Feasibility Randomized Controlled Trial of the Toolkit for Optimal Recovery After Concussion: A Live Video Program to Prevent Persistent Concussion Symptoms in Young Adults With Anxiety.
Jonathan Greenberg, Nadine S Levey, Molly Becker and 6 others
PMID 39505248WHAT IT FOUND
Both live video programs were feasible for young adults after concussion with anxiety.
Scores improved in both groups, but the trial did not compare them, so it cannot show either program prevented persistent symptoms.
Key findings
01The study’s primary outcomes were feasibility benchmarks, and both the TOR-C mind-body program and the HE-C education program met all set benchmarks.
02Participants in both groups showed significant within-group improvements in post-concussion symptoms, physical function, anxiety, depression and pain, but the trial did not make between-group comparisons.
03Among TOR-C participants, improvements in pain catastrophizing and fear avoidance were significantly associated with improvements in symptoms, function, anxiety and pain.
STILL TO COME
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What it does not show
The trial was a feasibility pilot with 50 randomized participants and was not powered to test whether either program prevents persistent concussion symptoms. No between-group comparisons were made, so improvement in either group cannot be separated from natural recovery, attention, or expectation. Participants were 3 to 10 weeks after concussion and had at least mild anxiety, so results may not apply to people with persistent symptoms or no anxiety. Only about 11% of screened people were excluded for not meeting the anxiety criterion, but the sample was 84% non-Hispanic White, so generalizability is limited. Follow-up beyond post-intervention was not collected, so prevention of persistent symptoms was not assessed. Self-report measures did not include embedded symptom validity indicators, and non-concussion injuries such as musculoskeletal injuries or fractures were not collected.
Declared interests
No conflicts-of-interest declaration is included in the supplied text. The supplied publication types list Research Support, Non-U.S. Gov't, and Research Support, N.I.H., Extramural.
The easy way to misread this
Do not read the significant within-group improvements as evidence that TOR-C prevents persistent concussion symptoms. The primary outcome was feasibility, the trial was not powered for efficacy, and no between-group comparison was made, so natural recovery and non-specific effects may explain the changes.