{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T16:33:28Z","timestamp":1787848408794,"version":"build-2784847793"},"reference-count":52,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2020,10,20]],"date-time":"2020-10-20T00:00:00Z","timestamp":1603152000000},"content-version":"unspecified","delay-in-days":19,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100014823","name":"VGH and UBC Hospital Foundation","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/100014823","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>New clinical practice guidelines for the management of mild traumatic brain injury (mTBI) emphasise that family physicians should proactively screen and initiate treatment for depression\/anxiety, insomnia and headaches. This study aimed to evaluate the feasibility of delivering an implementation intervention to family physicians.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Pilot cluster randomised controlled trial.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Specialty outpatient clinic (recruitment) and primary care (implementation).<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>114 primary care clinics were randomised. These clinics were associated with 137 unique family physicians caring for 148 adult patients who sustained an mTBI within the previous 3 months and were seeking care for persistent symptoms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interventions<\/jats:title><jats:p>Patients completed self-report screening measures for depression\/anxiety, insomnia and headaches. A tailored letter that incorporates the patient\u2019s screening test results and associated treatment algorithms was sent to their family physician (or walk-in clinic). Physicians at clinics assigned to the control condition received a generic letter, without the screening test results.<\/jats:p><\/jats:sec><jats:sec><jats:title>Primary outcome measures<\/jats:title><jats:p>Feasibility outcomes included the frequency of primary care follow-up, retention rates and reliability of patient recall of their physicians\u2019 actions (primary mechanistic outcome). The primary efficacy outcome was the Rivermead Post-Concussion Symptom Questionnaire (RPQ).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Most patients (97.8%; 128 of 131) followed up at the primary care clinic they planned to. Retention rates were 88% (131 of 148) and 78% (116 of 148) at the 1-month and 3-month assessments, respectively. Agreement between patient recall of their physicians\u2019 actions and medical chart audits was moderate (intraclass correlation coefficient=0.48\u20130.65). Patients in the experimental group reported fewer symptoms on the RPQ compared with those in the control group, whose physician received a general letter (B=\u22124.0, 95% CI: \u22127.3\u2009to \u22120.7).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A larger trial will need to address minor feasibility challenges to evaluate the effectiveness of this guideline implementation tool for improving mTBI clinical outcomes and confirm the mechanism(s) of intervention benefit.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial registration number<\/jats:title><jats:p><jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" specific-use=\"clinicaltrial results\" xlink:href=\"NCT03221218\">NCT03221218<\/jats:ext-link>.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2019-035527","type":"journal-article","created":{"date-parts":[[2020,10,20]],"date-time":"2020-10-20T21:10:22Z","timestamp":1603228222000},"page":"e035527","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":20,"title":["Promoting early treatment for mild traumatic brain injury in primary care with a guideline implementation tool: a pilot cluster randomised trial"],"prefix":"10.1136","volume":"10","clinical-trial-number":[{"clinical-trial-number":"nct03221218","registry":"10.18810\/clinical-trials-gov","type":"results"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6378-148X","authenticated-orcid":false,"given":"Noah D","family":"Silverberg","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William J","family":"Panenka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre-Paul","family":"Lizotte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark T","family":"Bayley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derry","family":"Dance","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6280-0511","authenticated-orcid":false,"given":"Linda C","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,10,20]]},"reference":[{"key":"2020102014101506000_10.10.e035527.1","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1080\/16501960410023732","article-title":"Incidence, risk factors and prevention of mild traumatic brain injury: results of the who collaborating centre Task force on mild traumatic brain injury","volume":"36","author":"Cassidy","year":"2004","journal-title":"J Rehabil Med"},{"key":"2020102014101506000_10.10.e035527.2","doi-asserted-by":"crossref","first-page":"E60","DOI":"10.1097\/HTR.0000000000000503","article-title":"Increasing incidence of concussion: true epidemic or better recognition?","volume":"35","author":"Langer","year":"2020","journal-title":"J Head Trauma Rehabil"},{"key":"2020102014101506000_10.10.e035527.3","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.ss6609a1"},{"key":"2020102014101506000_10.10.e035527.4","doi-asserted-by":"publisher","DOI":"10.1080\/13854040903074652"},{"key":"2020102014101506000_10.10.e035527.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2013.08.299"},{"key":"2020102014101506000_10.10.e035527.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2013.08.300"},{"key":"2020102014101506000_10.10.e035527.7","unstructured":"Foundation ON . 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