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

项目摘要/摘要 虽然运动相关脑震荡后的脑震荡症状通常是暂时的和可缓解的 在脑震荡损伤后两周内自发地，14%或更多的年轻人遭受脑震荡 经历严重的发病率，可能会持续很长时间，远远超过正常的病程。此外，邮寄- 脑震荡症状通常与包括抑郁和焦虑在内的情感症状并存 如果存在，可以延长从初级脑震荡后症状中恢复的时间。结合在一起，坚持不懈的身体和 心理症状会导致长期的功能障碍，并给患者带来沉重的负担 青年，他们的家庭，和学校。目前，还没有循证治疗指南。 青少年持续的脑震荡后症状。 针对缺乏循证治疗方法的青少年持续性后... 脑震荡症状，我们开发了一种新的协作护理治疗模式，同时针对 脑震荡后症状和同时出现的抑郁和焦虑。运动员及其家属 接受患者导航器护理管理服务，将伤后护理与急诊护理、专家 以及初级保健保健服务提供部门，以及认知行为心理治疗。病人 在最初的治疗努力后仍有症状的人接受加强护理，可能包括 精神药理学咨询。我们将对200名患者进行随机比较有效性试验 青少年，年龄11-18岁，在运动后至少1个月出现≥3脑震荡后症状 受伤。运动员将像往常一样随机接受协作性护理(干预)或运动损伤后护理 (对照组)条件。我们将确定阶梯式协作护理干预的有效性 减少持续性脑震荡后并发心理症状的模式 运动相关脑震荡后的脑震荡症状；检查干预的有效性 改善运动后持续症状的青少年的机能和与健康相关的生活质量- 相关脑震荡；并探索不同组之间在学校表现上的差异。

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.