MARS 2017

Cognitive behavioral intervention compared to telephone counselling early after mild traumatic brain injury: a randomized trial

Purpose Many patients do not return to work (RTW) following mild Traumatic Brain Injury (mTBI) due to persistent complaints that are often resistant to therapy in the chronic phase. Recent studies suggest that psychological interventions should be implemented early after injury to prevent patients from developing chronic complaints. This study is a randomized controlled trial which examines the effectiveness of a newly developed CBT intervention (CBTi) compared to telephonic counseling (TC) in at risk mTBI patients (patients with high reports of early complaints). Methods Patients underwent either five sessions of CBT treatment or five phone conversations starting 4-6 weeks after trauma. The main outcome measure was RTW six and twelve months after trauma. Secondary measures comprised functional outcome at six and twelve months, and depression, anxiety and reported posttraumatic complaints at three, six and twelve months after injury. Results After excluding drop outs, CBTi consisted of 39 patients and TC of 45 patients. No significant differences were found with regard to RTW, with 65% of CBTi patients and 67% of TC patients reporting a RTW at previous level. However, TC patients reported fewer complaints at three (8 vs. 6, p=.010) and twelve month post-injury (9 vs. 5, p=.006), and more patients in the TC group showed a full recovery twelve months post-injury compared to the CBTi group (62% vs. 39%).Conclusions The results of this study suggest that early follow-up of at risk patients can have a positive influence on patients' well-being, and that a low-intensive, low-cost telephonic intervention might be more effective than a CBT intervention at improving outcome in at-risk patients.

Source: Scheenen ME, Visser-Keizer AC, de Koning ME, van der Horn HJ, van de Sande P, van Kessel ME, van der Naalt J, Spikman JM, Journal of Neurotrauma, 2017 Mar.

Multidisciplinary outpatient treatment in patients with mild traumatic brain injury: A randomised controlled intervention study

Purpose To evaluate the efficacy of a multidisciplinary outpatient follow-up programme compared to follow-up by a general practitioner for patients being at-risk or sick-listed with persistent post-concussion symptoms two months after a mild traumatic brain injury.Design Randomised controlled trial. Patients One hundred fifty-one patients, 16–56 years.Methods: Multidisciplinary outpatient rehabilitation with individual contacts and a psycho-educational group intervention at two outpatient rehabilitation clinics compared to follow-up by a general practitioner after the multidisciplinary examination. Primary outcome was sustainable return-to-work first year post-injury. Secondary outcomes were post-concussion symptoms, disability, the patient’s impressions of change and psychological distress. Results Days to sustainable return-to-work was 90 in the intervention and 71 in the control group (p=0.375). The number of post-concussion symptoms were fewer in the intervention (6) compared to the control group (8) at 12 months (p=0.041). No group differences were observed for disability (p=0.193), patients impression of change (p=0.285) or psychological distress (p=0.716). Conclusions The multidisciplinary outpatient follow-up programme focusing on better understanding and reassurance of favourable outcome for mild traumatic brain injury did not improve return-to-work, but may have reduced the development of post-concussion symptoms. Additional studies should focus on which factors exhibit a direct impact on return-to-work.

Source: Vikane E, Hellstrøm T, Røe C, Bautz-Holter E, Aßmus J, Skouen JS, Brain Injury, Vol. 31 (4), 475-484, 2017 Mar.

Multidisciplinary outpatient treatment in patients with mild traumatic brain injury: A randomised controlled intervention study

Purpose To evaluate the efficacy of a multidisciplinary outpatient follow-up programme compared to follow-up by a general practitioner for patients being at-risk or sick-listed with persistent post-concussion symptoms two months after a mild traumatic brain injury. Design Randomised controlled trial. Patients One hundred fifty-one patients, 16-56 years. Methods Multidisciplinary outpatient rehabilitation with individual contacts and a psycho-educational group intervention at two outpatient rehabilitation clinics compared to follow-up by a general practitioner after the multidisciplinary examination. Primary outcome was sustainable return-to-work first year post-injury. Secondary outcomes were post-concussion symptoms, disability, the patient's impressions of change and psychological distress. Results Days to sustainable return-to-work was 90 in the intervention and 71 in the control group (p=0.375). The number of post-concussion symptoms were fewer in the intervention (6) compared to the control group (8) at 12 months (p=0.041). No group differences were observed for disability (p=0.193), patients impression of change (p = 0.285) or psychological distress (p=0.716). Conclusions The multidisciplinary outpatient follow-up programme focusing on better understanding and reassurance of favourable outcome for mild traumatic brain injury did not improve return-to-work, but may have reduced the development of post-concussion symptoms. Additional studies should focus on which factors exhibit a direct impact on return-to-work.

