Targeted Multidomain (T-MD) Interventions for Complex Mild Traumatic Brain Injury (mTBI) (T-MD)

  • End date
    Oct 15, 2025
  • participants needed
  • sponsor
    University of Pittsburgh
Updated on 15 June 2022


Objective: This 3-year multisite RCT will determine the effectiveness of a targeted multidomain intervention (T-MD) (anxiety/mood, cognitive, migraine, ocular, vestibular; and sleep, autonomic) compared to usual care (behavioral management) in military-aged civilians with complex mTBI.


A prospective single-blinded two-group multicenter randomized controlled trial (RCT) of a targeted multi-domain intervention in military-aged civilians with complex mTBI will be conducted at the University of Pittsburgh Medical Center Sports Concussion Program (UPitt) and Inova Sports Concussion Clinic. During year 1 the investigators will obtain appropriate contract and research agreements, and institutional, site-specific, and Human Research Protection Official (HRPO) Institutional Review Board (IRB) approvals for the trial. This study will enroll 250 military-aged civilians with a diagnosed complex mTBI from UPitt (125) and Inova (125). Upon enrollment, participants will complete a comprehensive multidomain evaluation of symptoms and impairment that will inform an adjudication process to determine affected clinical profiles and targeted interventions. Participants will then be randomized to either the T-MD or usual care intervention arm. The T-MD group will receive targeted interventions (cognitive behavioral therapy, cognitive accommodations/activities, behavioral regulation for headache/migraine, oculomotor exercises, behavioral sleep intervention, vestibular rehabilitation, graded exertion) for affected clinical profiles based on the adjudication process, whereas usual care will only receive behavioral management strategies (e.g., sleep, nutrition, hydration, activity, stress management). In-clinic treatment sessions will be complemented with at-home activities and compliance will be monitored using a text-based tool. Data collection will include demographic data, medical history, health care utilization (the number of visits and utilization costs), and length of time to return to activity (RTA). Primary outcomes for Aim 1 will be assessed at baseline, 2-week, 4-week, and 3-month post-intervention intervals. Secondary outcomes for Aim 1 will be assessed at baseline, 2-week, and 4-week post-intervention intervals, with select outcomes being measured again at 3-months. The investigators will also determine if participants are recovered (i.e., medically cleared for full return to activity) at 2 weeks, 4 weeks and 3 months post-intervention. Additionally, the investigators will tabulate each participant's healthcare utilization and related costs using electronic health record (EHR) at the conclusion of participation in the study protocol. For Aims 2 and 3, in years 2-3, concurrent measures of brain activation will be obtained (i.e., CBF) in the cerebral cortex using fNIRS for all participants at enrollment and 4 weeks-post intervention. Primary outcome measures for Aims 2 and 3 will be oxygenated (activation) and deoxygenated (deactivation) hemoglobin in regions of interest in the cerebral cortex at rest. Secondary outcomes will include the same fNIRS measures during cognitive and exertion activities. We will control for the time since injury in all analyses. For Aim 1, a linear mixed model will be used to compare primary and secondary outcomes between groups, while accounting for covariates. For Aim 2, a linear mixed model will be used to compare brain regions of interest, while accounting for covariates. For Aim 3, bivariate and partial correlational analyses will be conducted.

Condition Concussion, Mild
Treatment Targeted Multidomain, Behavioral Management
Clinical Study IdentifierNCT04549532
SponsorUniversity of Pittsburgh
Last Modified on15 June 2022


Yes No Not Sure

Inclusion Criteria

Participants must meet ALL of the following inclusion
-49 years of age
Normal/corrected vision
Diagnosed with complex mTBI in the past 8 days-6 months with clear mechanism of injury
Glascow coma scale (GCS) score no less than 13
Reported or sign of mTBI including loss of consciousness, amnesia, disorientation/confusion, dizziness, imbalance, memory problems, vomiting
Complex mTBI-related symptoms and/or impairments in at least one of the following areas: anxiety/mood, cognitive, migraine, ocular, vestibular, sleep, autonomic; per a comprehensive assessment, clinical exam/interview, and adjudication process

Exclusion Criteria

Participants will be excluded if they meet one or more of the following
exclusion criteria
History of vestibular disorder (e.g., benign paroxysmal positional vertigo
History of neurological disorder
unilateral, or bilateral vestibular hypofunction)
Previous moderate to severe TBI
Currently pregnant or become pregnant during study
History of brain surgery, malformations or tumors
Diagnosed with cardiac, peripheral or cerebrovascular disease
Experienced chest pain or shortness of breath while at rest or with mild exertion
Been told by a doctor to only conduct physical activity under medical supervision
Previous moderate to severe TBI
< 8 days or >6 months following current complex mTBI
Currently involved in litigation associated with current or previous mTBI
Currently on workman's compensation
Previously participated in the study
Previously received treatment at either site within last two years as this will
unblind treatment group(s)
Members of same household will not be included as they may determine their group
assignment if more than one person from same household is included and assigned
to different groups
Please note that participants with a history of mTBI, ADHD/LD, migraine, or
motion sickness will NOT be excluded. We will adjust for any imbalance in
the groups on these factors via covariate analysis
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