To examine the effectiveness of a six-session multidisciplinary intervention of coordinated cognitive behavioral therapy (CBT) and programmed aerobic exercise for patients suffering from persistent post-concussion symptoms (PPCS) as measured via a battery of validated patient-reported assessments. 

Between 10-30% of patients who suffer a concussion continue to experience elevated symptoms for a period lasting three months or longer post-injury. PPCS presentations are heterogeneous with respect to symptom domain, and while there are currently no clear evidence-based guidelines for treatment, emerging evidence suggests that multidisciplinary care incorporating medical management of symptoms, CBT, and aerobic exercise may be more effective than medical management alone.

Patients in this case series (n= 7, female= 6, age= 26.9±13.0) were referred to therapy from a concussion outpatient clinic. Patients completed a course of CBT and programmed aerobic exercise comprising six in-person sessions and prescribed CBT and aerobic exercise homework to be completed between sessions. Adherence was tracked and outcomes were measured via change in self-reported scores on the Beck Anxiety Inventory (BAI), Beck Depression Inventory II (BDI-II), Brief Illness Perception Questionnaire (Brief-IPQ), Pain Catastrophizing Scale (PCS), Pediatric/Adult Quality of Life (PedsQL), Pittsburgh Sleep Quality Index (PSQI), and Post-Concussion Symptom Inventory (PCSI).

All patients completed a full course of therapy and prescribed homework. Significance was defined as p<0.05. Patients showed significant improvement in PSCI total score (p= 0.026; d= -1.115) and improvement trending toward significance in BDI-II (p= 0.075; d= -0.842), PCS (p= 0.087; d= -0.484), and PedsQL (p= 0.089, d= 0.593).

A relatively short multidisciplinary intervention may alleviate symptom burden and improve quality of life in PPCS patients and deserves more systematic study.