title: Cognitive-behavioral prevention of postconcussion syndrome in at-risk patients: a pilot randomized controlled trial.
abstract: OBJECTIVE
  To examine the tolerability and estimate the treatment effect of cognitive-behavioral therapy (CBT) delivered soon after mild traumatic brain injury to patients at risk for chronic postconcussion syndrome (PCS).
  
  
  METHODS
  Tertiary rehabilitation center.
  
  
  METHODS
  Twenty-eight patients with uncomplicated mild traumatic brain injury, determined to be at risk for chronic PCS based on a published algorithm that incorporates subacute postconcussion symptoms and maladaptive illness beliefs (recovery expectations and perceived consequences). They were enrolled within 6 weeks postinjury.
  
  
  METHODS
  Open-label, parallel-group, randomized controlled trial, with masked outcome assessment 3 months after enrolment. Interventions were (1) treatment as usual (education, reassurance, and symptom management strategies) from an occupational therapist, or (2) treatment as usual plus CBT delivered by a psychologist.
  
  
  METHODS
  Rivermead Postconcussion Symptoms Questionnaire.
  
  
  RESULTS
  Four participants (2:2) withdrew. Treatment credibility and satisfaction ratings were high in the CBT group. Treatment effect sizes were moderate for postconcussion symptoms (Cohen d = 0.74) and moderate-large for most secondary outcome measures (Cohen d = 0.62-1.61). Fewer participants receiving CBT had a diagnosis of PCS at follow-up (54% vs 91%, P < .05).
  
  
  CONCLUSIONS
  Our preliminary data suggest that CBT delivered soon after mild traumatic brain injury is well tolerated and may facilitate recovery in patients who are at risk for chronic PCS. A definitive clinical trial is warranted.
authors: GF Strong Rehab Centre, Vancouver, University of British Columbia, Vancouver, Canada. noah.silverberg@vch.ca
authors: Noah D
authors: ND
authors: Silverberg
authors: Bradley J
authors: BJ
authors: Hallam
authors: Alice
authors: A
authors: Rose
authors: Heather
authors: H
authors: Underwood
authors: Kevin
authors: K
authors: Whitfield
authors: Allen E
authors: AE
authors: Thornton
authors: Maureen L
authors: ML
authors: Whittal
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000175:diagnosis / Q000628:therapy*; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010865:Pilot Projects; D038223:Post-Concussion Syndrome / Q000473:pathology* / Q000628:therapy; D011237:Predictive Value of Tests; D011322:Primary Prevention / Q000379:methods; D020127:Recovery of Function / Q000502:physiology; D012016:Reference Values; D012047:Rehabilitation Centers; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult