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McCarty CA, Hennings T, Zhou C, Law EF, Zatzick D, Chrisman SPD. Concussion Health Improvement Program (CHIP): study protocol for a randomized controlled optimization trial for youth with persistent post-concussive symptoms. Trials 2024; 25:668. [PMID: 39385279 PMCID: PMC11465506 DOI: 10.1186/s13063-024-08494-y] [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: 05/02/2024] [Accepted: 09/23/2024] [Indexed: 10/12/2024] Open
Abstract
BACKGROUND Up to 1.9 million youth in the USA sustain a concussion each year, and up to 30% experience persistent post-concussive symptoms (PPCS) lasting 1 month or more. PPCS can substantially interfere with social, emotional, and academic functioning. Despite these concerns, few evidence-based treatments are available for youth with PPCS. We previously found effectiveness in treating youth with concussion using a collaborative care intervention that integrates mental health care into a medical model, with improvements in concussive symptoms and quality of life at 1 year. Using the multiphase optimization strategy (MOST) framework, we now aim to assess the contribution of each of the three components that were part of collaborative care: concussion-focused cognitive behavioral therapy (cf-CBT), parenting skills training (PST), and care management (CM). METHODS The MOST factorial design examines all three intervention components with two levels of each (present or absent), resulting in 8 possible treatment combinations. We will recruit 368 youth with PPCS from 2 geographic locations (Seattle and Dallas), randomizing them to 1 of 8 treatment groups. Youth and/or parents will attend treatment sessions via video conferencing software over 3 months, and complete surveys regarding primary outcomes (concussive symptoms and health-related quality of life) and secondary outcomes (sleep, pain, mood, and parental distress) at 6 weeks and 3, 6, and 12 months. We will also assess potential mediators and moderators to allow for future tailoring and refinement. DISCUSSION The overarching goal of this investigation is to determine which collaborative care components (delivered individually or in combination) are most effective in treating PPCS in concussion-exposed youth. The investigation will inform mental health screening, intervention, and referral procedures for youth and families following concussion. At the completion of this study, we will have an optimized and refined intervention for youth with PPCS ready for large-scale implementation and dissemination. TRIAL REGISTRATION ClinicalTrials.gov NCT06036147. Registered on September 13, 2023.
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Affiliation(s)
- Carolyn A McCarty
- Division of General Pediatrics, Department of Pediatrics, University of Washington School of Medicine, Seattle, USA.
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, USA.
| | - Tayler Hennings
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, USA
| | - Chuan Zhou
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, USA
| | - Emily F Law
- Department of Pediatrics, and Department of Psychiatry & Behavioral Sciences, University of Kansas Medical Center, Kansas City, USA
| | - Douglas Zatzick
- Department of Psychiatry and Behavioral Science, University of Washington School of Medicine, Seattle, USA
| | - Sara P D Chrisman
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, USA
- Division of Adolescent Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, USA
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Cairns K, Beaulieu-Bonneau S, Jomphe V, Lamontagne MÈ, de Guise É, Moore L, Savard J, Sirois MJ, Swaine B, Ouellet MC. Four-year trajectories of symptoms and quality of life in individuals hospitalized after mild traumatic brain injury. Arch Phys Med Rehabil 2024:S0003-9993(24)01255-3. [PMID: 39341441 DOI: 10.1016/j.apmr.2024.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 08/31/2024] [Accepted: 09/12/2024] [Indexed: 10/01/2024]
Abstract
OBJECTIVES 1) To detect distinct trajectories of symptoms and quality of life (QoL) over the first four years after mild traumatic brain injury (mTBI); 2) assess the relationship between symptom trajectory membership and QoL trajectory membership; 3) identify participant characteristics associated with QoL trajectory membership. DESIGN Prospective longitudinal cohort study. Assessments occurred at 4, 8, 12, 24, 36, and 48 months post-mTBI. SETTING Recruitment occurred in Level 1 Trauma Centres; follow-up was completed in the community. PARTICIPANTS Participants were 143 adults (aged 18 to 65) who sustained a mTBI and were hospitalized (at least 24 hours) at a Level 1 Trauma Centre. INTERVENTIONS Not applicable MAIN OUTCOME MEASURES: Fatigue Severity Scale, Hospital Anxiety and Depression Scale, Insomnia Severity Index, Medical Outcomes Study Cognitive Functioning Scale, Quality of Life after Brain Injury questionnaire, presence/absence of headaches or dizziness RESULTS: Group-based trajectory modeling revealed relatively stable symptom and QoL trajectories over time. Considerable percentages of participants were classified in trajectories of clinically significant symptoms throughout the full follow-up period: 62% for subjective cognitive issues, 54% for fatigue, 44% for anxiety, 43% for insomnia, 27% for depression, 23% for headaches, and 17% for dizziness. Sixty-six percent of participants belonged to trajectories of persistently poor QoL. For all symptoms, trajectories of greater severity were associated with trajectories of poorer QoL. None of the sociodemographic or injury-related variables examined were associated with QoL trajectory membership. CONCLUSIONS A substantial proportion of individuals hospitalized after mTBI experiences clinically significant persistent symptoms up to four years post-injury, and those with more severe symptoms have poorer QoL. Further research is required to better understand the factors leading to symptom persistence and poor QoL.
