Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2022 Fall;85(3):270-281.
doi: 10.1080/00332747.2021.2004784. Epub 2022 Feb 9.

Exploring Heterogeneity of Stepped Collaborative Care Treatment Response Trajectories after Adolescent Sports Injury Concussion

Robert J Hilt, Carolyn A McCarty, Frederick P Rivara, Jin Wang, Lyscha A Marcynyszyn, Sara P D Chrisman, Ashleigh M Johnson, Douglas F Zatzick
Randomized Controlled Trial

Exploring Heterogeneity of Stepped Collaborative Care Treatment Response Trajectories after Adolescent Sports Injury Concussion

Robert J Hilt et al. Psychiatry. 2022 Fall.

Abstract

Objective: Few clinical trials of posttraumatic interventions have utilized symptom trajectory modeling to explore heterogeneity of treatment responses. The goal of this investigation was to conduct a secondary analysis of a randomized clinical trial of stepped collaborative care for adolescents with sports and recreational related concussion and persistent symptoms of >1 month.Method: Trajectory modeling was used to examine the impact of randomization to the intervention as well as demographic, clinical, and injury characteristics on adolescent post-concussive symptom trajectories. Two hundred male and female adolescents were assessed >1 month after a concussion, and then 3-, 6- and 12-months later with a standardized measure of concussive symptoms, the Health and Behavior Inventory (HBI). Multinomial logistic regression was used to compare the association between intervention, demographic, clinical and injury characteristics with trajectory group membership.Results: Four post-concussive symptom trajectories emerged: recovery, remitting, low-persistent, and high-persistent. In adjusted analyses randomization to the intervention condition was associated with significantly greater odds of HBI recovery trajectory group membership (OR 3.29 95% CI 1.06-10.28). Female gender and prior concussion history were associated with significantly greater odds of high-persistent trajectory group membership relative to all other trajectories. Greater odds of high-persistent versus recovery group trajectory membership was observed for adolescents with a pre-injury history of anxiety and/or depressive disorders.Conclusions: Stepped collaborative care was associated with an increased odds of recovery versus high-persistent post-concussive symptom trajectories, while readily identifiable baseline characteristics were associated high-persistent symptoms. Future post-concussive clinical trials and practice improvement efforts could incorporate these observations.

PubMed Disclaimer

Conflict of interest statement

Disclosure Statement

No potential competing interests were reported by the authors.

Figures

Figure 1.
Figure 1.
Four Post-Concussive Symptom Trajectories
See this image and copyright information in PMC

References

    1. Al Sayegh A, Sandford D, & Carson AJ (2010). Psychological approaches to treatment of postconcussion syndrome: A systematic review. Journal of Neurology, Neurosurgery, and Psychiatry, 81(10), 1128–1134. 10.1136/jnnp.2008.170092 - DOI - PubMed
    1. Ayr LK, Yeates KO, Taylor HG, & Browne M (2009). Dimensions of postconcussive symptoms in children with mild traumatic brain injuries. Journal of the International Neuropsychological Society: JINS, 15(1), 19–30. 10.1017/S1355617708090188 - DOI - PMC - PubMed
    1. Barlow KM, Crawford S, Stevenson A, Sandhu SS, Belanger F, & Dewey D (2010). Epidemiology of postconcussion syndrome in pediatric mild traumatic brain injury. Pediatrics, 126(2), e374–e381. 10.1542/peds.2009-0925 - DOI - PubMed
    1. Booker J, Sinha S, Choudhari K, Dawson J, & Singh R (2019). Description of the predictors of persistent post-concussion symptoms and disability after mild traumatic brain injury: The SHEFBIT cohort. British Journal of Neurosurgery, 33(4), 367–375. 10.1080/02688697.2019.1598542 - DOI - PubMed
    1. Bryan MA, Rowhani-Rahbar A, Comstock RD, Rivara F, & Seattle Sports Concussion Research Collaborative (2016). Sports- and recreation-related concussions in US youth. Pediatrics, 138(1), e20154635. 10.1542/peds.2015-4635 - DOI - PubMed

Publication types