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Completion of Multidisciplinary Treatment for Persistent Postconcussive Symptoms Is Associated With Reduced Symptom Burden

Janak, Jud C. PhD; Cooper, Douglas B. PhD; Bowles, Amy O. MD; Alamgir, Abul H. PhD; Cooper, Sharon P. PhD; Gabriel, Kelley P. PhD; Pérez, Adriana PhD; Orman, Jean A. ScD

Section Editor(s): Caplan, Bruce PhD, ABPP; Bogner, Jennifer PhD, ABPP; Brenner, Lisa PhD, ABPP

The Journal of Head Trauma Rehabilitation: January/February 2017 - Volume 32 - Issue 1 - p 1–15
doi: 10.1097/HTR.0000000000000202
Original Articles

Objective: To investigate the pre- to posttreatment changes in both posttraumatic stress disorder (PTSD) and persistent postconcussive symptoms (PPCSs).

Setting and Participants: We studied 257 active-duty patients with a history of mild traumatic brain injury (mTBI) who completed multidisciplinary outpatient treatment at Brooke Army Medical Center TBI Clinic from 2008 to 2013. This treatment program included cognitive rehabilitation; vestibular interventions; headache management; and integrated behavioral healthcare to address co-occurring psychiatric conditions such as PTSD, depression, and sleep disturbance.

Design: A 1-group; preexperimental, pre- to posttreatment study.

Main Measures: The Neurobehavioral Symptom Inventory (NSI) was used to assess PPCSs, and the PTSD Checklist–Military Version (PCL-M) was used to asses PTSD symptoms.

Results: Global PPCS resolution (mean NSI: 35.0 pre vs 23.8 post; P < .0001; d = 0.72) and PTSD symptom resolution (mean PCL-M: 43.2 pre vs 37.7 post; P < .0001; d = 0.34) were statistically significant. Compared with those with only mTBI, patients with mTBI and PTSD reported greater global PPCS impairment both pretreatment (mean NSI: 48.7 vs 27.9; P < .0001) and posttreatment (mean NSI: 36.2 vs 17.4; P < .0001). After adjusting for pretreatment NSI scores, patients with comorbid PTSD reported poorer PPCS resolution than those with mTBI alone (mean NSI: 27.9 pre vs 21.7 post; P = .0009).

Conclusion: We found a reduction in both self-reported PPCSs and PTSD symptoms; however, future studies are needed to identify specific components of care associated with symptom reduction.

Oak Ridge Institute for Science and Education, United States Army Institute of Surgical Research (Dr Janak), Defense and Veterans Brain Injury Center (Dr Cooper), Brooke Army Medical Center (Dr Bowles), and Statistics and Epidemiology, United States Army Institute of Surgical Research (Dr Orman), JBSA Fort Sam Houston, San Antonio, Texas; University of Texas School of Public Health-San Antonio, San Antonio, Texas (Drs Cooper and Alamgir); and University of Texas School of Public Health-Austin, Austin, Texas (Drs Gabriel and Perez).

Corresponding Author: Jud C. Janak, PhD, Oak Ridge Institute for Science and Education, United States Army Institute of Surgical Research, JBSA Fort Sam Houston, 3698 Chambers Pass, Bldg 3611, San Antonio, TX 78234 (

Support and funding for this study was provided by grant No. 5T42OH008421 from the National Institute of Occupational and Environmental Health/Centers for Disease Control and Prevention to the Southwest Center for Occupational and Environmental Health. In addition, this project was supported in part by an appointment to the Internship/Research Participation Program at the United States Army Institute of Surgical Research, administered by the Oak Ridge Institute for Science and Education through an interagency agreement between the US Department of Energy and the Environmental Protection Agency. The authors thank the staff at Brooke Army Medical Center Traumatic Brain Injury Clinic for their hard work and dedication. The authors also thank both the service members and their families for their service to the United States.

The views expressed herein are those of the authors and do not reflect the official policy or position of Brooke Army Medical Center, the US Army Medical Department, the US Army Office of the Surgeon General, the Department of the Army and Department of Defense, or the US Government.

The authors declare no conflicts of interest.

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