Research Reports - Cognitive behavioral intervention compared to telephone counselling early after mild traumatic brain injury

J Neurotrauma. 2017 Mar 23. doi: 10.1089/neu.2016.4885. [Epub ahead of print]

Scheenen ME(1), Visser-Keizer AC(2), de Koning ME(3), van der Horn HJ(4), van de
Sande P(5), van Kessel ME(6), van der Naalt J(7,)(8), Spikman JM(9).

Many patients do not return to work (RTW) following mild Traumatic Brain Injury
(mTBI) due to persistent complaints that are often resistant to therapy in the
chronic phase. Recent studies suggest that psychological interventions should be
implemented early after injury to prevent patients from developing chronic
complaints. This study is a randomized controlled trial which examines the
effectiveness of a newly developed CBT intervention (CBTi) compared to telephonic
counseling (TC) in at risk mTBI patients (patients with high reports of early
complaints). Patients underwent either five sessions of CBT treatment or five
phone conversations starting 4-6 weeks after trauma. The main outcome measure was
RTW six and twelve months after trauma. Secondary measures comprised functional
outcome at six and twelve months, and depression, anxiety and reported
posttraumatic complaints at three, six and twelve months after injury. After
excluding drop outs, CBTi consisted of 39 patients and TC of 45 patients. No
significant differences were found with regard to RTW, with 65% of CBTi patients
and 67% of TC patients reporting a RTW at previous level. However, TC patients
reported fewer complaints at three (8 vs. 6, p=.010) and twelve month post-injury
(9 vs. 5, p=.006), and more patients in the TC group showed a full recovery
twelve months post-injury compared to the CBTi group (62% vs. 39%). The results
of this study suggest that early follow-up of at risk patients can have a
positive influence on patients' well-being, and that a low-intensive, low-cost
telephonic intervention might be more effective than a CBT intervention at
improving outcome in at-risk patients. 

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