TY - JOUR
T1 - Psychological approaches for the management of persistent postconcussion symptoms after mild traumatic brain injury
T2 - a systematic review
AU - Sullivan, Karen A
AU - Kaye, Sherrie-Anne
AU - Blaine, Hannah
AU - Edmed, Shannon L.
AU - Meares, Susanne
AU - Rossa, Kalina
AU - Haden, Catherine
PY - 2020/8
Y1 - 2020/8
N2 - Background: To evaluate the evidence for psychological treatments for persistent postconcussion symptoms following mild traumatic brain injury. There is scant evidence from limited clinical trials to direct the psychological management of persistent symptoms.Method: Databases were searched for studies that: (1) included adults (≥ aged 16 years) following injury (from any cause); (2) tested interventions for postconcussion symptoms after the acute injury period (e.g., after hospital discharge), but prior to established chronicity (e.g., not more than 12 months post-injury), and; (3) applied one of five broadly-defined psychological interventions (cognitive behavioural therapy, counselling, psychoeducation, education/reassurance, or mindfulness). All controlled trials were eligible for inclusion.Results: Of the 20,945 articles identified, 10 underwent risk-of-bias analysis by two independent reviewers. Nine were retained for data extraction. They used: cognitive behaviour therapy (n = 2), counselling (n = 2), psychoeducation (n = 2), education/reassurance (n = 2), or compared cognitive behaviour therapy to counselling (n = 1).Conclusion: Counselling or cognitive behaviour therapy have the most support but the evidence remains limited. We encourage further randomized controlled trials of early interventions in samples at risk for persistent symptoms, including closer study of psychological risk-factors and the 'active' ingredient. To advance the field, future trials must include additional methodological controls and improved reporting. Implications for rehabilitation Persistent symptoms following mild traumatic brain injury can be disabling and psychological management for rehabilitation may be proposed. However, Controlled trials show that while some psychological approaches hold promise for this purpose, there are significant gaps in the underpinning evidence. The best results are seen when postconcussion programs use counselling or cognitive behaviour therapy and are targetted for people with an increased risk of persistent symptoms.
AB - Background: To evaluate the evidence for psychological treatments for persistent postconcussion symptoms following mild traumatic brain injury. There is scant evidence from limited clinical trials to direct the psychological management of persistent symptoms.Method: Databases were searched for studies that: (1) included adults (≥ aged 16 years) following injury (from any cause); (2) tested interventions for postconcussion symptoms after the acute injury period (e.g., after hospital discharge), but prior to established chronicity (e.g., not more than 12 months post-injury), and; (3) applied one of five broadly-defined psychological interventions (cognitive behavioural therapy, counselling, psychoeducation, education/reassurance, or mindfulness). All controlled trials were eligible for inclusion.Results: Of the 20,945 articles identified, 10 underwent risk-of-bias analysis by two independent reviewers. Nine were retained for data extraction. They used: cognitive behaviour therapy (n = 2), counselling (n = 2), psychoeducation (n = 2), education/reassurance (n = 2), or compared cognitive behaviour therapy to counselling (n = 1).Conclusion: Counselling or cognitive behaviour therapy have the most support but the evidence remains limited. We encourage further randomized controlled trials of early interventions in samples at risk for persistent symptoms, including closer study of psychological risk-factors and the 'active' ingredient. To advance the field, future trials must include additional methodological controls and improved reporting. Implications for rehabilitation Persistent symptoms following mild traumatic brain injury can be disabling and psychological management for rehabilitation may be proposed. However, Controlled trials show that while some psychological approaches hold promise for this purpose, there are significant gaps in the underpinning evidence. The best results are seen when postconcussion programs use counselling or cognitive behaviour therapy and are targetted for people with an increased risk of persistent symptoms.
KW - concussion
KW - rehabilitation
KW - psychotherapy
KW - cognitive behaviour therapy
KW - psychoeducation
KW - counselling
KW - therapy
UR - http://www.scopus.com/inward/record.url?scp=85088838532&partnerID=8YFLogxK
U2 - 10.1080/09638288.2018.1558292
DO - 10.1080/09638288.2018.1558292
M3 - Article
C2 - 30741023
SN - 0963-8288
VL - 42
SP - 2243
EP - 2251
JO - Disability and Rehabilitation
JF - Disability and Rehabilitation
IS - 16
ER -