Investigating the Effectiveness of Multidisciplinary Rehabilitation for Persistent Post-Concussive Symptoms.

Abstract

To evaluate the effectiveness of an individualized multidisciplinary rehabilitation program for treating individuals with persistent post-concussive symptoms (PPCS), and identify initial symptoms which predict overall symptom burden after rehabilitation. This retrospective cohort study employed routine assessment data from the Epworth HealthCare Rehabilitation Concussion Clinic. Patients with PPCS (n=528) participated in an individualized outpatient rehabilitation program, and self-reported symptoms and activity levels (using the Oregon Post-Concussion Symptom Checklist) on clinic admission and discharge. Summed checklist scores produced four subscale scores (physical, thinking, emotional and sleep) and a total score. On Clinic admission, patients self-reported a mean of 10.9 symptoms (SD: 6.0). Fatigue, cognitive impairments and headache were common. There was a statistically significant mean decrease in checklist scores (symptom burden) after rehabilitation (P=<0.001). Patients' mean daily activity levels also significantly increased between clinic admission (43.1%) and discharge (73.9%) (mean difference: 30.8%, 95% CI: 28.2-33.5, P=<.001). A subset of somatic and vestibular-ocular symptoms cumulatively predicted 31.1% of the total variance in symptom burden on clinic discharge. This study suggested that a multidisciplinary rehabilitation model was effective for treating PPCS. A focus should be on early, tailored intervention to moderate the initial symptom burden and improve patient prognosis.