Multidisciplinary Therapy for Persistent Post-Concussion Symptoms: A Case Series from the UCLA Steve Tisch BrainSPORT Clinic

Abstract

ObjectiveTo examine the effectiveness of a six-session multidisciplinary intervention of coordinated cognitive behavioral therapy (CBT) and programmed aerobic exercise for patients suffering from persistent post-concussion symptoms (PPCS) as measured via a battery of validated patient-reported assessments.BackgroundBetween 10–30% of patients who suffer a concussion continue to experience elevated symptoms for a period lasting three months or longer post-injury. PPCS presentations are heterogeneous with respect to symptom domain, and while there are currently no clear evidence-based guidelines for treatment, emerging evidence suggests that multidisciplinary care incorporating medical management of symptoms, CBT, and aerobic exercise may be more effective than medical management alone.Design/MethodsPatients in this case series (n = 7, female = 6, age = 26.9 ± 13.0) were referred to therapy from a concussion outpatient clinic. Patients completed a course of CBT and programmed aerobic exercise comprising six in-person sessions and prescribed CBT and aerobic exercise homework to be completed between sessions. Adherence was tracked and outcomes were measured via change in self-reported scores on the Beck Anxiety Inventory (BAI), Beck Depression Inventory II (BDI-II), Brief Illness Perception Questionnaire (Brief-IPQ), Pain Catastrophizing Scale (PCS), Pediatric/Adult Quality of Life (PedsQL), Pittsburgh Sleep Quality Index (PSQI), and Post-Concussion Symptom Inventory (PCSI).ResultsAll patients completed a full course of therapy and prescribed homework. Significance was defined as p < 0.05. Patients showed significant improvement in PSCI total score (p = 0.026; d = −1.115) and improvement trending toward significance in BDI-II (p = 0.075; d = −0.842), PCS (p = 0.087; d = −0.484), and PedsQL (p = 0.089, d = 0.593).ConclusionsA relatively short multidisciplinary intervention may alleviate symptom burden and improve quality of life in PPCS patients and deserves more systematic study.