Grant: Project Grant

Concussions are very common. Although many people recover well from concussion, at least 1 in 5 will have persistent symptoms and difficulties with daily activities. How people cope with their symptoms following concussion powerfully influences their recovery. We have recently identified two unhelpful coping styles following a concussion - (1) avoidance, where people perceive activity as unnecessarily dangerous and take great care to avoid overexertion, and (2) endurance, where people engage in high levels of activity despite worsening symptoms until they "crash," requiring recuperative rest. These same unhelpful coping styles are seen in other health conditions, such as chronic pain. We believe that individuals who engage in avoidance behaviour benefit from a different type of concussion treatment than those who engage in endurance behaviour. If our belief is true, the current one-size-fits-all approach is not likely to work for everyone who suffers a concussion. We will evaluate whether assigning individuals to a specific treatment tailored to their coping style is practical, acceptable, and beneficial for their recovery. In the proposed study, patients will be recruited from concussion clinics and offered one of two treatment programs based on random assignment (like a coin toss). Both programs will be delivered by an occupational therapist and psychologist over eight weeks, using a videoconference system. We expect that the majority of patients who we approach will choose to join the study and that most of them will attend regularly, do their therapy assignments, and complete a final assessment. We will also check that the therapists are providing the treatments as outlined in a treatment manual. The information collected in this study will inform the development for a larger trial involving additional clinics across Canada, so that we can learn more definitively whether our matching approach can speed up recovery and reduce the burden of concussion.