VA/DOD Clinical Practice Guideline for the Management and Rehabilitation of Post-acute Mild Traumatic Brain Injury
Management and Rehabilitation of Post-Acute Mild Traumatic Brain Injury Work Group. (2021).
Washington, D.C.: Department of Vetarans Affairs; Department of Defense, (Version 3.0), 1-128.
<div>This clinical practice guidelines updates the Department of Defense and Department of Veterans Affairs' 2016 clinical practice guidelines on mild traumatic brain injury (mTBI). It provides evidence-based recommendations regarding the care of veterans and active duty service members with symptoms attributed to mTBI in the post-acute stage.</div>
U.S. Department of Veterans Affairs; U.S. Department of Defense
<div>This guideline was reviewed with several supporting documents available at the <a class="ApplyClass" title="https://www.healthquality.va.gov/guidelines/Rehab/mtbi/index.asp">VA/DoD Clinical Practice Guidelines Post-Acute mTBI</a> webpage.</div>
<div>"We suggest a primary care (as opposed to specialty care), symptom-focused apporach in the evaluation and management of the majority of patients with symptoms attributed to mild traumatic brain injury [mTBI]" (p. 25; Weak For Evidence). In other words, the authors recommend "[a]pproaching these symptoms in a manner consistent with the treatment of chronic, multisystem conditions commonly managed in the primary care model... acknowled[ing] symptoms (i.e., not labeling them as psychogenic) and reinforc[ing] normalcy rather than impairment and self-labeling." (p. 25).</div>
<div>"There is insufficient evidence to recommend for or against specialized treatment programs to improve morbidity, function, and return to work in patients with persistent symptoms attributed to mild traumatic brain injury" (p. 26; Neither For or Against Evidence). In other words, "[p]atients with persistent symptoms attributed to mTBI are often best treated in the primary care setting... [h]owever, some patients who present with chronic, persistent symptoms and cooccurring conditions may benefit from an individualized treatment plan for symptom management developed through an interdisciplinary, team-based approach" (p. 26).</div>
<div>"For patients with new symptoms that develop more than 30 days after mild traumatic brain injury, we suggest a symptom-specific evaluation for non-mild traumatic brain injury etiologies", as these symptoms are unlikely to be the result of the mTBI (p. 26; Weak For Evidence)</div>
<div>"We suggest against using computerized post-concussive screening batteries for routine diagnosis and care of patients with symptoms attributed to mild traumatic brain injury" (p. 29; Weak Against Evidence).</div>
<div>"We suggest against performing comprehensive neuropsychological [and/or] cognitive testing during the first 30 days following mild traumatic brain injury" (p. 29; Weak Against Evidence).</div>
<div>When counseling patients about the long-term side effects of mTBI, there is insufficient evidence to state that <span style="color: #333333;">"single or repeated mild traumatic brain injury increases their risk of future neurocognitive decline... [or that] </span><span style="color: #333333;">demographic, injury-related clinical, and management factors increase the risk of future neurocognitive decline in patients with symptoms attributed to single or repeated mild traumatic brain injury" (p. 30; Neither For or Against Evidence). </span></div>
<div>"We suggest against adjusting outcome prognosis and treatment strategy based on mechanism of injury" (p. 32; Weak Against Evidence).</div>
<div>"We suggest that patients with symptoms attributed to mild traumatic brain injury who present with memory, attention, or executive function problems despite appropriate management of other contributing factors (e.g., sleep, pain, behavioral health, headache, disequilibrium) should be referred for a short trial of clinician-directed cognitive rehabilitation services" (p. 33; Weak For Evidence).</div>
<div>"We suggest against the use of self-administered computer training programs for the cognitive rehabilitation of patients with symptoms attributed to mTBI" (p. 34; Weak Against Evidence).</div>
<div>"We suggest that patients with symptoms attributed to mild traumatic brain injury who present with behavioral health conditions, including posttraumatic stress disorder, substance use disorders, and mood disorders, be evaluated and managed the same whether they have had mild traumatic brain injury or not, according to the relevant existing VA/DoD clinical practice guidelines" (p. 35; Weak For Evidence).</div>
<div>"We suggest that patients with persistent symptoms of dizziness and imbalance attributed to mild traumatic brain injury be offered a trial of specific vestibular rehabilitation and proprioceptive therapeutic exercise" (p. 37; Weak For Evidence).</div>
<div>"There is insufficient evidence to suggest for or against the use of any particular modality for the treatment of visual symptoms attributed to mild traumatic brain injury such as diplopia, accommodation or convergence deficits, visual tracking deficits and/or photophobia" (p. 38; Neither For or Against Evidence).</div>
<div>"There is no evidence to suggest for or against the use of any particular modality for the treatment of tinnitus attributed to mild traumatic brain injury" (p. 39; Neither For or Against Evidence).</div>
<div>There is insufficient evidence to recommend for or against the use of cranial electrotherapy stimulation for the treatment of patients with symptoms attributed to mTBI (Neither For or Against Evidence).</div>
