title: Completion of Multidisciplinary Treatment for Persistent Postconcussive Symptoms Is Associated With Reduced Symptom Burden.
abstract: To investigate the pre- to posttreatment changes in both posttraumatic stress disorder (PTSD) and persistent postconcussive symptoms (PPCSs).
  
  
  
  We studied 257 active-duty patients with a history of mild traumatic brain injury (mTBI) who completed multidisciplinary outpatient treatment at Brooke Army Medical Center TBI Clinic from 2008 to 2013. This treatment program included cognitive rehabilitation; vestibular interventions; headache management; and integrated behavioral healthcare to address co-occurring psychiatric conditions such as PTSD, depression, and sleep disturbance.
  
  
  
  A 1-group; preexperimental, pre- to posttreatment study.
  
  
  
  The Neurobehavioral Symptom Inventory (NSI) was used to assess PPCSs, and the PTSD Checklist-Military Version (PCL-M) was used to asses PTSD symptoms.
  
  
  
  Global PPCS resolution (mean NSI: 35.0 pre vs 23.8 post; P < .0001; d = 0.72) and PTSD symptom resolution (mean PCL-M: 43.2 pre vs 37.7 post; P < .0001; d = 0.34) were statistically significant. Compared with those with only mTBI, patients with mTBI and PTSD reported greater global PPCS impairment both pretreatment (mean NSI: 48.7 vs 27.9; P < .0001) and posttreatment (mean NSI: 36.2 vs 17.4; P < .0001). After adjusting for pretreatment NSI scores, patients with comorbid PTSD reported poorer PPCS resolution than those with mTBI alone (mean NSI: 27.9 pre vs 21.7 post; P = .0009).
  
  
  
  We found a reduction in both self-reported PPCSs and PTSD symptoms; however, future studies are needed to identify specific components of care associated with symptom reduction.
authors.affiliation: Oak Ridge Institute for Science and Education, United States Army Institute of Surgical Research (Dr Janak), Defense and Veterans Brain Injury Center (Dr Cooper), Brooke Army Medical Center (Dr Bowles), and Statistics and Epidemiology, United States Army Institute of Surgical Research (Dr Orman), JBSA Fort Sam Houston, San Antonio, Texas; University of Texas School of Public Health-San Antonio, San Antonio, Texas (Drs Cooper and Alamgir); and University of Texas School of Public Health-Austin, Austin, Texas (Drs Gabriel and Perez).
authors.forename: Jud C
authors.initials: JC
authors.lastname: Janak
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Cooper
authors.forename: Amy O
authors.initials: AO
authors.lastname: Bowles
authors.forename: Abul H
authors.initials: AH
authors.lastname: Alamgir
authors.forename: Sharon P
authors.initials: SP
authors.lastname: Cooper
authors.forename: Kelley P
authors.initials: KP
authors.lastname: Gabriel
authors.forename: Adriana
authors.initials: A
authors.lastname: Pérez
authors.forename: Jean A
authors.initials: JA
authors.lastname: Orman
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000379:methods; D001924:Brain Concussion / Q000175:diagnosis / Q000534:rehabilitation* / Q000628:therapy; D015928:Cognitive Behavioral Therapy / Q000379:methods; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008889:Military Personnel; D009483:Neuropsychological Tests; D009788:Occupational Therapy / Q000379:methods; D010348:Patient Care Team / Q000458:organization & administration; D026741:Physical Therapy Modalities; D038223:Post-Concussion Syndrome / Q000175:diagnosis / Q000534:rehabilitation*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D018709:Statistics, Nonparametric; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000534:rehabilitation*; D016896:Treatment Outcome; D014481:United States