Projects

Psychological profile matching: A precision medicine approach to concussion rehabilitation

PROBLEM

It is well-established that psychosocial factors often adversely influence recovery from mild traumatic brain injury (MTBI), but not how to effectively mitigate their influence. Similar to the chronic pain literature, distinct psychological profiles after MTBI have emerged in our research: (i) avoiders, who perceive activity as dangerous and take care to avoid overdoing, and (ii) endurers, who persist with high levels of activity despite exacerbated symptoms until they “crash,” requiring recuperative rest. Patients with these psychological profiles may benefit from very different treatment approaches.

STUDY HYPOTHESES AND OBJECTIVES

We hypothesize that the avoidance and endurance subtypes will be reproducible, stable over time, and associated with activity diary metrics and poor prognosis. We further hypothesize that matching patients to tailored rehabilitation programs based on their psychological profiles will be feasible, meeting benchmarks for enrollment, retention, fidelity, and perceived credibility.

METHODS

Participants will be recruited from five outpatient concussion clinics. Those enrolled in the observational arm (Vancouver, Calgary, and Toronto) will complete questionnaires at clinic intake, an activity diary over the following week, and a follow-up assessment 3-4 months later. In the treatment arm (Vancouver only), participants will be randomized at clinic intake to an interdisciplinary rehabilitation package tailored to avoidance (graded exposure therapy) or endurance (pacing and mindfulness) subtype, stratified to ensure that half the sample receives the intervention matched to their psychological profile.

EXPECTED RESULTS AND POTENTIAL SIGNIFICANCE

The study results will guide design of a Phase III multi-site clinical trial. Most clinical trials targeting persistent symptoms after MTBI have produced modest or non-significant results, possibly because they ignore between-subject heterogeneity, offering the same treatment to all patients. The proposed project aims to leverage heterogeneity and determine the feasibility and potential efficacy of using psychological risk factor profiling to match patients to tailored rehabilitation programs

TIMELINES

CIHR Project Grant application in March 2018.