Psychologically Informed Rehabilitation for Concussion
(PIC Rehab Trial)
What You Need to Know Before You Apply
What is the purpose of this trial?
Mild traumatic brain injuries ("mTBIs") affect over 480,000 Canadians each year. While many individuals recover in the initial 4 weeks following mTBI, in up to 30% of individuals symptoms and functional impairments often persist leading to significant disability, decreased quality of life and participation in education, physical and occupational related activities. An assessment that evaluates multiple systems is recommended for individuals with mTBI, often involving multiple health care professionals to assess different areas of function (e.g. oculomotor, vestibular, balance, mood, cognition, etc). Current evidence supports the use of cervicovestibular rehabilitation (CVPT) (which includes physiotherapy techniques aimed at treating the neck, balance, visual and other sensory systems) and symptom-tolerated exercise. Evidence suggests that collaborative care, cognitive behavioural therapy (CBT) may be of benefit. However, the added value of CVPT and CBT in combination co-designed by patients and community partners has not yet been evaluated in mTBI. In other pain and dizziness conditions, the addition of CBT to physical/vestibular rehabilitation yielded improved outcomes. Here we take a transdisciplinary team-based approach to evaluate an integrated combination of CVPT and CBT.
This study will recruit a total of 34 people ages 18-70 years old who have ongoing symptoms following an mTBI for more than two weeks. The first 17 patients will receive CVPT along and the second 17 patients will receive psychologically informed CVPT ("PIC" Rehab). This study will help determine if combined therapy has an additive effect on helping patients recovery from mTBI.
Who Is on the Research Team?
Kathryn Schneider, PT PhD
Principal Investigator
University of Calgary
Are You a Good Fit for This Trial?
This trial is for individuals aged 18-70 in Canada who have had symptoms like dizziness, neck pain, or headaches for over two weeks after a mild traumatic brain injury or concussion. They should need cervicovestibular physiotherapy and have related impairments.Inclusion Criteria
Timeline for a Trial Participant
Screening
Participants are screened for eligibility to participate in the trial
Treatment
Participants receive either CVPT or PIC Rehab once weekly for 8 weeks
Follow-up
Participants are monitored for safety and effectiveness after treatment
What Are the Treatments Tested in This Trial?
Interventions
- Psychologically Informed Cervicovestibular Rehabilitation (PIC Rehab)
Trial Overview
The study compares traditional Cervicovestibular Rehabilitation (CVPT) with Psychologically Informed CVPT (PIC Rehab), which combines CVPT with cognitive behavioural therapy techniques. It aims to see if the combined approach better aids recovery from mTBI.
How Is the Trial Designed?
2
Treatment groups
Experimental Treatment
Active Control
Cognitive behavioural therapy (CBT) is a form of treatment that uses multiple non-pharmacological strategies including education, behavioural and cognitive strategies to assist with decreasing symptoms. The experimental PIC Rehab arm will include principles of CBT in combination with the CVPT.
CVPT includes treatments targeting neuromuscular and sensorimotor control in combination with manual therapy and soft tissue techniques as indicated.5 16 Specific rehabilitation exercises are gradually progressed, performed in combination with symptom-tolerated aerobic exercise, and eventually evolve to task, context, and/or sport specific exercises.16 From a mechanistic standpoint, the goal of this treatment is to facilitate sensorimotor integration (i.e. integration of visual, vestibular, proprioceptive input and resultant motor output) and either reweigh central balancing of stimuli to optimize function of these systems or upregulate the use of alternate systems in the event that one of the sensory systems is not optimally operating.5 17 Recent international consensus recommendations and clinical practice guidelines recommend CVPT as a treatment that has some of the strongest evidence to date to facilitate recovery.14 18
Find a Clinic Near You
Who Is Running the Clinical Trial?
Sport Injury Prevention Research Centre
Lead Sponsor
University of Calgary
Collaborator
Brain Canada
Collaborator
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