Responsivity of Concussion Symptom Domains to a Mind-Body Intervention for Young Adults With a Recent Concussion and Anxiety: A Pilot RCT

Background: Given the heterogeneity of concussion symptoms and the variety of associated multidisciplinary treatment needs, classifying concussion symptoms into domains (eg, cognitive, physical, affective, and sleep/arousal) can allow a more comprehensive approach to management. However, little is known about whether and how concussion symptom domains respond to interventions. This study aimed to (1) characterize symptom domains represented in a sample of young adults with recent concussion and co-occurring anxiety, and (2) examine changes in concussion symptom domains after 2 interventions. Methods: We randomized 50 young adults (aged 18-35 years) with recent concussion (3-10 weeks prior) and anxiety (≥5 on the Generalized Anxiety Disorder-7 questionnaire) to a mind-body intervention (Toolkit for Optimal Recovery—Concussion [ TOR-C ]), and a comparison intervention (Health Enhancement after Concussion [ HE-C ]). Participants completed the Post Concussion Symptom Scale at 3 time points: baseline, post-intervention, and 3-month post-intervention follow-up. We used mixed-model Analysis of Variance (ANOVA)s to test changes in symptom domain scores across the 3 time points after each intervention. Results: At baseline, participants exhibited roughly similar ratio scores across domains (range = 0.20-0.25). All 4 domains improved for both groups across the 3 time points. Effect sizes for improvements following TOR-C were large for all domains from baseline to post-intervention (Cohen’s d = −0.88 to −1.05) and from baseline to follow-up ( d = −0.92 to −1.15). Effect sizes for the HE-C control were medium-sized for all domains from baseline to post-intervention ( d = −0.54 to−0.71) and baseline to follow-up for the physical ( d = −0.71) and sleep domains ( d = −0.70), and large for the cognitive ( d = −0.94) and affective domains ( d = −0.89). Conclusions: This study is the first to examine changes in concussion symptom domains following interventions. Symptom domains were largely equally prevalent and may be interconnected. TOR-C , a mind-body intervention which addresses anxiety, may help support concussion recovery across symptom domains.