Multimodal symptom-targeted treatment for young people with persisting post-concussion symptoms: a randomised clinical trial

Clinical Snapshot

Key Findings

• P Value: Not reported for primary outcome; p<0.0001 for secondary outcome

• Effect Size: Adjusted risk difference 25.5%

• Primary Outcome: Full recovery rate: CE 62.5% vs UC 37.0%

• Nnt Or Sensitivity: Number needed to treat = 4 (based on 25.5% absolute risk difference)

• Confidence Interval: 95% CI -10.0% to 41.0%

Clinical Application

Requires multidisciplinary team including psychology, physiotherapy, and medical staff. 8-week treatment duration is reasonable for most healthcare settings. Highly relevant to Australian practice. Study conducted at Australian tertiary paediatric hospital. Aligns with current TGA guidelines for concussion management and could inform future PBS considerations for multidisciplinary care. Children and adolescents aged 8-18 years with persisting post-concussion symptoms at 3 weeks post-injury presenting to emergency departments or specialist clinics

Abstract

OBJECTIVE: To evaluate the effectiveness of Concussion Essentials (CE), a symptom-targeted, multidisciplinary treatment for persisting post-concussion symptoms (PPCS). METHODS: This single-site, open-label, assessor-blinded, parallel-group randomised clinical trial recruited 8-18-year-olds within 17 days of concussion from the emergency department of a tertiary paediatric hospital and from community referrals. Participants who endorsed ongoing PPCS on review at 14 (±3) days post-injury were invited to a baseline assessment at 3 weeks post-injury, where symptoms were re-assessed. Symptomatic participants were randomised to CE or usual care (UC). CE participants received individualised, multidisciplinary treatment modules (education, psychological, physiotherapy) for up to 8 weeks, while UC participants received weekly monitoring. Primary outcome was full recovery at intervention completion, defined as <1 symptom of increased severity compared with pre-injury on the Post-Concussion Symptom Inventory, parent version (PCSI-P). RESULTS: Participants were recruited between August 2019 and July 2024. Outcomes were analysed for 158 participants (CE=78; UC=80, mean age 13±2.5 years, 57.6% male). Pre-treatment PCSI-P total mean scores were: CE 36.7 (95% CI 31.0 to 42.4) and UC 33.5 (95% CI 28.4 to 38.7). Proportions with full resolution were CE 62.5% and UC 37.0% (adjusted risk difference=25.5%, 95% CI -10.0 to 41.0%). Post-treatment mean scores were CE 8.5 (5.9-11.2), UC 21.8 (95% CI 15.6 to 27.9) (p<0.0001). Seven adverse events, unrelated to trial factors, were recorded. CONCLUSION: Individualised, multidisciplinary treatment is associated with accelerated recovery in young people with PPCS. Implementation of such approaches should be considered in routine clinical care of concussion. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (number: ACTRN12617000418370).

References

1. 1.Anderson, V., Davies, K., Rausa, V. C., Anderson, N., Barlow, K. M., Bray, K., Charles, B., Davis, G. A., Dunne, K., Fabiano, F., Hearps, S., Ignjatovic, V., McKinlay, A., Orsini, F., Parkin, G., Shapiro, J., Takagi, M., & Babl, F. E. (2026). Multimodal symptom-targeted treatment for young people with persisting post-concussion symptoms: a randomised clinical trial. British Journal of Sports Medicine. https://doi.org/10.1136/bjsports-2025-110880