Enhanced Screening for Early Treatment Targets After Mild Traumatic Brain Injury
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Brain Concussion
- Sponsor
- University of British Columbia
- Enrollment
- 150
- Locations
- 1
- Primary Endpoint
- Family physician compliance with guidelines
- Status
- Completed
- Last Updated
- 4 years ago
Overview
Brief Summary
The study will examine whether enhancing screening-informed follow-up letters will improve (i) family physician compliance with best practice guidelines for managing persistent symptoms following concussion, and (ii) clinical outcomes from concussion.
Detailed Description
Family physicians are well positioned to proactively manage symptoms in the weeks following MTBI, which could prevent chronicity and reduce the need for specialist treatment. Clinical practice guidelines are now available for MTBI management in primary care, such as those developed by the Ontario Neurotrauma Foundation (ONF). However, awareness and use of these guidelines may be low. Distilling the guidelines into a small number of actionable messages that are tailored to an individual patient may facilitate family physician implementation. The ONF guidelines for MTBI propose that early intervention should prioritize the most readily treatable symptoms - mood (depression and anxiety), insomnia, and headaches. The present cluster randomized trial will evaluate whether screening for these conditions and sending family physicians treatment algorithms for positive screening test results will result in earlier evidence-based treatment. Patients will be recruited from two concussion clinics that provide group education sessions. Following the education session, eligible participants will complete self-reported screening measures for depression, anxiety, insomnia, and headaches. Family physicians will be randomized to receive these screening test results with associated treatment algorithms from the ONF guidelines or a letter providing generic MTBI management recommendations from the ONF guidelines (currently done as usual care). Patients will be assessed by telephone one month and three months after the intervention. The primary outcome will be patient-reported treatment utilization that is congruent with the ONF guidelines for depression, anxiety, insomnia, and headaches after MTBI.
Investigators
Noah Silverberg
Clinical Assistant Professor
University of British Columbia
Eligibility Criteria
Inclusion Criteria
- •Aged 18 to 60 years.
- •Has a family physician.
- •Physician diagnosed MTBI less than 3 months ago.
- •English reading comprehension sufficient for the consent form and standardized questionnaires.
Exclusion Criteria
- •English reading comprehension not sufficient for the consent form and standardized questionnaires.
Outcomes
Primary Outcomes
Family physician compliance with guidelines
Time Frame: 1 month after intervention.
Patient recall of receiving advice, referrals, and prescriptions from their family physician.
Secondary Outcomes
- Family physician compliance with guidelines (chart review)(6 to 12 months post injury)
- Personal Health Questionnaire-9 (PHQ-9)(1- and 3-months after intervention.)
- Insomnia Severity Scale (ISI)(1- and 3-months after intervention.)
- World Health Organization Disability Schedule (WHODAS-II) 12 item(1- and 3-months after intervention.)
- Quality of Life after Brain Injury Overall Scale (QOLIBRI-OS)(1- and 3-months after intervention.)
- Rivermead Post-Concussion Symptoms Questionnaire(1- and 3-months after intervention.)
- Generalized Anxiety Disorder-7 (GAD-7)(1- and 3-months after intervention.)