Postconcussion syndrome and posttraumatic headache: follow-up and ACT-based rehabilitation

Prolonged Postconcussion Symptoms and Posttraumatic Headache: Follow-up and ACT-based rehabilitationThe PhD project investigates the prognosis and characteristics of patients with persistent postconcussion symptoms and posttraumatic headache after mild traumatic brain injury (concussion), looks at change over time, and further evaluates an intervention based on Acceptance and Commitment Therapy for these patients.This PhD project is linked to our research program on mild traumatic brain injury (MTBI) and persistent postconcussion symptoms (PCS). It links two research groups at the Institute for Neuromedicine and Movement Sciences at NTNU, and two clinical departments at St. Olavs Hospital: the Trondheim TBI Group, committed by the Rehabilitation Clinic, and the Trondheim Headache Group, committed by the Department of Neurology. A significant minority of those experiencing a mild traumatic injury (MTBI), still suffer months and years after the injury, with symptoms such as headaches, irritability, problems with sleep and attention. This is often referred to as persistent postconcussion symptoms and posttraumatic headache (PTH). These conditions are not well understood, and the patients represent a large patient group who lack sufficiently evidence-based health care. During the past year, focus has been on data collection in our study on patients with PCS after a mild traumatic brain injury or a minimal head injury, who were referred to specialized hospital care (the PCS study). Follow-up interviews with fixed intervals have been carried out, as well as organizing and initiating gathering of blood samples from participants in the study. Preliminary data has been analyzed and an abstract written for a new article on the data, that will be presented in March 2023 at the international conference the 14th biennial World Congress on Brain Injury, organized by the International Brain Injury Association. The writing of the second article in the PhD, with the preliminary title "Demographic and Clinical Characteristics of Patients referred with Persistent Post-concussion Symptoms after Mild Traumatic Brain Injury or Minimal Head Injury", has begun. Another study in the project, the randomized controlled study named the ACT study, utilizing the psychological treatment Acceptance- and Comittment Therapy along with other rehabilitative measures to help patients with PCS after a mild traumatic brain injury or a minimal head injury, has continued and several participants have gone through the treatment or been controls during 2022. Much time has also been spent on recruiting, teaching and supervising students working in the project, helping us gather data, as well as working as a coordinator in the PCS study. The candidate has successfully completed the course "Quantitative multivariate methods", gaining 10 credits (ECTs). The candidate has also participated in clinical consultations with new potential participants in the PCS study. A research stay at Harvard Medical School and Massachusetts General Hospital was planned for 2022, but was postponed due to the pandemic.

Prolonged Postconcussion Symptoms and Posttraumatic Headache: Follow-up and ACT-based rehabilitationThe PhD project investigates the prognosis and characteristics of patients with persistent postconcussion symptoms and posttraumatic headache after mild traumatic brain injury, looks at change over time, and further evaluates an intervention based on Acceptance and Commitment Therapy for these patients.This PhD project is linked to our research program on mild traumatic brain injury and persistent postconcussion symptoms. It links two research groups at the Institute for Neuromedicine and Movement Sciences at NTNU, and two clinical departments at St. Olavs Hospital: the Trondheim TBI Group, committed by the Clinic of Physical Medicine and Rehabilitation, and the Trondheim Headache Group, committed by the Department of Neurology. A significant minority of those experiencing a mild traumatic injury (MTBI), still suffer months and years after the injury, with symptoms such as headaches, irritability, problems with sleep and attention. This is often referred to as persistent postconcussion symptoms (PCS) and posttraumatic headache (PTH). These conditions are not well understood, and the patients represent a large patient group who lack sufficiently evidence-based health care. During the past year, an article has been published online in Archives of Physical Medicine and Rehabilitation, it will appear on print in 2022: Trajectories of persistent postconcussion symptoms and factors associated with symptom reporting after mild traumatic brain injury. We used data from the Trondheim MTBI follow-up study to examine the trajectories of persistent PCS after MTBI and investigated which injury-related and personal factors were associated with symptom reporting. We compared patients with MTBI to trauma controls and healthy controls 3 and 12 months postinjury, and found that the MTBI group had a similar prevalence of moderate to severe PCS both times, and reported more symptoms than the control groups. Analyses of individual trajectories, however, revealed considerable change in the MTBI group, where both worsening and improvement was common. Intracranial lesions on computed tomography were associated with a greater likelihood of improving from 3 to 12 months. Those with moderate to severe persistent PCS at both assessments were more likely to be women and to have one or several of these personal preinjury factors: reduced employment, pain, poor sleep, low resilience, high neuroticism, high pessimism and a psychiatric history. We have continued the randomized controlled study we started in 2020, using attachment and commitment therapy (ACT) for patients with PCS/PTH after MTBI.

"Postconcussion syndrome and posttraumatic headache: follow-up and ACT-based rehabilitation"Dette er et phd prosjekt som har pågått siden juni 2020. Kandidaten har veldig god progresjon; hun er i ferd med å publisere sin første artikkel og den randomiserte kontrollerte studien av ACT-basert rehabilitering av postkommotiosymptomer rekrutterer pasienter som planlagt. Den ble imidlertid noe forsinket av koronapandemien.Phd kandidaten har vært aktiv i rekruttering til ACT-basert rehabilitering. Her er det inkludert 14 personer til nå, 6 av disse i 2020. Prosjektet ble noe forsinket av koronapandemien. Parallelt med denne RCT, har kandidaten jobbet med en publikasjon basert på tidligere innsamlete data. Dette arbedet har gått veldig raskt, og artikkel vil bli sendt inn i løpet av mars 2021: Trajectories of Postconcussion Symptoms and Factors Associated with Stability and Change after Mild Traumatic Brain Injury. Her kan hun påvise at personlige faktorer ser ut til å ha stor betydning for hvilket forløp pasienter med plager etter hjernerystelse får gjennom det første året. Kandidaten har også begynt med en protokollartikkel for RCTen sammen med en av medveilederne. Hun har også tatt fag som planlagt. Hun skal ha foreldrepermisjon fra 1.4.21, dette fraværet er godt planlagt og vil ikke påvirke prosjektet på noen måte som krever egne tiltak.