title: The effect of telephone counselling on reducing post-traumatic symptoms after mild traumatic brain injury: a randomised trial.
abstract: BACKGROUND
  Mild traumatic brain injury (MTBI) is a significant public health problem affecting approximately 1 million people annually in the USA. A total of 10-15% of individuals are estimated to have persistent post-traumatic symptoms. This study aimed to determine whether focused, scheduled telephone counselling during the first 3 months after MTBI decreases symptoms and improves functioning at 6 months.
  
  
  METHODS
  This was a two-group, parallel, randomised clinical trial with the outcome assessed by blinded examiner at 6 months after injury. 366 of 389 eligible subjects aged 16 years or older with MTBI were enrolled in the emergency department, with an 85% follow-up completion rate. Five telephone calls were completed, individualised for patient concerns and scripted to address education, reassurance and reactivation. Two composites were analysed, one relating to post-traumatic symptoms that developed or worsened after injury and their impact on functioning, the other related to general health status.
  
  
  RESULTS
  The telephone counselling group had a significantly better outcome for symptoms (6.6 difference in adjusted mean symptom score, 95% confidence interval (CI) 1.2 to 12.0), but no difference in general health outcome (1.5 difference in adjusted mean functional score, 95% CI 2.2 to 5.2). A smaller proportion of the treatment group had each individual symptom (except anxiety) at assessment. Similarly, fewer of the treatment group had daily functioning negatively impacted by symptoms with the largest differences in work, leisure activities, memory and concentration and financial independence.
  
  
  CONCLUSIONS
  Telephone counselling, focusing on symptom management, was successful in reducing chronic symptoms after MTBI.
  
  
  BACKGROUND
  ClinicalTrials.gov, #NCT00483444.
authors.affiliation: Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA. krbell@u.washington.edu
authors.forename: K R
authors.initials: KR
authors.lastname: Bell
authors.forename: J M
authors.initials: JM
authors.lastname: Hoffman
authors.forename: N R
authors.initials: NR
authors.lastname: Temkin
authors.forename: J M
authors.initials: JM
authors.lastname: Powell
authors.forename: R T
authors.initials: RT
authors.lastname: Fraser
authors.forename: P C
authors.initials: PC
authors.lastname: Esselman
authors.forename: J K
authors.initials: JK
authors.lastname: Barber
authors.forename: S
authors.initials: S
authors.lastname: Dikmen
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000523:psychology*; D003376:Counseling; D003710:Demography; D005260:Female; D015600:Glasgow Coma Scale; D015277:Hotlines; D006801:Humans; D008297:Male; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology / Q000517:prevention & control / Q000523:psychology; D014057:Tomography, X-Ray Computed