Telehealth Interdisciplinary Care Reduces Symptoms in Persistent Post-Concussion Syndrome

Expanding Access to Interdisciplinary Care for Persistent Post-Concussion Symptoms

Persistent post-concussion symptoms constitute a major public health challenge, as more than 50 million individuals sustain a traumatic brain injury annually [1]. Clinical consensus from the 6th International Conference on Concussion in Sport dictates that management must be symptom-based and interdisciplinary, integrating neurological, vestibular, and psychological interventions [2, 3]. Specialized interdisciplinary rehabilitation has proven effective in randomized trials (n=89), showing a significant reduction in symptoms on the Rivermead Postconcussion Symptoms Questionnaire (a standard 16-item scale used to rate the severity of cognitive and physical symptoms) with an effect size of 0.28 [4]. However, these resource-intensive programs are often geographically limited to metropolitan centers, prompting investigation into remote delivery models to improve patient access [5]. Recent feasibility data (n=73) suggest that interdisciplinary protocols delivered via videoconferencing can achieve high treatment fidelity (96.8%) and strong patient retention (89%), offering a viable strategy for clinicians to manage patients in rural or underserved areas [6].

Adapting Multi-Modal Rehabilitation for Remote Delivery

The researchers adapted an established in-person treatment protocol, Interdisciplinary Rehabilitation for Concussion Recovery (i-RECOVER), for remote delivery via videoconferencing, termed i-RECOVER-TH. To evaluate the feasibility and preliminary efficacy of this model, the study utilized a non-concurrent multiple-baseline A-B single-case experimental design (a rigorous methodology where participants serve as their own controls and start the intervention at staggered intervals to ensure that improvements are due to the treatment rather than the natural passage of time). The study sample consisted of 13 adults with a mean age of 43 years (SD 15.51), and 62% of the participants were female. This cohort was characterized by chronic morbidity, with a mean of 581 days post-injury (SD 629.19), indicating that many participants had been living with persistent symptoms for over a year and a half before enrollment. This long duration of symptoms is particularly relevant for clinicians, as it represents a population that has often failed to recover through spontaneous resolution or primary care alone. To establish a stable pre-treatment reference point, participants were randomized to 2-, 3-, or 4-week baseline periods before beginning the active phase of the study. The subsequent 12-week interdisciplinary intervention integrated three core clinical components: neuropsychology, physiotherapy, and medical care. This multi-modal structure allowed for the simultaneous management of cognitive, physical, and physiological symptoms through a coordinated remote platform. By transitioning the i-RECOVER model to a telehealth format, the researchers sought to determine if the complex coordination required for interdisciplinary concussion care could be maintained without face-to-face interaction, potentially offering a solution for patients who lack access to specialized metropolitan clinics.

Feasibility and Statistical Rigor in Telehealth Assessment

Determining whether the remote delivery of complex rehabilitation is viable for clinical practice required a rigorous framework of primary feasibility outcomes. These metrics included recruitment and retention rates, which measure the ability to enroll and keep patients in the program, as well as treatment adherence and fidelity to ensure the interdisciplinary protocol was delivered as intended. The study also monitored participant acceptance of the telehealth intervention to gauge patient satisfaction and usability, which are critical factors in ensuring long-term compliance in a remote setting. Safety was a critical component of this assessment, tracked through the systematic recording of adverse events throughout the 12-week intervention period. The researchers utilized a multi-faceted analytical strategy to evaluate the data collected from the 13 participants, including descriptive analysis to summarize cohort characteristics and systematic visual analysis (a method of inspecting data graphs to identify trends and shifts in symptom patterns over time). A key component of the statistical evaluation was the Tau-U non-overlap method, which is a specialized statistical technique for analyzing single-case experimental data by calculating the non-overlap between baseline and intervention phases while controlling for existing trends. This method allowed the authors to quantify individual improvements with greater precision than traditional group-level averages, providing a more granular view of how each patient responded to the remote care model. The study findings confirmed that the remote delivery model is a viable alternative to traditional in-person care, as i-RECOVER-TH met all a priori criteria for feasibility. By meeting these pre-established benchmarks for recruitment, adherence, and safety, the study demonstrates that the complex coordination of neuropsychology, physiotherapy, and medical care can be successfully managed via telehealth. For the practicing clinician, these results suggest that geographical barriers to interdisciplinary concussion care can be overcome without compromising the structural integrity or safety of the treatment protocol.

