychosocial processing during recovery for college students with concussion.
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Affiliation(s)
- Katy H. O’Brien
- Department of Communication Sciences and Special Education, University of Georgia, Athens, GA 30602, USA
- Courage Kenny Rehabilitation Institute, Allina Health, Minneapolis, MN 55407, USA
| | - Yalian Pei
- Department of Communication Sciences and Special Education, University of Georgia, Athens, GA 30602, USA
| | - Amy M. Kemp
- Department of Communication Sciences and Special Education, University of Georgia, Athens, GA 30602, USA
| | - Rebecca Gartell
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA 30309, USA (T.W.)
| | - Russell K. Gore
- Complex Concussion Clinic, Shepherd Center, Atlanta, GA 30309, USA
| | - Tracey Wallace
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA 30309, USA (T.W.)
- Complex Concussion Clinic, Shepherd Center, Atlanta, GA 30309, USA
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Ranney ML, Stettenbauer EG, Delgado MK, Yao KA, Orchowski LM. Uses of mHealth in Injury Prevention and Control: a Critical Review. CURR EPIDEMIOL REP 2022; 9:273-281. [PMID: 36404873 PMCID: PMC9644389 DOI: 10.1007/s40471-022-00312-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2022] [Indexed: 11/10/2022]
Abstract
Purpose of Reviews The purpose of this review was to summarize the current state of the literature on the use of "mHealth" (the use of mobile devices for health promotion) for injury prevention and control. Recent Findings mHealth is being used to measure, predict, and prevent the full spectrum of injuries. However, most literature remains preliminary or in a pilot stage. Use of best-of-class design principles (e.g., user-centered design, theory-based development) is uncommon, and wide-scale dissemination of effective monitoring or intervention tools is rare. Summary mHealth for injury prevention holds promise, but further work is needed across the full spectrum of development and translation.
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Affiliation(s)
- Megan L. Ranney
- Department of Emergency Medicine, Alpert Medical School Brown University, Providence, USA
- Brown-Lifespan Center for Digital Health, Providence, USA
- Department of Behavioral and Social Science, School of Public Health, Brown University, Providence, USA
| | - E. G. Stettenbauer
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, USA
| | - M. Kit Delgado
- Department of Emergency Medicine and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, USA
| | | | - Lindsay M. Orchowski
- Brown-Lifespan Center for Digital Health, Providence, USA
- Department of Psychiatry and Human Behavior, Rhode Island Hospital, Providence, RI USA
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