Effectiveness of Targeted Individualized Rehabilitation in Adults Suffering from Persistent Concussion Symptoms Compared to Usual Care: A Randomized Clinical Trial - Currently Enrolling

Patients who sustain a concussion and experience persistent symptoms beyond the normal healing time are among the more difficult cases to manage for even the most experienced clinician. Symptoms are non-specific and patients often fail to achieve a full recovery with standard forms of therapy. Current guidelines suggest treatments be individualized and target specific impairments; however, the lack of trials investigating rehabilitative interventions directed to patients’ physical symptoms is a considerable limitation. Aerobic exercise and multimodal rehabilitation have consistently shown to be a possibly effective means to manage this population; however, the optimal training prescription is unclear. To date, exercise has not been compared to anything but a stretching program and largely this intervention has only been applied to a young athletic population. Thus, there is a need to further examine the effectiveness of multimodal individualized rehabilitative treatments inclusive of an exercise program in a representative population.

Participants (n = 50) will be eligible for study participation if they meet the following inclusion criteria: 21 years and older; meet the definition of post-concussion syndrome as defined by Tator et al., and have adequate language skills in English to read and take part in the rehabilitation treatment programs.  

Study Design: We will be conducting a 12-week case-crossover randomized controlled trial. Participants will undergo 6-weeks of care in their respective streams. After 6-weeks, participants will undergo a re-examination. They will then crossover and undertake the alternative treatment for 6 weeks. At the end of 12 weeks, participants will undertake the endpoint examinations.  Participants will undergo a comprehensive clinical evaluation at the KITE research clinics to differentiate their post-concussive subgroup(s). Evaluation will consist of recommended elements of a standardized clinical physical examination outlined by Matuszaket al., inclusive of an exercise stress test via the Buffalo ConcussionTreadmill Test (BCTT). The BCTT has shown clinical utility in identifying those likely to suffer persistent symptoms and the test is an excellent guide for exercise prescription following a concussion
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