MOVING TO TELEHEALTH FROM THE CLINIC DURING COVID PANDEMIC – THE EFFECT OF IN-CLINIC VERSUS TELEREHABILITATION FOR PERSISTENT POST-CONCUSSION SYMPTOMS?

P. Langevin^1,2, P. Frémont¹, P. Fait³, M.-O. Dubé^1,2, J.-S. Roy^1,2

¹Université Laval, Rehabilitation, Quebec City, Canada, ²Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Québec, Canada, ³Université du Quebec à Trois-Rivières, Kinesiology, Trois-Rivières, Canada

Background: Mild traumatic brain injury (mTBI) is an acknowledged public health problem. Up to 30% of adults with mTBI present with persistent post-concussion symptoms. Headache, dizziness, nausea, and neck pain are the most reported post-concussion symptoms and are frequently associated with cervical spine and vestibular impairments. The most recent international consensus statement (2016 Berlin consensus) recommends the addition of an individualized rehabilitation approach for mTBI with persistent symptoms. The addition of an individualized rehabilitation approach including the evaluation and treatment of cervical and vestibular impairments leading to symptoms such as neck pain, headaches and dizziness is then recommended and has been proven effective. Recently, the COVID-19 pandemic has led tele-consultations to seek health care professionals in primary care. The benefit of such a telerehabilitation approach compared to in-clinic rehabilitation program should therefore be further investigated.

Purpose: The objective of this study was to compare the effects of an in-clinic cervicovestibular rehabilitation program combined with symptom-limited aerobic exercise (SLAE) program to the same program in a telerehabilitation format in adults with persistent post-concussion symptoms on the severity of symptoms and other indicators of clinical recovery.

Methods: In this parallel-group non-randomized clinical trial, 40 adults with persistent symptoms following mTBI were assigned to: 1) an in-clinic 6-week cervicovestibular rehabilitation program combined with SLAE program (n=30) OR 2) the same program performed in a tele-rehabilitation format (n=11). All participants took part in 4 evaluation sessions (baseline, week 6, 12 and 26) performed by a blinded evaluator. The primary outcome was the Post-Concussion Symptoms Scale (PCSS). The secondary outcomes were Numerical Pain Rating Scale (NPRS), Neck Disability Index (NDI), Headache Disability Inventory (HDI), Dizziness Handicap Inventory (DHI), and time to return to function. Nonparametric analysis for longitudinal data was used to evaluate the effect of interventions on outcomes.

Results: For the PCSS total score there was group-by-time interaction (p=0.045) with between-group differences at weeks 6 and 26 (p<0.04); clinically significant time effects were observed for both groups (p<0.05). There were group-by-time interactions for NPRS neck pain and headaches. Significant between group differences in favour of the in-clinic rehabilitation program were also found at several time-point follow-up for NPRS and NDI (p<0.05). There were no group-by-time interactions for HDI and DHI.

Conclusions: The study indicates that an in-clinic cervicovestibular rehabilitation combined with SLAE program was superior to the same telerehabilitation program in terms of symptoms improvement and neck-related disability. However, other outcome measures were equally improved after either the in-clinic or the telerehabilitation program. These results must be interpreted with caution given the limited number of participants in the telerehabilitation group and the non-randomized group allocation.

Implications: In-clinic rehabilitation program seems to be superior to telerehabilitation for post-concussion symptoms care. However, there is a need for a large randomized clinical trial to confirm these findings.

Funding acknowledgements: Funding was provided by REPAR ([email protected]) and OPPQ ([email protected]).

Keywords:
postconcussion symptoms
tele-rehabilitation

Topics:
Sport & sports injuries
Musculoskeletal: spine
Disability & rehabilitation

Did this work require ethics approval? Yes

Institution: Centre Intégré Universitaire Santé Services Sociaux - Capitale Nationale

Committee: Sectorial Rehabilitation and Social Integration Research Ethics Committee

Ethics number: 2018-619