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Affiliation(s)
- Kathleen Cairns
- École de psychologie, Université Laval, Québec, QC, Canada;; Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Québec, QC, Canada
| | - Simon Beaulieu-Bonneau
- École de psychologie, Université Laval, Québec, QC, Canada;; Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Québec, QC, Canada
| | - Valérie Jomphe
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Québec, QC, Canada;; Centre de recherche CERVO, Québec, QC, Canada
| | - Marie-Ève Lamontagne
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Québec, QC, Canada;; École des sciences de la réadaptation, Université Laval, Québec, QC, Canada
| | - Élaine de Guise
- Département de psychologie, Université de Montréal, Montréal, QC, Canada; Research Institute of the McGill University Health Centre (RI‑MUHC), Montréal, QC, Canada;; Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Montréal, QC, Canada
| | - Lynne Moore
- Département de médecine sociale et préventive, Université Laval, Québec, QC, Canada;; Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Josée Savard
- École de psychologie, Université Laval, Québec, QC, Canada;; Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Marie-Josée Sirois
- École des sciences de la réadaptation, Université Laval, Québec, QC, Canada; Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada;; Institut sur le vieillissement et la participation sociale des aînés, Québec, QC, Canada;; Centre de recherche en santé durable VITAM, Québec, QC, Canada
| | - Bonnie Swaine
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Montréal, QC, Canada;; École de réadaptation, Université de Montréal, Montréal, QC, Canada
| | - Marie-Christine Ouellet
- École de psychologie, Université Laval, Québec, QC, Canada;; Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Québec, QC, Canada;.
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Scheenen ME, van der Horn HJ, de Koning ME, van der Naalt J, Spikman JM. Identification of At-Risk Patients That Need More Intensive Treatment Following mTBI: Post-Hoc Insights From the UPFRONT-Study. J Head Trauma Rehabil 2024; 39:E372-E380. [PMID: 38453626 DOI: 10.1097/htr.0000000000000931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
OBJECTIVE To investigate which factors within an at-risk group make patients less likely to benefit from preventive treatment following mild traumatic brain injury (mTBI). SETTING Inclusion in 3 level I trauma centers in the Netherlands. Data collection through surveys as outpatients. PARTICIPANTS mTBI patients (18-66 years), reporting 3 or more complaints 2 weeks postinjury (at-risk status). Eighty-four patients included and randomized (39 patients cognitive behavioral therapy, 45 patients telephonic counseling). Eighty patients filled out the questionnaires 12 months postinjury. Post hoc analysis investigating 80 patients as 1 at-risk group receiving psychological treatment. DESIGN Post hoc study of a randomized controlled trial (RCT). Binomial logistic regression performed determining which variables 2 weeks postinjury contributed strongly to unsuccessful return to work/study (RTW) and unfavorable outcome at 12 months. MAIN MEASURES RTW and functional outcome as measured with the Glasgow Outcome Scale-Extended (GOSE) at 12 months postinjury. RESULTS Out of 80 patients, 43 (53.8%) showed a favorable functional outcome at 12 months, and 56 (70%) patients had a full RTW. Patients with unfavorable outcome had a higher age and higher reports of anxiety, depression at 2 weeks and 12 months postinjury. Patients with an unsuccessful RTW had a higher age and higher reports of depression, and posttraumatic stress disorder at 2 weeks and 12 months postinjury. A logistic regression model for functional outcome (GOSE) was statistically significant (χ² 7 = 40.30, P < .0001). Of 6 predictor variables, 3 were significant: anxiety, depression, and treatment condition. For RTW, logistic regression was also statistically significant (χ² 7 = 19.15, P = .008), with only 1 out of 6 predictor variables (ie, age) being significant. CONCLUSION Main findings comprise differences in demographic and psychological measures between patients with favorable and unfavorable outcomes and patients with RTW versus no RTW. Prediction models of outcome and RTW showed several psychological measures at 2 weeks greatly determining patients' likelihood benefitting from the preventive treatment. Results suggest that from the beginning there are some patients for whom a short preventive treatment is not sufficient. Selection and treatment of at-risk patients might be better based on psychological symptoms instead of posttraumatic complaints.
