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Two Treatments for MTBI

This new study1 is a follow up to a study by Paniak et al2. The original study compared the effectiveness of two treatment methods for mild traumatic brain injury (MTBI). One treatment type was single-session (SS) therapy, aimed at educating the patient about common complaints after MTBI, offering advice on how to cope with common problems, offering the patient recognition that their experience was "real," and reassuring the patient that a good outcome was possible. The other method was treatment-as-necessary (TAN) therapy, which included the same elements as the SS therapy with the addition of consultation with a physical therapist, neuropsychological and personality assessment and feedback, and further treatment as needed for MTBI.

To measure the effectiveness of the two treatment types three outcome questionnaires were utilized. The questionnaires were the Problem Checklist (PCL), The Community Integration Questionnaire (CIQ), and the Short Form-36 Health Survey (SF-36 Canadian acute version). (For more on these questionnaires, please see Soft Tissue Review Volume IV, Number 8.)The authors found at a three-month follow-up that the SS method of therapy was just as effective as the TAN method when applied within three weeks of injury.

This follow-up study was undertaken to test the author's hypotheses that gains shown at three months after injury would be maintained at twelve months post-injury, and that the differences in outcome measures between the two treatment groups would continue to be negligible at twelve months. The authors also hoped to find out if patients would continue to improve between three and twelve months post-injury, or if the improvement levels would remain the same as they had been at three months.

Follow up research confirmed that the SS method of treatment was as effective as the more intense and costly TAN method, not only at three months post-injury but also at twelve months. The finding that there is apparently no decline in function between three and twelve months supports the notion presented in the first study that brief educational intervention, as in the SS therapy, is effective for most MTBI patients if it is used soon after injury occurs. Just as there was no apparent decline in function, the follow up found that there was also no significant improvement in symptoms between three and twelve months.

The authors state:

"Finally, other conclusions drawn in the first paper are reinforced by the present findings, and by other findings recently reported for the present sample. Specifically, future research into treatments applied soon after MTBI can probably focus more on refining early, brief treatments than researching potentially more extensive and expensive rehabilitation models for all MTBI survivors. Findings reported elsewhere indicate that non-brain injuries accompanying MTBI were generally more problematic than are MTBI symptoms for most of the patients. This suggests that injuries that commonly co-occur with MTBI (e.g., musculoskeletal injuries or whiplash-associated disorders) often present a more pressing demand for treatment than do MTBI sequelae. These findings reinforce the need not to readily attribute all complaints after MTBI to the MTBI, but to evaluate carefully other causes for patient complaints. This is especially important because mis-attributing persisting complaints to MTBI may increase the risk of iatrogenic disability. It may also deflect attention away form underlying causes of lingering patient complaints (e.g. pain or psychological problems), and lead to long-term inappropriate treatment for MTBI, instead of treating more likely causes for persisting symptom complaints."

  1. Paniak C, Toller-Lobe G, Reynolds S, Melnyk A, Nagy J. A randomized trial of two treatments for mild traumatic brain injury: 1 year follow-up. Brain Injury 2000;14(3):219-226.
  2. Paniak C, Toller-Lobe G, Durand A, et al.: A randomized trial of two treatments for mild traumatic brain injury. Brain Injury 1998;12:1011-1023.