BJSM - 2026-06-12 - Journal Article; Randomized Controlled Trial
Multimodal symptom-targeted treatment for young people with persisting post-concussion symptoms: a randomised clinical trial.
Anderson V, Davies K, Rausa VC, Anderson N, Barlow KM, Bray K, Charles B, Davis GA, Dunne K, Fabiano F, Hearps S, Ignjatovic V, McKinlay A, Orsini F, Parkin G, Shapiro J, Takagi M, Babl FE
Topics
Key Takeaway
Multimodal symptom-targeted treatment (Concussion Essentials) achieved full recovery in 62.5% of pediatric PPCS patients vs. 37.0% with usual care, an adjusted risk difference of 25.5% at 8 weeks.
Summary Depth
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Summary
This single-site, open-label RCT randomized 8-18-year-olds with persisting post-concussion symptoms at 3 weeks post-injury to individualized multidisciplinary treatment (education, psychological, physiotherapy modules) or usual care with weekly monitoring. Full recovery rate was 62.5% (CE) vs. 37.0% (UC), with post-treatment PCSI-P mean scores of 8.5 vs. 21.8 (p<0.0001). Adverse events were recorded in 7 participants and deemed unrelated to trial interventions.
Key Limitation
The wide confidence interval for the primary adjusted risk difference (-10.0 to 41.0%) means the true treatment effect magnitude remains uncertain, limiting precision of clinical decision-making.
Original Abstract
OBJECTIVE
To evaluate the effectiveness of Concussion Essentials (CE), a symptom-targeted, multidisciplinary treatment for persisting post-concussion symptoms (PPCS).
METHODS
This single-site, open-label, assessor-blinded, parallel-group randomised clinical trial recruited 8-18-year-olds within 17 days of concussion from the emergency department of a tertiary paediatric hospital and from community referrals. Participants who endorsed ongoing PPCS on review at 14 (±3) days post-injury were invited to a baseline assessment at 3 weeks post-injury, where symptoms were re-assessed. Symptomatic participants were randomised to CE or usual care (UC). CE participants received individualised, multidisciplinary treatment modules (education, psychological, physiotherapy) for up to 8 weeks, while UC participants received weekly monitoring. Primary outcome was full recovery at intervention completion, defined as < 1 symptom of increased severity compared with pre-injury on the Post-Concussion Symptom Inventory, parent version (PCSI-P).
RESULTS
Participants were recruited between August 2019 and July 2024. Outcomes were analysed for 158 participants (CE=78; UC=80, mean age 13±2.5 years, 57.6% male). Pre-treatment PCSI-P total mean scores were: CE 36.7 (95% CI 31.0 to 42.4) and UC 33.5 (95% CI 28.4 to 38.7). Proportions with full resolution were CE 62.5% and UC 37.0% (adjusted risk difference=25.5%, 95% CI -10.0 to 41.0%). Post-treatment mean scores were CE 8.5 (5.9-11.2), UC 21.8 (95% CI 15.6 to 27.9) (p<0.0001). Seven adverse events, unrelated to trial factors, were recorded.
CONCLUSION
Individualised, multidisciplinary treatment is associated with accelerated recovery in young people with PPCS. Implementation of such approaches should be considered in routine clinical care of concussion.
TRIAL REGISTRATION NUMBER
Australian New Zealand Clinical Trials Registry (number: ACTRN12617000418370).