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Affiliation(s)
- Myrthe E Scheenen
- Author Affiliations: Departments of Neuropsychology (Dr Scheenen and Ms Spikman) and Neurology (Dr van der Horn and Ms van der Naalt), University of Groningen, University Medical Center Groningen, Groningen, Netherlands; and Department of Medical Psychology, Elisabeth-Tweesteden Hospital, Tilburg, Netherlands (Dr de Koning)
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Meshberg-Cohen S, Cook JM, Fischer IC, Pietrzak RH. Mild Traumatic Brain Injury in U.S. Military Veterans: Results from the National Health and Resilience in Veterans Study. Psychiatry 2024:1-15. [PMID: 39186319 DOI: 10.1080/00332747.2024.2392226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
OBJECTIVE This study provides nationally representative data on the prevalence, risk factors, and associated mental health and functional outcomes of mild traumatic brain injury (mTBI) in U.S. military veterans. METHODS Data (N = 4,069) were analyzed from the National Health and Resilience in Veterans Study (NHRVS). Analyses estimated mTBI prevalence, exposure to different mTBI injuries, and past-week mTBI symptoms (i.e. persistent post-concussive symptoms [PCS]). Comparisons were made between veterans with and without mTBI+PCS on sociodemographic, military, trauma, and psychiatric characteristics. Associations between mTBI+PCS and measures of cognitive, mental, and psychosocial functioning were examined. RESULTS Overall, 43.7% endorsed a possible mTBI event on the Veterans Affairs' Mild TBI Injury Screening and Evaluation tool, and 10.0% screened positive for mTBI. After combining a self-reported healthcare professional diagnosis of concussion/mTBI/TBI (5.8%) with a positive mTBI screen, the prevalence of mTBI+PCS was 3.0%. Veterans with specific trauma characteristics (e.g. adverse childhood events), military service (e.g. combat), and lifetime psychiatric conditions were more likely to have mTBI+PCS. mTBI+PCS was associated with increased odds of current posttraumatic stress disorder, major depressive disorder, generalized anxiety disorder, and drug use disorder. These veterans also scored significantly lower on cognitive, mental, and psychosocial functioning. CONCLUSIONS Overall, 3.0% of veterans had mTBI+PCS, suggesting that while mTBI may be prevalent in this population, the majority will likely recover without developing chronic symptoms. Those with mTBI+PCS are at significant risk for comorbid psychiatric diagnoses and poorer psychosocial functioning relative to those without mTBI+PCS, and early targeted identification may assist in prevention of disability and recovery.
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Manglani HR, Lovette BC, Grunberg VA, Frieder J, Vranceanu AM, Greenberg J. "I Wish I Had That!": A Qualitative Analysis of Psychosocial Treatment Preferences Among Young Adults With Recent Concussion and Anxiety. Arch Phys Med Rehabil 2024; 105:1268-1274. [PMID: 38369228 PMCID: PMC11227383 DOI: 10.1016/j.apmr.2024.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/15/2024] [Accepted: 01/25/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVE To assess psychosocial treatment preferences and factors that may affect treatment participation among young adults with a recent concussion and co-occurring anxiety. DESIGN In-depth, semi-structured individual qualitative interviews, followed by thematic analysis using a hybrid deductive-inductive approach. SETTING Academic medical center in the US Northeast. PARTICIPANTS Seventeen young adults (18-24y) who sustained a concussion within the past 3-10 weeks and reported at least mild anxiety (≥5 on the Generalized Anxiety Disorder-7 questionnaire). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Primary outcomes include preferences for program content (eg, topics and skills), delivery modality, format, and barriers and facilitators to participation. RESULTS We identified 4 domains characterizing participants' perceptions of and preferences for treatment. (1) Program content: Participants preferred a program early after injury that included psychoeducation and coping skills (eg, activity pacing, deep breathing, mindfulness). (2) Therapeutic processes: Participants preferred a person-centered approach in which clinicians normalized anxiety postconcussion and reassured them of recovery. (3) Program logistics: Participants endorsed that a brief, virtual program would be acceptable. They preferred access to program components through multiple modalities (eg, audio, video) and accommodations to manage concussion symptoms. (4) Barriers and facilitators to participation: Barriers included acute concussion symptoms (eg, screen sensitivity), time constraints, and forgetting sessions. Facilitators included a program that is flexible (format, scheduling), personalized (self-chosen mode for reminders, measure of accountability), and accessible (ie, advertising through health care professionals or social media). CONCLUSIONS Participants need psychosocial support that normalizes their experiences and provides education and coping tools. Treatments should be accessible, flexible, and person centered. Psychosocial treatments meeting these preferences may help optimize the recovery of young adults with recent concussion and anxiety.
