Multidisciplinary outpatient treatment in patients with mild traumatic brain injury: A randomised controlled intervention study

ABSTRACT

Objective: To evaluate the efficacy of a multidisciplinary outpatient follow-up programme compared to follow-up by a general practitioner for patients being at-risk or sick-listed with persistent post-concussion symptoms two months after a mild traumatic brain injury. Design: Randomised controlled trial. Patients: One hundred fifty-one patients, 16–56 years. Methods: Multidisciplinary outpatient rehabilitation with individual contacts and a psycho-educational group intervention at two outpatient rehabilitation clinics compared to follow-up by a general practitioner after the multidisciplinary examination. Primary outcome was sustainable return-to-work first year post-injury. Secondary outcomes were post-concussion symptoms, disability, the patient’s impressions of change and psychological distress. Results: Days to sustainable return-to-work was 90 in the intervention and 71 in the control group (p = 0.375). The number of post-concussion symptoms were fewer in the intervention (6) compared to the control group (8) at 12 months (p = 0.041). No group differences were observed for disability (p = 0.193), patients impression of change (p = 0.285) or psychological distress (p = 0.716). Conclusion: The multidisciplinary outpatient follow-up programme focusing on better understanding and reassurance of favourable outcome for mild traumatic brain injury did not improve return-to-work, but may have reduced the development of post-concussion symptoms. Additional studies should focus on which factors exhibit a direct impact on return-to-work.

KEYWORDS:

• Mild traumatic brain injury
• post-concussion symptoms
• randomised controlled trial
• return-to-work
• vocational rehabilitation

Acknowledgments

We thank the teams at Haukeland and Ullevål; the facilitators Kaia Frøyland, Anne Lerfald Grostad, Karen Marie Haga, Silje Mæhle Haugland, Gunvor Hjelmervik, Lise Kristin Holter, Øyvor Øistensen Holthe, Anne Hummelsgaard, Matthias Hütler, MD, Vibeche Thon Iversen, Ingerid Kleffelgård, Ragnhild Lossius, Tone Brodal, Mongstad, Tomas Brandal Myklebust, Silje Karin Pedersen, Unni Sveen, PhD, Helene Lundgaard Søberg, PhD, Tore Wenzel-Larsen and Randi Aabol for their contributions; and Unn H. Høydahl, Statistics Norway and her staff for the data collection.

Declaration of Interest

Eirik Vikane, MD, PhD, was supported by the Norwegian Extra Foundation for Health and Rehabilitation. The authors report no other declarations of interest.

Supplemental Materials

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