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

J Neurotrauma. 2017 Oct 1;34(19):2713-2720. doi: 10.1089/neu.2016.4885. Epub 2017
May 17.

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

Many patients do not return to work (RTW) after mild traumatic brain injury
(mTBI) because of persistent complaints that are often resistant to therapy in
the chronic phase. Recent studies suggest that psychological interventions should
be implemented early post-injury to prevent patients from developing chronic
complaints. This study is a randomized, controlled trial that examines the
effectiveness of a newly developed cognitive behavioral therapy (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 post-trauma. The main outcome measure was RTW 6 and 12 months post-trauma.
Secondary measures comprised functional outcome at 6 and 12 months, and
depression, anxiety, and reported post-traumatic complaints at 3, 6, and 12
months post-injury. After excluding dropouts, 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 3 (8 vs. 6; p = 0.010) and 12
months post-injury (9 vs. 5; p = 0.006), and more patients in the TC group showed
a full recovery 12 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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