Effects of cognitive-vocational rehabilitation on post-concussion symptoms and emotional distress: a secondary RCT...

To examine the long-term effects of a combined Compensatory Cognitive Training and Supported Employment (CCT-SE) intervention on post-concussion symptoms (PCS) and emotional distress in individuals with mild-to-moderate traumatic brain injury (TBI) on sick leave 8-12 weeks post-injury.

In this secondary analysis of a randomized controlled trial at Oslo University Hospital, 116 working-age adults were randomized to CCT-SE or treatment as usual (TAU). CCT-SE consisted of a 10-week cognitive rehabilitation program and up to 6 months of individualized vocational support. Outcomes included PCS (Rivermead Post-Concussion Symptoms Questionnaire, RPQ), depression (PHQ-9), and anxiety (GAD-7), assessed at 3, 6, and 12 months. Linear mixed-effects models evaluated group differences over time.

At baseline, participants reported a moderate-to-severe PCS burden (mean RPQ 28, SD 11); 38% had moderate-to-severe depressive symptoms and 17% moderate-to-severe anxiety. The CCT-SE group showed significantly greater improvement in RPQ cognitive scores at 12 months versus TAU. No between-group differences were found for PHQ-9, GAD-7, or RPQ somatic and emotional subscales, though both groups demonstrated significant within-group improvement across all outcomes.

Early cognitive and vocational rehabilitation may benefit individuals with persistent cognitive symptoms after mild-to-moderate TBI. Given the prevalence of emotional distress, integrating psychological interventions may strengthen CCT-SE.