Article

OBJECTIVE: To examine the tolerability and estimate the treatment effect of
cognitive-behavioral therapy (CBT) delivered soon after mild traumatic brain
injury to patients at risk for chronic postconcussion syndrome (PCS). SETTING:
Tertiary rehabilitation center. PARTICIPANTS:
Twenty-eight patients with
uncomplicated mild traumatic brain injury, determined to be at risk for chronic
PCS based on a published algorithm that incorporates subacute postconcussion
symptoms and maladaptive illness beliefs (recovery expectations and perceived
consequences). They were enrolled within 6 weeks postinjury. DESIGN: Open-label,
parallel-group, randomized controlled trial, with masked outcome assessment 3
months after enrolment. Interventions were (1) treatment as usual (education,
reassurance, and symptom management strategies) from an occupational therapist,
or (2) treatment as usual plus CBT delivered by a psychologist. MAIN MEASURES:
Rivermead Postconcussion Symptoms Questionnaire. RESULTS: Four participants (2:2)
withdrew. Treatment credibility and satisfaction ratings were high in the CBT
group. Treatment effect sizes were moderate for postconcussion symptoms (Cohen d
= 0.74) and moderate-large for most secondary outcome measures (Cohen d =
0.62-1.61). Fewer participants receiving CBT had a diagnosis of PCS at follow-up
(54% vs 91%, P < .05). CONCLUSION: Our preliminary data suggest that CBT
delivered soon after mild traumatic brain injury is well tolerated and may
facilitate recovery in patients who are at risk for chronic PCS. A definitive clinical trial is warranted.

Langue : ANGLAIS