Collaborative care model for the treatment of persistent symptoms after concussion among youth

治疗青少年脑震荡后持续症状的协作护理模式

• 批准号: 9218476
• 负责人: CAROLYN A MC CARTY
• 金额: $ 74.87万
• 依托单位: SEATTLE CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-02-03 至 2021-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9218476
• 关键词: Acute; Adolescence; Adolescent; Affect; Affective Symptoms; Age; Anxiety; Athletic Injuries; Attenuated; Behavioral; Brain Concussion; Caring; Childhood; Clinical; Clinical Trials; Cognitive; Communities; Consultations; Control Groups; Development; Disease; Effectiveness; Effectiveness of Interventions; Ensure; Evidence based treatment; Exhibits; Family; Family member; Foundations; Health Personnel; Injury; International; Intervention; Medical; Mental Depression; Modeling; Morbidity - disease rate; Participant; Patients; Pediatric Hospitals; Performance; Policies; Post-Concussion Syndrome; Primary Health Care; Psychotherapy; Public Health; Randomized; Randomized Controlled Trials; Recovery; Recruitment Activity; Research; Resources; Schools; Services; Specialist; Sports; Symptoms; Telephone; Testing; Translating; Validation; Work; Youth; anxiety symptoms; arm; behavioral health; collaborative care; common symptom; comparative effectiveness; critical period; depressive symptoms; design; disability; effectiveness trial; evidence base; evidence based guidelines; experience; functional disability; health care delivery; health related quality of life; improved; improved functioning; individualized medicine; innovation; medical specialties; multidisciplinary; novel; patient population; persistent symptom; personalized approach; physical symptom; pilot trial; psychological symptom; psychopharmacologic; response; scale up; service intervention; treatment as usual

PROJECT SUMMARY/ABSTRACT While post-concussive symptoms following sports-related concussion are typically transient and resolve spontaneously within two weeks of concussive injury, 14% or more of youth who sustain concussion experience significant morbidity that can persist well beyond the normal disease course. Furthermore, post- concussive symptoms commonly co-occur with affective symptoms including depression and anxiety which when present can prolong recovery from primary post-concussive symptoms. Together, persistent physical and psychological symptoms confer protracted functional impairment and create a significant burden for affected youth, their family, and school. Currently, there are no evidence-based guidelines to inform treatment of persistent post-concussive symptoms in youth and adolescents. In response to the dearth of evidence-based treatment approaches for youth with persistent post- concussive symptoms, we developed a novel collaborative care treatment model that simultaneously targets post-concussive symptoms and co-occurring depression and anxiety. Athletes and their family members receive patient navigator care management services that bridge post-injury care across acute care, specialist and primary care health service delivery sectors, in addition to cognitive behavioral psychotherapy. Patients who remain symptomatic after initial treatment efforts receive stepped-up care that may include psychopharmacologic consultation. We will conduct a randomized comparative effectiveness trial with 200 youth, ages 11-18, suffering from ≥ 3 post-concussive symptoms at least 1 month after their sports-related injury. Athletes will be randomized to collaborative care (intervention) or post-sports injury care as usual (control group) conditions. We will determine the effectiveness of a stepped-collaborative care intervention model in reducing post-concussive and co-occurring psychological symptoms in youth with persistent post- concussive symptoms after sports-related concussion; examine the effectiveness of the intervention in improving function and health-related quality of life amongst youth with persistent symptoms after sports- related concussion; and explore differences in school performance between groups.

项目总结/摘要 虽然运动相关脑震荡后的脑震荡后症状通常是短暂的， 在脑震荡损伤的两周内自发地，14%或更多的青年人遭受脑震荡 经历显著的发病率，可以持续远远超过正常的疾病过程。此外，后 脑震荡症状通常与包括抑郁和焦虑的情感症状同时发生， 当存在时，可以延长从主要的脑震荡后症状的恢复。在一起，持续的身体和 心理症状会导致长期的功能障碍，并对受影响的人造成重大负担。 青年、家庭和学校。目前，没有循证指南来指导治疗 青少年脑震荡后的持续症状。 为了应对缺乏循证治疗方法的青年持续后， 脑震荡症状，我们开发了一种新的合作护理治疗模式，同时针对 脑震荡后的症状以及同时出现的抑郁和焦虑运动员及其家属 接受患者导航护理管理服务，在急性护理、专科护理和创伤后护理之间架起桥梁， 和初级保健卫生服务提供部门，除了认知行为心理治疗。患者 在初步治疗后仍有症状的患者接受加强护理，可能包括 精神药理咨询我们将进行一项随机比较有效性试验， 11-18岁的青少年，在运动相关性脑震荡后至少1个月出现≥ 3次脑震荡后症状 损伤运动员将像往常一样随机接受协作护理（干预）或运动损伤后护理 （对照组）条件。我们将确定分步协作护理干预的有效性 模型在减少脑震荡后和并发心理症状的青年持续后， 运动相关脑震荡后的脑震荡症状;检查干预的有效性， 改善运动后症状持续存在的青少年的功能和健康相关生活质量- 相关的脑震荡;并探讨组之间的学校表现的差异。