Effectiveness of a Customized Rehabilitation Program for Adults With Post-Concussion Syndrome—A Randomized Controlled Crossover Trial

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OBJECTIVE: Post-concussion syndrome is a challenging condition to assess and triage rehabilitation secondary to the heterogeneity of patients' presentations. The aim of the present study was to examine the effectiveness of a subgroup-informed customized rehabilitation (CR) program in adults with persistent concussion symptoms as compared to the current symptom-based treatment approach. SETTING: Rehabilitation hospital in Toronto, Ontario, Canada. PARTICIPANTS: 40 adults (mean age ± SD, 39.1 ± 13.6 years) with persistent post-concussion symptoms (mean symptom duration ± SD, 5 ± 3.1 months) were recruited from various head injury clinics around the greater Toronto area. DESIGN: Participants underwent a comprehensive standardized clinical exam to subgroup the ostensible symptom generators into autonomic, cervical, or vestibulo-ocular. In a crossover design, participants were randomized to undertake either a CR program for 6 weeks followed by standard care (SC) for 6 weeks (Group A) or SC followed by CR (Group B). The CR program was tailored to the individual based on the findings of the exam. The SC program was reflective of symptom-based rehabilitative recommendations. MAIN MEASURES: The primary outcome measure was the Rivermead Post-Concussion Questionnaire (RPQ-3 and RPQ-13). Secondary outcome measures included the Neck Disability Index, the Patient Health Questionnaire-9 and exercise tolerance as assessed via the Buffalo Concussion Treadmill Test. RESULTS: Participants in Group A made a clinically meaningful and statistically significant change to the primary and secondary outcome measures at the 6-week follow-up. These changes were maintained at the 12-week follow-up. Only following the CR program did Group B demonstrate significant and clinically meaningful changes in RPQ scores, as well as significant improvements in the secondary outcome measures. CONCLUSIONS: A shift away from symptom-based management to subgroup-informed customized rehabilitation may be key to advancing patient care and improving clinical outcomes for this population.

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