Source: Vikane E, Hellstrøm T, Røe C, Bautz-Holter E, Aßmus J, Skouen JS, Brain Injury, 1-10, 2017 Mar.

NOVEMBRE 2016

Biographical disruption, adjustment and reconstruction of everyday occupations and work participation after mild traumatic brain injury. A focus group study

Purpose To explore traumatic brain injury (TBI) as a biographical disruption and to study the reconstruction of everyday occupations and work participation among individuals with mild TBI. Methods Seven focus groups were conducted with 12 women and 8 men (22–60 years) who had sustained mild TBI and participated in a return-to-work program. Interviews were analyzed using qualitative content analysis. Results Four interrelated themes emerged: disruption of occupational capacity and balance; changes in self-perceptions; experience of time; and occupational adjustment and reconstruction. The meaning of the impairments lies in their impact on the individual’s everyday occupations. The abandonment of meaningful daily occupations and the feeling of not recognizing oneself were experienced as threats to the sense of self. Successful integration of the past, present and future was paramount to continuing life activities. The unpredictability of the future seemed to permeate the entire process of adjustment and reconstruction of daily life. Conclusions Our findings show that the concept of time is important in understanding and supporting the reconstruction of daily life after TBI. The fundamental work of rehabilitation is to ameliorate the disruptions caused by the injury, restoring a sense of personal narrative and supporting the ability to move forward with life. Implications for Rehabilitation Individuals with a protracted recovery after a mild traumatic brain injury must reconstruct a new way of being and acting in the world to achieve biographical continuity. The perceived anxiety regarding changes in self and occupational identity, as well as loss of control over the future, can be attenuated through informational sessions during the hospital stay and at follow-up visits. The significant personal costs of returning to full-time employment too early indicate the need for early and ongoing vocational support in achieving a successful return to work.

Source: Sveen U; Søberg HL, Østensjø S, Disability & Rehabilitation, Vol. 3 (23), 2296-2304, 2016 Nov.

JUILLET 2016

Factors associated with return to work in men and women with work-related traumatic brain injury

Purpose Symptoms that persist subsequent to a work-related traumatic brain injury (wrTBI) influence the ability to return to work (RTW) and indicate areas of functional disability, as classified in the International Classification of Functioning, Disability and Health (ICF) framework. The purpose of this study was to describe the relationship between RTW status and ICF framework domains in men and women with a wrTBI. Methods A retrospective chart review of 209 consecutive workers with TBI (mild TBI: 71.8%; mean age: 40.2 ± 11.1, men: 71.3%) was conducted. Workers were assessed during the chronic post-injury phase, at the neurology service of a large rehabilitation hospital in Ontario, Canada in 2003. Frequency distributions were calculated and chi-square tests performed.Results At the point of assessment, 78.0% of workers were in receipt of disability benefits, while the remainder had returned to work on a full- or part-time basis. Significant differences were observed in the Body Functions and Structures domain of the ICF model, specifically clinical diagnoses of depression, anxiety, pain disorders; self-perceived cognitive disturbance, and certain psychosocial factors (p < 0.05), between workers who had returned to work and those who had not. When stratified according to sex, these associations remained significant only in men.Conclusions The factors outlined above should be subject to further TBI research, as indicators for RTW. The lack of significant findings in women warrants further exploration of variables within the physical and social environmental domains of the ICF.

Source: Xiong C, Martin T, Sravanapudi A, Colantonio A, Mollayeva T, Disability and Health Journal, Vol. 9 (3), 439-448, 2016 Jul.