Course 200: Brain injury: The Effect of Telephone Counseling in Reducing Symptoms After Mild Traumatic Brain Injury: A Randomized Trial

Abstract

Objective: To determine whether focused, scheduled telephone counseling during the first 3 months after mild traumatic brain injury (MTBI) decreases symptoms and improves functioning at 6 months. Design: 2-group, parallel, randomized clinical trial with outcome assessed by a blinded examiner at 6 months after injury. Setting: Emergency departments of Harborview Medical Center and University of Washington Medical Center. Participants: 366 of 389 eligible subjects age 16 or older with MTBI enrolled between February 2004 and February 2006 with an 85% follow-up completion rate. Interventions: 5 telephone calls, individualized for patient concerns and scripted to address education, reassurance, and reactivation. Main Outcome Measures: 2 composites, 1 relating to posttraumatic symptoms that developed or worsened after injury and their impact on functioning and the other related to general health status. Results: The group assigned to receive telephone counseling had a significantly better outcome for symptoms (6.6 difference in adjusted mean symptom score, 95% confidence interval [CI], 1.2–12.0), but there was no difference in general health outcome (1.5 difference in adjusted mean functional score, 95% CI, −2.2–5.2). A smaller proportion of the treatment group had each individual symptom in the 2 weeks prior to assessment. Similarly, a smaller proportion assigned to the treatment group had daily functioning negatively impacted by symptoms with the largest differences in impact on work, leisure activities, memory and concentration, and financial independence. Conclusions: Telephone counseling with a focus on symptom management was successful in reducing the development of chronic symptoms after MTBI.