Moving from the clinic to telehealth during the COVID-19 pandemic – a pilot clinical trial comparing in-clinic rehabilitation versus telerehabilitation for persisting symptoms following a mild Traumatic brain injury

Abstract

Purpose

The objective of this study was to compare the effects of an in-clinic cervicovestibular rehabilitation program (education, home exercises, manual techniques, sub-symptom threshold aerobic exercise [STAE] program) to a similar program (education, home-exercises, STAE program), but without manual techniques, provided in a telerehabilitation format in adults with persisting post-concussion symptoms (PCS).

Materials and methods design

In this parallel-group non-randomized clinical trial, 41 adults with persisting PCS were allocated to the in-clinic (n = 30) or telerehabilitation (n = 11) program. The outcome measures, which included the Post-Concussion Symptom Scale (PCSS; primary outcome), Numerical Pain Rating Scale (NPRS) for neck pain and headache and three disability questionnaires, were collected at baseline, weeks 6, 12, and 26. Non-parametric analysis for longitudinal data (NparLD) was used.

Results

For the PCSS, there was a group-by-time interaction (p = 0.05) with significant between-group differences at week 6, 12, and 26 (p < 0.05) for the in-clinic group. There were also group-by-time interactions for NPRS neck pain and headache (p < 0.05) for the in-clinic group.

Conclusion

The study suggests that a telehealth format failed to reach the efficiency of an in-clinic rehabilitation program in terms of symptoms reduction and functional improvement. These results must be interpreted with caution given the limited number of participants. ClinicalTrials.gov Identifier: NCT03677661.

IMPLICATION FOR REHABILITATION

• The telerehabilitation format for adults with persisting post-concussion symptoms was widely implemented in the COVID-19 pandemic without any evidence of efficacy over the more traditional in-clinic rehabilitation format.

• The study suggests that a telerehabilitation format failed to reach the efficiency of an in-clinic rehabilitation program in terms of symptoms reduction and functional improvement.

• Clinicians should try to incorporate some in-clinic appointments when a telerehabilitation format is required such as for patients in underserved area.

Keywords:

• Persisting post-concussive symptoms
• telerehabilitation
• neck pain
• dizziness
• headache

Aknowledgments

The authors want to thank Jean Leblond, PhD biostatistician, for help in statistical analysis. The authors want to thank Roland Lavallée for his review of the English writing and grammar.

Authors contribution

PL, JSR, PFa, PFr, – Protocol creation

PL, JSR, PFr, PFa – manuscripts write-up and revisions

PL, JSR – Training of evaluators

PL, PFa – Training of therapists

PL, MOD, MBC – Data collection

MOD – Data collection coordination

PL – publication

JSR, PFr – methodological quality assessment

All the authors have read and approved the final manuscript.

Disclosure statement

The authors declare that they have no competing interests. Pierre Langevin and Philippe Fait are co-owner of a concussion clinic in which intervention of the in-Clinic group of this trial was delivered. However, the clinic and the authors did not financially support the project, nor did they gain or lose financially from the publication of this manuscript.

Additional information

Funding

Funding was provided by the Réseau Provincial de Recherche en Adaptation-Réadaptation (REPAR) and by the Ordre Professionnel de la physiothérapie du Québec (OPPQ). Trial sponsors are REPAR ([email protected]) and OPPQ ([email protected]). The funding agency and sponsors had no role in the study design, writing the manuscript, or in the decision to submit for publication.