Interdisciplinary Interventions After mTBI

A concussion typically results from a trauma to the head or body and, for most people, causes symptoms that resolve within a few weeks. Approximately 25,000 individuals in Denmark experience concussions annually. However, about 8,000 to 11,000 of those affected experience prolonged symptoms such as fatigue, dizziness, headaches, pain, and cognitive impairments. These symptoms can significantly reduce quality of life and work capacity, and in some cases, become chronic. Consequently, a subset of individuals with concussions require ongoing social support even two years post-injury.

Denmark currently lacks a comprehensive national guideline for managing concussions within regional and municipal healthcare systems. As a result, individuals with concussions are often left to navigate the healthcare system on their own, leading to limited or no access to rehabilitation services. The Danish Center for Concussion and other experts have recommended the establishment of national concussion clinics.

Since 2016, the Special Education and Employment Unit (SuB) in Slagelse, part of the municipality's Center for Disability and Psychiatry, has been developing and providing concussion interventions based on national and international evidence. Participants in these programs have reported significant improvements in weekly work hours and overall quality of life. However, the long-term effects of these interventions remain unknown.

Participants are typically in great distress and need help, which is why a lack of interventions-or the delay of interventions for several months-in a control group is considered unethical. It should be noted that single-group studies, which evaluate outcomes longitudinally, are often the only possible method and can provide both interesting and reliable results. Investigators will be blinded for participants being allocated to early or late interventions.

This single-center and uncontrolled study aims to investigate the long-term impact of interdisciplinary and personalized concussion rehabilitation programs on quality of life and work capacity. Researchers will compare the outcomes of individuals who begin the program within 1-3 months post-concussion to those who start later (more than 9 months post-concussion) to determine the significance of early intervention. This research is groundbreaking as it will provide valuable insights into the long-term effects of concussions and the importance of timely interventions.

Aim: To evaluate the effectiveness of tailored concussion rehabilitation programs.

Outcomes: Changes in quality of life and work capacity. Timeframes: Immediate post-program and at 1 and 3 years. Comparison: Early vs. late intervention. Significance: The study will fill a gap in the current understanding of concussion recovery.

In essence, this study seeks to determine if a comprehensive and individualized approach to concussion rehabilitation can lead to sustained improvements in the lives of those affected, and whether starting treatment sooner is beneficial.

The investigators expect that an early intervention will result in significantly higher average weekly work hours and quality of life compared to a late intervention. The main hypothesis is that an early intervention will counteract the chronic effects and prevent worsening, including by inhibiting the development of hypersensitivity to sound and light.

The vision is to offer an intervention for concussion sufferers at the highest international level, and with this focus, it is important to know the long-term effects.

• Rivermead Post-Concussion Symptoms Questionnaire (RPQ) [Time frame: Measured at inclusion, through study completion (an average of 6 months), and after 6, 12 and 36 months of no intervention]
• Work Role Functioning Questionnaire v. 2.0 (WRFQ 2.0). [Time frame: Measured at inclusion, through study completion (an average of 6 months), and after 6, 12 and 36 months of no intervention]
• Behavioural Rating Inventory of Executive Function - Adults (BRIEF-A) [Time frame: Measured at inclusion, through study completion (an average of 6 months), and after 6, 12 and 36 months of no intervention]
• European Quality of Life - 5 Dimensions [Time frame: Measured at inclusion, through study completion (an average of 6 months), and after 6, 12 and 36 months of no intervention]
• Clinical Global Impression Scale (CGI) [Time frame: Measured at inclusion, through study completion (an average of 6 months), and after 6, 12 and 36 months of no intervention]
• Brain Injury Vision Symptom Survey (BIVSS) [Time frame: Measured at inclusion, through study completion (an average of 6 months), and after 6, 12 and 36 months of no intervention]
• King-Devick (K-D) [Time frame: Measured at inclusion, through study completion (an average of 6 months), and after 6, 12 and 36 months of no intervention]
• Vestibular Ocular Motor Screening (VOMS) [Time frame: Measured at inclusion, through study completion (an average of 6 months), and after 6, 12 and 36 months of no intervention]
• Reading test [Time frame: Measured at inclusion, through study completion (an average of 6 months), and after 6, 12 and 36 months of no intervention]
• Major Depression Inventory (MDI) [Time frame: Measured at inclusion, through study completion (an average of 6 months), and after 6, 12 and 36 months of no intervention]
• Fatigue Severity Scale - 7 item (FSS-7) [Time frame: Measured at inclusion, through study completion (an average of 6 months), and after 6, 12 and 36 months of no intervention]
• Visual Analogue Scale for Smerte (VAS) [Time frame: Measured at inclusion, through study completion (an average of 6 months), and after 6, 12 and 36 months of no intervention]