Clinical Efficacy and Functional Goal Attainment

Persistent post-concussion symptoms (pPCS) represent a significant clinical burden, affecting one-third of individuals following a mild traumatic brain injury (mTBI). To address this, the researchers evaluated the efficacy of the 12-week telehealth intervention by tracking several secondary outcomes, including pPCS severity, functional improvement, mood, fatigue, sleep, and physical functioning. Statistical analysis of the cohort revealed that seven out of 13 participants (54%) experienced statistically meaningful reductions in pPCS from the baseline period to the post-intervention assessment. These findings suggest that a structured, remote interdisciplinary approach can effectively target the core symptomatic distress associated with chronic concussion recovery. Beyond symptom mitigation, the study emphasized the importance of patient-centered recovery through the achievement of personalized functional goals. The researchers found that 10 out of 13 participants (77%) successfully achieved at least one personalized functional goal during the treatment period. Notably, improvements in functional goals and secondary outcomes occurred even in participants who reported residual pPCS, suggesting that clinical recovery is not strictly dependent on the total resolution of symptoms. For the practicing clinician, this indicates that functional rehabilitation can be successful and meaningful for the patient even when some level of symptomatic baseline persists, reinforcing the value of evaluating functional improvement alongside traditional symptom scales. This distinction is vital in chronic cases where complete symptom eradication may be less realistic than the restoration of daily function.

Implications for Rural and Underserved Populations

The geographic distribution of specialized medical services remains a significant barrier to recovery for many patients, as interdisciplinary treatment for persistent post-concussion symptoms is difficult to access in non-metropolitan areas of Australia. By utilizing a remote delivery model, this study represents the first global evaluation of interdisciplinary concussion treatment via telehealth, offering a potential solution to bridge the gap in care equity. For clinicians managing patients in rural or remote settings, these findings suggest that the i-RECOVER-TH protocol can effectively deliver multi-modal rehabilitation that was previously restricted to major metropolitan centers. The results support the potential efficacy of i-RECOVER-TH in improving patient-centered outcomes for individuals experiencing persistent symptoms following a mild traumatic brain injury. Based on these preliminary outcomes, the authors conclude that the data justify progression to a phase-II randomized controlled trial to provide a more rigorous validation of the intervention. Future research will focus on evaluating treatment efficacy more thoroughly and aims to identify specific sources of variability in treatment response, which will help clinicians better predict which patients are most likely to benefit from remote interdisciplinary rehabilitation and how to tailor these interventions to individual patient needs.

References

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2. Patricios J, Schneider K, Dvořák J, et al. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport–Amsterdam, October 2022. British Journal of Sports Medicine. 2023. doi:10.1136/bjsports-2023-106898

3. Feddermann‐Demont N, Echemendía RJ, Schneider K, et al. What domains of clinical function should be assessed after sport-related concussion? A systematic review. British Journal of Sports Medicine. 2017. doi:10.1136/bjsports-2016-097403

4. Rytter HM, Westenbaek K, Henriksen H, Christiansen P, Humle F. Specialized interdisciplinary rehabilitation reduces persistent post-concussive symptoms: a randomized clinical trial.. Brain injury. 2019. doi:10.1080/02699052.2018.1552022

5. Jennings T, Islam MS. Examining the interdisciplinary approach for treatment of persistent post-concussion symptoms in adults: a systematic review. Brain Impairment. 2022. doi:10.1017/BrImp.2022.28

6. Silverberg ND, Cairncross M, Brasher PMA, et al. Feasibility of Concussion Rehabilitation Approaches Tailored to Psychological Coping Styles: A Randomized Controlled Trial.. Archives of physical medicine and rehabilitation. 2022. doi:10.1016/j.apmr.2021.12.005