Collaborative care model for treatment of persistent symptoms after concussion among youth (CARE4PCS-II): Study protocol for a randomized, controlled trial

Abstract

Background Currently, there is limited evidence to guide intervention and service delivery coordination for youth who suffer a concussion and subsequently experience persistent post-concussive symptoms (PCS) (Lumba-Brown et al. JAMA Pediatr 172(11):e182853, 2018; Lumba-Brown A et al. JAMA Pediatr 172(11):e182847, 2018). We have developed a collaborative care intervention with embedded cognitive-behavioral therapy, care management, and stepped-up psychotropic medication consultation to address persistent PCS and related psychological comorbidities. The CARE4PCS-II study was designed to assess whether adolescents with persistent symptoms after sports-related concussion will demonstrate better outcomes when receiving this collaborative care intervention compared to a usual care (control) condition. Methods/design This investigation is a randomized comparative effectiveness trial to receive intervention (collaborative care) or control (usual care). Two hundred sports-injured male and female adolescents aged 11–18 years with three or more post-concussive symptoms that persist for at least 1 month but less than 9 months after injury will be recruited and randomized into the study. The trial focuses on the effects of the intervention on post-concussive, depressive, and anxiety symptoms measured 3, 6, and 12 months after baseline. Discussion The CARE4PCS II study is a large comparative effectiveness trial targeting symptomatic improvements in sports injured adolescents after concussion. The study is unique in its adaptation of the collaborative care model to a broad spectrum of primary care, sports medicine, and school settings. The investigation incorporates novel elements such as the delivery of CBT through HIPAA complaint video conferenceing technology and has excellent widespread dissemination potential should effectiveness be demonstrated. Trial registration ClinicalTrials.gov, NCT03034720. Registered on January 27, 2017.

Effect of Collaborative Care on Persistent Postconcussive Symptoms in Adolescents

“…A flexible modular CBT format was used, in which the care manager could address any of the following topics according to the adolescent’s presenting concerns: pain management, relaxation and breathing, sleep hygiene, emotion regulation, mindfulness, challenging negative thinking, problem solving, crisis management, behavioral activation, avoidance, family communication, and/or the parent-child interaction. 16 The adolescents were taught coping skills, relaxation, and cognitive strategies to manage their symptoms, while they were encouraged to pace their activities and increase activation as possible. We hoped to provide a minimum of 4 CBT sessions to all adolescents, with additional sessions if symptoms were not improving or more support was requested.…”

“…Components of the intervention were offered in person or by video telehealth (see the study protocol in Supplement 1 for more details). 16 …”

“…Components of the intervention were offered in person or by video telehealth (see the study protocol in Supplement 1 for more details). 16 Intervention patients were provided access to collaborative care for the duration of their symptoms, and access was terminated on symptom resolution or at the end of the 6-month intervention period. Symptom resolution was defined as either a 50% reduction in symptoms or reaching a subclinical threshold on measures of postconcussive, depressive, and anxiety symptoms.…”

Physical Exercises in Relieving the Current State of Depression

“…It can effectively reflect the degree and changes of depressive symptoms and is especially suitable for general hospitals to find patients with depressive disorders. 4 The scale has high reliability and validity. The sensitivity is 88% to 93%.…”

Management of oral medicine emergencies during COVID-19: A study to develop practise guidelines

“…In addition to teaching and meetings, Zoom Video Communications has been used in many health care settings, including multidisciplinary hospital meeting, cardiology, and mental health. 11 , 13 WhatsApp Messenger is an American freeware, cross-platform messaging and Voice over IP (VoIP) service owned by Facebook. It has been suggested to be used in the management of orthodontic emergencies during COVID-19.…”