Moving from the clinic to telehealth during the COVID-19 pandemic – a pilot clinical trial comparing in-clinic rehabilitation versus telerehabilitation for persisting symptoms following a mild Traumatic brain injury
Creators: name: Langevin, Pierre
name: Frémont, Pierre
name: Fait, Philippe
name: Dubé, Marc-Olivier
name: Roy, Jean-Sébastien
Publisher: name: Taylor & Francis
Year: 2023
Subjects: subject: Medicine
subject: Pharmacology
subject: Biological Sciences not elsewhere classified
subject: Cancer
subject: Infectious Diseases
subject: FOS: Health sciences
subject: Virology

description: The objective of this study was to compare the effects of an in-clinic cervicovestibular rehabilitation program (education, home exercises, manual techniques, sub-symptom threshold aerobic exercise [STAE] program) to a similar program (education, home-exercises, STAE program), but without manual techniques, provided in a telerehabilitation format in adults with persisting post-concussion symptoms (PCS). In this parallel-group non-randomized clinical trial, 41 adults with persisting PCS were allocated to the in-clinic (<i>n</i> = 30) or telerehabilitation (<i>n</i> = 11) program. The outcome measures, which included the Post-Concussion Symptom Scale (PCSS; primary outcome), Numerical Pain Rating Scale (NPRS) for neck pain and headache and three disability questionnaires, were collected at baseline, weeks 6, 12, and 26. Non-parametric analysis for longitudinal data (NparLD) was used. For the PCSS, there was a group-by-time interaction (<i>p</i> = 0.05) with significant between-group differences at week 6, 12, and 26 (<i>p</i> &lt; 0.05) for the in-clinic group. There were also group-by-time interactions for NPRS neck pain and headache (<i>p</i> &lt; 0.05) for the in-clinic group. The study suggests that a telehealth format failed to reach the efficiency of an in-clinic rehabilitation program in terms of symptoms reduction and functional improvement. These results must be interpreted with caution given the limited number of participants. <b>ClinicalTrials.gov Identifier:</b> NCT03677661.IMPLICATION FOR REHABILITATIONThe telerehabilitation format for adults with persisting post-concussion symptoms was widely implemented in the COVID-19 pandemic without any evidence of efficacy over the more traditional in-clinic rehabilitation format.The study suggests that a telerehabilitation format failed to reach the efficiency of an in-clinic rehabilitation program in terms of symptoms reduction and functional improvement.Clinicians should try to incorporate some in-clinic appointments when a telerehabilitation format is required such as for patients in underserved area. The telerehabilitation format for adults with persisting post-concussion symptoms was widely implemented in the COVID-19 pandemic without any evidence of efficacy over the more traditional in-clinic rehabilitation format. The study suggests that a telerehabilitation format failed to reach the efficiency of an in-clinic rehabilitation program in terms of symptoms reduction and functional improvement. Clinicians should try to incorporate some in-clinic appointments when a telerehabilitation format is required such as for patients in underserved area.