Multidisciplinary Concussion Management: A Model for Outpatient Concussion Management in the Acute and Post-Acute Settings

Objective: To describe a model of multidisciplinary concussion management and explore management methods in the acute and post-acute settings. Setting: A multidisciplinary concussion management program within a large health system. Participants: Patients with sports and non-sports-related concussions aged 14 to 18 years with persisting concussion symptoms at 4 weeks postinjury or beyond. Design: Pilot randomized controlled trial comparing a subsymptom threshold exercise program with standard-of-care treatment in the post-acute setting. Main Measures: Beck Depression Inventory-II and the Post-Concussion Scale-Revised. Results: Across groups, 60% improvement in concussion symptoms was noted. After removing the influence of depression, the intervention showed a large effect on symptom reduction, with participants in the intervention group improving more than those in the control group. There was no difference in response to the intervention by the sports and nonsports groups. Conclusion: Results demonstrate that exercise intervention is effective in reducing symptoms in adolescents with persisting symptoms. The finding that participants in the control group who underwent education, light activity, and sophisticated monitoring still had meaningful recovery supports the utility of active engagement in a multidisciplinary management program. Finally, depression had a clinically meaningful effect on recovery, highlighting the need for targeted intervention of noninjury factors relevant to persisting symptoms.