The Effect of Combined Mental Health and Physical Treatment on Clinical Outcomes Following Concussions in Adolescent/Young Adult

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Title: The Effect of Combined Mental Health and Physical Treatment on Clinical Outcomes Following Concussions in Adolescent/Young Adult: a dissertation
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Description: Concussions and traumatic brain injuries (TBI) are a major health concern, with an average of 2-4 million concussions occurring in the United States each year (Langlois, Rutland-Brown, & Thomas, 2006). Among these injuries, 79.6% required emergency department care, 16.8% required admittance to a hospital, and 3.6% of these cases resulted in death (Langlois, et al., 2006). Concussions are individualized with different symptoms and impairments, which may be delayed or changing in presentation (McCrory et al., 2017). Although many concussions resolve within a few weeks some involve long-term continued physical, behavioral, cognitive, and sleep symptoms (McCrory et al., 2017). The purpose of this research was to investigate the hypothesis that a combined physical and mental health treatment would be associated with a more rapid recovery (i.e., resolution of symptoms) and improved cognitive outcomes. This causal-comparative quasi-experimental design involved data from 29 adolescents and young adults (13 females, 16 males) aged 16-25 years with a sport-related concussion (SRC) between January 2017 and December 2019. The deidentified data were accessed from an electronic health records database at a concussion specialty clinic located in the mid-Atlantic region. The data of 25 patients who received only a physical health intervention, consisting of dynamic or aerobic exertion therapies and sport-specific training as clinically appropriate, formed the physical health treatment control group. The data of four patients who received a combined mental health and physical health treatment formed the mental health treatment group. The mental health treatment group received both a physical and a mental health treatment consisting of dynamic or aerobic exertion therapy or sport-specific training, and a targeted mental health treatment such as cognitive behavioral therapy or psychiatric care as clinically appropriate. Results of an ANOVA and generalized linear model indicated that subjects receiving the mental health treatment recovered in 116.50 days (SD = 39.06), whereas the physical health treatment control group recovered in 29.44 days (SD = 16.34) (p<.001, effect size [ES]= .25). Initial reports of problems sleeping in both groups, as measured on the Post-concussion Symptom Scale (PCSS) (p=.006), elevated second visit ImPACT® (p=.02) scores, VOMS total scores (p=.01), and loss of consciousness (p=.02) were all significantly correlated with a longer recovery. Other medical history and injury-related factors, such as a personal history of migraine, concussion history, disorientation at time of injury, post-traumatic amnesia, and gender, were unrelated to recovery. These findings suggest that differences in treatment groups’ symptoms and clinical presentation may indicate more complex initial injuries that could be responsible for both the referral to mental health treatment and prolonged recovery. Patients who experience mental health symptoms post-concussion may be more likely to require specialized treatment and take longer to recover.
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Contributor: Smith, Patrick J. (Author)
Date: 2020-06-18
Type: Text
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Identifier: cali:1248
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