Cognitive and psychological interventions for the reduction of post-concussion symptoms in patients with mild traumatic brain injury: a systematic review

Objective: To evaluate the effects of cognitive and psychological interventions for the reduction of post-concussion symptoms (PCS) in patients with mild traumatic brain injury (MTBI). Data sources: The databases of CINAHL, Medline, PubMed, PsycINFO, Web of Science, and Cochrane Database of Systematic Reviews. Review methods: Meta-analysis was conducted for randomized-controlled trials that have included an assessment of PCS using the Rivermead Post-concussion Symptoms Questionnaire as primary outcomes by calculating the mean difference/standardized mean difference using fixed/random effect models as appropriate. Results: Systematic review with the date of the last search in Mar 2018 yielded 16080 articles, 17 articles including 3081 participants were included in the final review. Interventions included psychoeducation (n = 8), telephone problem-solving treatment (n = 4), individual-based cognitive behavioral therapy (n = 4), and cognitive training (n = 1). No intervention is effective in reducing PCS at 3 to 6 months follow-up, however, an overall small effect size was found in pooled functional outcomes at 6 months. Conclusions: There was no effect on symptom reduction at 3 to 6 months for PCS interventions but improved functional outcomes were shown for patients with MTBI at 6 months. Long-lasting effects of interventions at 12 months or after were not studied.