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Updated: Oct 19, 2026
Development and Implementation of a Multi-Disciplinary Technology Enhanced Care Pathway for Youth and Adults with Concussion
Published on: January 20, 2019
Interdisciplinary intervention (GAIN) vs. enhanced usual care for reducing severe post-concussion symptoms in adults
Line Amalie Hellemose1, Mille Møller Thastum1, Henriette Holm Stabel1
1Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Aarhus, Denmark.
Background:
Up to 30% of adults presenting to emergency departments develop persisting post-concussion symptoms (PPCS). Get going After concussIoN (GAIN), has previously shown promising effects in reducing PPCS in adolescents and young adults.
Methods:
This stepped wedge cluster randomised trial tested the effect of GAIN in reducing high levels of PPCS (i.e. a score ≥20 on the Rivermead Post-concussion Symptoms Questionnaire (RPQ)) 2-4 months post-injury in adults (18-60 years). GAIN was delivered in five clusters of municipalities in the Central Denmark Region sequentially allocated to implement the intervention, with one cluster transitioning to deliver GAIN every 3 months over six recruitment periods in the order of a computer-generated randomisation schedule. Participants were allocated to enhanced usual care (EUC) or GAIN + EUC depending on time and their place of residence. Masking of participants and therapists was not feasible. Primary outcome was change in RPQ total score from baseline to 3-month follow-up. Analyses were based on intention to treat using linear-mixed models. The trial is registered with ClinicalTrials.gov, NCT04798885.
Findings:
Between May 1, 2021 and November 1, 2022, 310 participants were included. The average difference in change in RPQ score between GAIN + EUC (n = 170) and EUC (n = 140) from baseline to 3-month follow-up was -2.4 points (95% CI -5.4 to 0.4, p = 0.09) in the adjusted model. GAIN reduced maladaptive, symptom-related perceptions and behaviours and patient satisfaction was high. GAIN + EUC was not associated with a greater improvement in psychological distress or physical and mental health than EUC. No serious adverse events were reported.
Interpretation:
This study could not confirm the hypothesis that GAIN added to EUC led to a larger long-term reduction in PPCS than EUC alone in adults. However, GAIN may improve long-term prognosis by reducing maladaptive, symptom-related perceptions and behaviours.
Funding:
The foundation Sygeforsikringen "danmark" and Central Denmark Region.