Collaborative care with CBT may improve adolescents' persistent postconcussive symptoms
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Collaborative care with cognitive behavioral therapy may alleviate symptoms and improve functioning among adolescents with persistent postconcussive symptoms, according to study results published in JAMA Network Open.
“We were hoping that this study could help with testing a new multicomponent strategy to help adolescents who have had a concussion and continue to have symptoms and problems beyond a month,” Carolyn A. McCarty, PhD, of the Center for Child Health, Behavior and Development at the University of Washington, told Healio Psychiatry. “Currently, there is not sufficient science to inform best practices to help these young people. We need better interventions to alleviate their suffering and get them back on track.”
McCarty and colleagues conducted the randomized clinical trial the Collaborative Care Model for Treatment of Persistent Symptoms After Concussion Among Youth II Trial between March 2017 and May 2020 with follow-up assessment at 3, 6 and 12 months. They analyzed data of 200 adolescents aged 11 to 18 years who had a diagnosis of a sports-related or recreational-related concussion within the past 9 months and who had three or more symptom that persisted at least 1 month after injury. Mean participant age was 14.7 years and 62% were girls. The researchers included cognitive behavioral therapy and care management, delivered primarily through telehealth, in the collaborative care intervention (N = 101) throughout the 6-month treatment period, with enhanced medication consultation when necessary. Usual care provided via specialty clinics comprised the comparator group (N = 101). Participants’ reports of postconcussive, quality of life, anxiety and depressive symptoms served as the primary outcomes, and parent-reported symptoms as the secondary outcomes.
Results showed significant improvements in Health Behavior Inventory scores vs. usual care at 3 months (3.4 point decrease) and 12 months (4.1 point decrease) among participants who received collaborative care. Further, the intervention group exhibited a mean improvement of 4.7 points in youth-reported Pediatric Quality of Life Inventory scores at 12 months compared with the control group. The researchers reported no differences by group over time for adolescent depressive or anxiety symptoms or for parent-reported outcomes.
“This study is clinically relevant because it provides valuable information to providers who care for concussed youth,” McCarty said. “These youth may especially benefit from interventions to address the full range of symptoms they experience, including mental health issues that arise, and from coordinating their care across different settings and specialty providers. We have developed and now tested this strategy with specific procedures to address their symptoms and we see effects on functioning and symptoms that are helpful even after a year.”