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Six-month collaborative care model improves postconcussive symptoms more than usual care

A 6-month collaborative care model improved adolescents’ postconcussive symptoms significantly more than usual care, according to recent findings published in Pediatrics.

“This study provides evidence of the effectiveness of a collaborative care intervention in reducing postconcussive symptoms in a sample of adolescents with prolonged recovery from sports-related concussion,” Carolyn A. McCarty, PhD, research associate professor of pediatrics at the University of Washington, and colleagues wrote. “Although patients in both groups showed symptom reduction in the first 3 months, only those who received collaborative care demonstrated sustained improvements through 6 months of follow-up.”

According to the researchers, 3.7% of school-aged children with concussions remain symptomatic after 3 months. To improve postconcussion symptoms, cognitive-behavioral therapy is recommended in adults and has been shown to reduce depression, anxiety and chronic pain in adolescents, they wrote.

McCarty and colleagues developed a collaborative care model including cognitive-behavioral therapy, care management and psychopharmacological consultation. They evaluated their model in patients aged between 11 and 17 years with at least 1 month of concussion symptoms. The researchers assigned patients to either collaborative care (n = 25) or usual care (n= 24) and assessed patients at baseline and then at 1, 3 and 6 months.

Cognitive-behavioral therapy focused on coping skills, relaxation strategies, sleep hygiene and positive thinking. Care management included motivational interviews to maintain treatment engagement. A pediatric psychopharmacology expert provided pharmacologic consultation for patients with severe symptoms.

Usual care consisted of a visit to a physician trained in sports medicine. If symptoms lasted beyond 6 weeks, patients underwent MRI. Patients with trouble sleeping were prescribed hypnotic medication.

The researchers found that collaborative care patients experienced clinically significant improvements in postconcussive symptoms in addition to functional gains at 6 months when compared with usual care patients. After 6 months, 13% of patients receiving collaborative care and 41.7% of patients receiving usual care reported high levels of postconcussive symptoms (P = .03). In addition, 78% of patients receiving collaborative care and 45.8% of patients receiving usual care reported a 50% reduction in depressive symptoms (P = .02). However, there was no difference between groups for anxiety symptoms.

“This is the first randomized controlled treatment trial of a collaborative care intervention for persistent post-concussive symptoms in the pediatric population,” the researchers wrote. “In the absence of empirically based treatment options for this patient population, this study provides evidence for the application of the collaborative care model of integrated care for post-concussive symptoms.” – by Will Offit

Disclosure: The researchers report no relevant financial disclosures.