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Affiliation(s)
- Heena R Manglani
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Brenda C Lovette
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA; MGH Institute of Health Professions, Boston, MA
| | - Victoria A Grunberg
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA; Division of Newborn Medicine, Massachusetts General Hospital for Children, Boston, MA
| | | | - Ana-Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Jonathan Greenberg
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.
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Obenaus A, Noarbe BP, Lee JB, Panchenko PE, Noarbe SD, Lee YC, Badaut J. Progressive lifespan modifications in the corpus callosum following a single juvenile concussion in male mice monitored by diffusion MRI. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.12.21.572925. [PMID: 38187748 PMCID: PMC10769374 DOI: 10.1101/2023.12.21.572925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Introduction The sensitivity of white matter (WM) in acute and chronic moderate-severe traumatic brain injury (TBI) has been established. In concussion syndromes, particularly in preclinical rodent models, there is lacking a comprehensive longitudinal study spanning the lifespan of the mouse. We previously reported early modifications to WM using clinically relevant neuroimaging and histological measures in a model of juvenile concussion at one month post injury (mpi) who then exhibited cognitive deficits at 12mpi. For the first time, we assess corpus callosum (CC) integrity across the lifespan after a single juvenile concussion utilizing diffusion MRI (dMRI). Methods C57Bl/6 mice were exposed to sham or two severities of closed-head concussion (Grade 1, G1, speed 2 m/sec, depth 1mm; Grade 2, G2, 3m/sec, 3mm) using an electromagnetic impactor at postnatal day 17. In vivo diffusion tensor imaging was conducted at 1, 3, 6, 12 and 18 mpi (21 directions, b=2000 mm2/sec) and processed for dMRI parametric maps: fractional anisotropy (FA), axial (AxD), radial (RD) and mean diffusivity (MD). Whole CC and regional CC data were extracted. To identify the biological basis of altered dMRI metrics, astrocyte and microglia in the CC were characterized at 1 and 12 mpi by immunohistochemistry. Results Whole CC analysis revealed altered FA and RD trajectories following juvenile concussion. Shams exhibited a temporally linear increase in FA with age while G1/G2 mice had plateaued FA values. G2 concussed mice exhibited high variance of dMRI metrics at 12mpi, which was attributed to the heterogeneity of TBI on the anterior CC. Regional analysis of dMRI metrics at the impact site unveiled significant differences between G2 and sham mice. The dMRI findings appear to be driven, in part, by loss of astrocyte process lengths and increased circularity and decreased cell span ratios in microglia. Conclusion For the first time, we demonstrate progressive perturbations to WM of male mice after a single juvenile concussion across the mouse lifespan. The CC alterations were dependent on concussion severity with elevated sensitivity in the anterior CC that was related to astrocyte and microglial morphology. Our findings suggest that long-term monitoring of children with juvenile concussive episodes using dMRI is warranted, focusing on vulnerable WM tracts.
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Affiliation(s)
- Andre Obenaus
- Department of Pediatrics, School of Medicine, University of California Irvine, Irvine, CA, USA
| | - Brenda P. Noarbe
- Department of Pediatrics, School of Medicine, University of California Irvine, Irvine, CA, USA
| | - Jeong Bin Lee
- Basic Science Department, Loma Linda University School of Medicine, Loma Linda, CA, US
| | | | - Sean D. Noarbe
- Department of Pediatrics, School of Medicine, University of California Irvine, Irvine, CA, USA
| | - Yu Chiao Lee
- Department of Pediatrics, School of Medicine, University of California Irvine, Irvine, CA, USA
| | - Jerome Badaut
- CNRS UMR 5536 RMSB-University of Bordeaux, Bordeaux, France
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