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The effect of telephone counselling on reducing post-traumatic symptoms after mild traumatic brain injury: A randomised trial
  1. K R Bell1,
  2. J M Hoffman1,
  3. N R Temkin1,2,3,
  4. J M Powell1,
  5. R T Fraser1,4,
  6. P C Esselman1,
  7. J K Barber2,
  8. S Dikmen1,2
  1. 1
    Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
  2. 2
    Department of Neurological Surgery, University of Washington, Seattle, WA, USA
  3. 3
    Department of Biostatistics, University of Washington, Seattle, WA, USA
  4. 4
    Department of Neurology, University of Washington, Seattle, WA, USA
  1. Kathleen R Bell, University of Washington, Department of Rehabilitation Medicine, Box 356490, Seattle, WA 98195, USA; krbell{at}


Background: Mild traumatic brain injury (MTBI) is a significant public health problem affecting approximately 1 million people annually in the USA. A total of 10–15% of individuals are estimated to have persistent post-traumatic symptoms. This study aimed to determine whether focused, scheduled telephone counselling during the first 3 months after MTBI decreases symptoms and improves functioning at 6 months.

Methods: This was a two-group, parallel, randomised clinical trial with the outcome assessed by blinded examiner at 6 months after injury. 366 of 389 eligible subjects aged 16 years or older with MTBI were enrolled in the emergency department, with an 85% follow-up completion rate. Five telephone calls were completed, individualised for patient concerns and scripted to address education, reassurance and reactivation. Two composites were analysed, one relating to post-traumatic symptoms that developed or worsened after injury and their impact on functioning, the other related to general health status.

Results: The telephone counselling group had a significantly better outcome for symptoms (6.6 difference in adjusted mean symptom score, 95% confidence interval (CI) 1.2 to 12.0), but no difference in general health outcome (1.5 difference in adjusted mean functional score, 95% CI 2.2 to 5.2). A smaller proportion of the treatment group had each individual symptom (except anxiety) at assessment. Similarly, fewer of the treatment group had daily functioning negatively impacted by symptoms with the largest differences in work, leisure activities, memory and concentration and financial independence.

Conclusions: Telephone counselling, focusing on symptom management, was successful in reducing chronic symptoms after MTBI.

Trial registration number:, #NCT00483444

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  • Competing interests: None.

  • Funding: This research was funded by the Centers for Disease Control, Award No. R49/CCR023226-03. The Centers for Disease Control provided funding for the research but had no control over the design, data collection, analysis or interpretation of the data.