Targeted Concussion Care Improves Quality of Life Over Longer Term

As the fall sports season approaches, athletes and their families may be concerned about the potential risk of head injuries. Now, they can take comfort in the findings of a clinical study done on the long-term outcomes of concussion patients. After receiving targeted treatment for concussion in which an individualized “profile” is created for patients, more than 83% of them reported still being fully recovered from their concussions, ranging from 1-6 years after the injury.  

 Creating an individualized clinical profile of a patient’s concussion is a relatively new practice and has gained much wider acceptance over the last decade. But to date, no one has followed up with patients who have received what’s known as “clinical-profiles informed care” for their concussion.  

 The study, published in the Journal of Head Trauma Rehabilitation, was an important step in exploring long-term outcomes following this new approach.  

 Melissa Womble, a clinical neuropsychologist and director of the Inova Sports Medicine Concussion Program in Fairfax, Virginia, was first author on the paper. Womble was assisted by researchers from the University of Arkansas: corresponding author R.J. Elbin, a professor in the Department of Health, Human Performance and Recreation, and second author, Kori Durfee, a Ph.D. candidate in the same department. 

Melissa Womble, neuropsychologist and director of the Inova Sports Medicine Concussion Program

 Elbin noted that while there will continue to be concussion concerns for people who may have prolonged exposure to concussion and/or repetitive head impacts, this study is encouraging news for people who sustain a concussion without this history and who may be fearful it will have long-term consequences for their health.  

 “Rightfully so, there is a lot of attention on the long-term health outcomes following concussion – especially on individuals with a long history of these injuries and exposures to repetitive head impacts,“ Elbin explained. “However, the clinical approaches, therapies and treatments that are being used for concussion care today weren’t around 20 years ago. So we really don’t know how the long-term health of patients that receive these new care models is going to be after they recover, and using individuals with a lengthy history of this injury that received older models of care, if any at all, as a benchmark for future long-term health expectation is probably not the most accurate comparison.” 

The Study 

 Health-related quality of life (or HRQoL) is how a person thinks about their health condition, functioning and well-being in the areas of physical, psychological, social and daily life. Several studies have documented lower HRQoL scores in people who have sustained a concussion, supporting the notion that a concussion may result in poor long-term health outcomes. However, much of what is known about the long-term effects of concussions comes from patients who either received no care or older models of clinical carel, which was limited in terms of what is now known about diagnosing, managing and treating this injury.  

Many clinicians and researchers on concussion now agree the best way to manage and treat this injury is by identifying a “concussion clinical profile.” This is done through in-depth evaluation of a patient’s health history, concussion details and symptoms, as well as administration of a variety of cognitive, mood, vision and vestibular (relating to a patient’s sense of dizziness/balance) assessments. Doctors look for patterns and trends in the results and determine a profile that is matched to a treatment.  

For example, a patient with dizziness, difficulty tolerating busy environments and positive findings on vestibular screening may be assigned a Vestibular Profile and referred to a concussion-trained vestibular physical therapist for specialty treatment. This clinical profiles-informed care model is a more “active” treatment approach than previous clinical models that relied on cognitive and physical “rest” – which can actually make people worse after this injury. 

But since the profile approach is relatively new, there has been little scientific study of how patients are doing years after they were cleared from their concussion. 

Womble and Elbin addressed this question by measuring HRQoL scores in 125 former concussion patients who received clinical profiles-informed care at the Inova Sports Medicine Concussion Program for their injury 1-6 years after they were medically cleared. In addition, they asked former patients if they considered themselves “still recovered” from their injury.  

Eighty-three percent of former patients reported still being recovered from their concussion. Similarly, 85% of former patients’ HRQoL scores were within normal limits of the U.S. population. 

Interestingly, patients who had “non-normal” HRQoL scores or considered themselves not recovered from their injury were more likely to have experienced a significant negative life event (such as loss of job or a loved one) or had a history of anxiety and/or depression. No information about their previous concussion (e.g., greater severity, longer recovery) identified these individuals from those with “normal” HRQoL scores – suggesting that the previous concussion was not associated with their current “non-normal” HRQoL scores.  

Broader Outlook

 The findings reinforce what Womble routinely sees in her clinic. “Patients present to clinic both acutely and years after their concussion with significant fear and worry about potential long-term effects,” she said. “With targeted, individualized care, I see patients make a full recovery. Proper care is critical, and I hope the results from this study minimizes the oftentimes associated anxiety and/or depression symptoms that can occur with concussion. Future research needs to consider and compare the types of concussion care that patients receive when examining long-term health outcomes following this injury.” 

She emphasizes two things: the importance of timely care and finding a comprehensive team for concussion care.  

“I see patients every week who have been sitting in dark rooms or have delayed reporting their injury due to fear of getting pulled out of sports. I also see cases that have been missed by other medical professionals.” 

Womble noted that implementing a clinical-profiles-informed care approach requires a well-trained medical team. Her team consists of neuropsychologists, neuropsychology post-doctoral fellows, specialty physical therapists, primary caresports medicine physicians, athletic training staff and other medical professionals as needed on a consultation basis.  

While acknowledging that not everyone may have access to a comprehensive concussion care team, Womble noted that ideally you would look for a team that “is talking about active-based recovery strategy versus a rest-based strategy. Also, look for a team using a comprehensive battery of tools, not just asking about symptoms, and the team has to be talking about getting the individual or patient back to everyday life activities.” 

Elbin added, “No two concussions are the same and everyone has their own individualized presentation and they experience their own individualized recovery. There is no longer a wait and see approach to managing this injury.” 

Additional authors included Sabrina Jennings, Christina M. Dollar, Sheri Fedor and Philip Schatz.