Mild traumatic brain injuries: the impact of early intervention on late sequelae. A randomized controlled trial.
BACKGROUND
Positive results from early clinical intervention of mild traumatic brain injury (MTBI) patients by rehabilitation specialists have been reported. Various treatments have been used, but few controlled studies are published. We hypothesised that early rehabilitation of selected MTBI patients would reduce long term sequelae.


METHODS
A randomised controlled trial with one year follow-up. Among 1719 consecutive patients with MTBI, 395 individuals, 16-60 years of age, met the MTBI definition. Exclusion criteria were: previous clinically significant brain disorders and/or a history of substance abuse. The control group (n = 131) received regular care. The intervention group (n = 264) was examined by a rehabilitation specialist. 78 patients were mainly referred to an occupational therapist. The problems were identified in daily activities and in terms of post-concussion symptoms (PCS), an individualised, tailored treatment was given. Primary endpoint was change in rate of PCS and in life satisfaction at one-year follow-up between the groups.


RESULTS
No statistical differences were found between the intervention and control groups. Patients who experienced few PCS two to eight weeks after the injury and declined rehabilitation recovered and returned to their pre-injury status. Patients who suffered several PCS and accepted rehabilitation did not recover after one year.


CONCLUSIONS
In this particular MTBI sample, early active rehabilitation did not change the outcome to a statistically-significant degree. Further studies should focus on patients with several complaints during the first 1-3 months and test various types of interventions.
Elgmark Andersson
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Department of Rehabilitation Medicine, Institute of Clinical Neuroscience, Göteborg University, Göteborg, Sweden.
Emanuelson
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Björklund
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Stålhammar
D A
DA
D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000150:complications / Q000523:psychology / Q000534:rehabilitation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010549:Personal Satisfaction; D011788:Quality of Life; D012046:Rehabilitation / Q000379:methods*; D012649:Self Concept; D013997:Time Factors; D015599:Trauma Severity Indices; D016896:Treatment Outcome