Early intervention for mild traumatic brain injury patients: is it effective and feasible?


Flinders University researchers have helped establish an Early Management of Mild Traumatic Brain Injury Service (EMMBIRS), supporting individuals who sustain a mild traumatic brain injury (mTBI) from a transport accident, to investigate whether early intervention is feasible and improves long term outcomes.

Historically, clients with concussion or mild or moderate TBI (mTBI) have been expected to recover fully within several weeks to months without specific therapy. Furthermore, nearly half are discharged directly home from the emergency department, with only a small proportion of clients receiving follow-up services.

Chief Investigator and Flinders Caring Futures Institute member, Associate Professor Maayken van den Berg says up to 20 per cent of mTBI clients experience physical, psychological and cognitive symptoms for months or even years after their brain injury.

“The lack of effective and efficient specialised treatment or rehabilitation services in the acute stages of recovery may result in unfavourable outcomes and can cause functional limitations and reduce productivity when working or studying.”

Associate Professor Maayken van den Berg

A project team involving researchers and expert clinicians from South Australia Brain Injury Rehabilitation Services and Flinders University investigated whether active and early management, focusing on client-centred care and an understanding of how the client’s life has changed post TBI, would be feasible and lead to improved outcomes. Dr Maggie Killington, a former Flinders University staff member, was the lead on this project.

With the backing of Lifetime Support Authority, an Early Management of Mild Traumatic Brain Injury Service (EMMBIRS) was established at Hampstead Rehabilitation Centre, and later moved to the Repatriation General Hospital, to support individuals who sustained a mTBI, providing interdisciplinary rehabilitation for up to six months.

“Team-based rehabilitation included input from occupational therapy, social work, physiotherapy, clinical psychology, speech pathology and rehabilitation medicine and referral pathways were developed as part of the service,” A/Prof van den Berg explains. “Individuals who sustained a mTBI in any transport accident, on or off-road, were referred to the new clinic.”

The study investigated the number of people who sustained a mild, complex mild or moderate TBI in South Australia following a transport accident, and the team evaluated the feasibility and efficacy of providing early rehabilitation to this patient group, while also exploring the use of new and innovative technologies to support clients and caregivers during their rehabilitation program and beyond.

A total of 357 people utilised the EMMBIRS service, of which the majority aged between  21 and 50 and male.  The research team measured outcomes related to mTBI related disability, fatigue, depression, anxiety and stress, as well as other symptoms and impact of disease on the partner or family member.

From conducting qualitative interviews with 41 clients, the research team were able to demonstrate that people who suffer mTBI experience a confusing and anxious journey prior to referral to clinicians who understand and can validate their symptoms and support their recovery.

“The study has shown that early rehabilitation can support clients to reduce the effects of somatic, cognitive, physical and communication disorders and return to normal life,” A/Prof van den Berg says. “Early improvements were shown to be sustained in the longer term as clients’ symptoms resolved or they learnt to use strategies to support them achieve their goals.”

Findings from the health economic analysis suggested that providing early intervention to individuals who have sustained a mild TBI was associated with higher health related quality of life and that the effectiveness of the intervention was sustained for up to 18 months post-intervention. However, these gains were also associated with higher costs.

The inter-disciplinary EMMBIRS team identified the need for technology solutions to assist in the delivery of rehabilitation. Using a co-design approach, a team of clinicians, clients, developers, and researchers co-created a number of tools, including an app facilitating remote vestibular assessment and intervention, an app to support self-management, and a virtual environment to safely retrain impairments.  In addition, two informative videos have been produced about mild TBI for clients, families and community clinicians to access.

“I believe this study has shown how much can be achieved when making consumers and clinicians key partners in clinical research and it has been truly inspiring to be part of this,” A/Prof van den Berg says.

“Working collaboratively in the real-life health care setting, drawing on clinical expertise and lived experiences, fosters the conduct of clinically relevant and meaningful research. This has resulted in the development of innovative and targeted services and supporting tools that met the identified needs.”

Upon completion of the study the EMMBIRS service was translated into a condensed but ongoing program, renamed as the CAMBI (Concussion and Mild Brain Injury) clinic.

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