Feasibility and preliminary efficacy of telehealth interdisciplinary rehabilitation for concussion recovery: a single-case experimental design

BACKGROUND: Persistent post-concussion symptoms (pPCS) affect one-third of individuals following mild traumatic brain injury (mTBI), yet interdisciplinary treatment is difficult to access in non-metropolitan areas of Australia. Telehealth-delivered interdisciplinary concussion care may improve equity of access; however, the feasibility and efficacy of this approach are unknown. OBJECTIVES: We adapted our previously piloted in-person treatment, Interdisciplinary Rehabilitation for Concussion Recovery (i-RECOVER), for telehealth delivery (i-RECOVER-TH) and aimed to evaluate its feasibility and preliminary efficacy. METHODS: Thirteen adults completed a non-concurrent multiple-baseline A-B single-case experimental design. The sample was 62% female, with a mean (SD) age of 43 (15.51) years and a mean (SD) post-injury days of 581 (629.19). Participants were randomized to 2-, 3-, or 4-week baselines before receiving a 12-week interdisciplinary neuropsychology, physiotherapy, and medical intervention. The primary outcome was feasibility, assessed through recruitment and retention rates, treatment adherence and fidelity, participant acceptance of the telehealth intervention, and adverse events. Secondary outcomes included changes in pPCS severity, functional improvement, mood, fatigue, sleep, and physical functioning. Data were analyzed descriptively, visually (systematic visual analysis), and statistically (Tau-U non-overlap method). RESULTS: i-RECOVER-TH was feasible based on a priori criteria. Over half of participants (7/13) showed statistically meaningful reductions in pPCS from baseline to post-intervention. Most (10/13) achieved at least 1 personalized functional goal. Despite residual pPCS for some, improvements in functional goals and other secondary outcomes were possible. CONCLUSIONS: As the first global evaluation of interdisciplinary concussion treatment via telehealth, the results support the feasibility of i-RECOVER-TH and its potential efficacy in improving patient-centered outcomes for those with pPCS after mTBI. These preliminary outcomes justify progression to a phase-II randomized controlled trial to more thoroughly evaluate treatment efficacy and to identify sources of variability in treatment response.