Cifu

Clinical Bottom Line:

1. No effect on postconcussion syndrome of either HBOT regimen compared to a sham treatment. **2. Some minor improvements in all groups compared to baseline but did not reach pre-defined clinical significance. **3, No improvement in eye tracking abnormailities with HBOT

• • Citation/s:

1. Cifu DX, Hart BB, West SL, Walker W, Carne W. The effect of hyperbaric oxygen on persistent postconcussion symptoms. Journal of Head Trauma and Rehabilitation 2014;29(1):11-20.

2. Cifu DX, Walker WC, West SL, Hart BB, Franke LM, Sima A, Graham CW, Carne W. Hyperbaric oxygen for blast-related postconcussion syndrome: three-month outcomes. Annals of Neurology 2014;75:277-286.

3. Cifu DX, Hole KW, Wetzel PA, Wares JR, Gitchel G, Carne W. Effects of hyperbaric oxygen on eye tracking abnormalities in males after mild traumatic brain injury. Journal of Rehabilitation Research and Development 2014;51(7):1047-1056

Lead author's name and fax: William Carne William.Carne@va.gov

• • Three-part Clinical Question:For patients with postconcussion syndrome following blast injury, does HBOT compared to a sham therapy result in any improvement in symptoms?

Search Terms: postconcussion syndrome; blast injury; post-truamatic stress disorder

• • The Study: Double-blinded concealed randomised controlled trial with intention-to-treat.

The Study Patients: Patients diagnosed with mild traumatic brain injury 3 months to 3 years in the past and with postconcussion symptoms.

Control group (N = 21; 21 analysed): Sham treatment using compression to 2 ATA breathing 10.5% oxygen for 40 daily exposures for 60 minutes

Experimental group (N = 40; 39 analysed): 1. 100% oxygen breathing at 1.5 ATA on the same schedule as control. 2. 100% oxygen breathing at 2 ATA on the same schedule as control.

• • The Evidence:

Measure		Control Group		HBOT Groups	Difference	P-value
^	Mean	SD	Mean	SD	^	^
RPQ-16 at end of treatment	32.86		28.62		4.24	NS
PCL-M at end treatment	43.9		42.93		0.970	NS

RPQ-16: Rivermead Postconcussion Questionnaire-16. PCL-M: Posttraumatic Disorder Checklist – Military Version.

Mixed model ANOVA for tracking variables - Interaction of oxygen level and time:

• • VerticalMean of non-normalized primary position error: P = 0.44
  • HorizontalMean of normalized primary position error: P = 0.68

• • Comments:

1. Well conducted study with rigorous design including blinding, allocation concealment and two regimens for HBOT.

2. Sham here unusual in that there was pressure exposure at a PIO2 identical with air at 1 ATA.

3. Improvements noted were ascribed most likely due to placebo or Hawthorne effects.

4. Three month outcomes were analysed by repeated measure mixed effects modelling - no difference was found due to the group allocation.

5. Males only studied and all were military personnel.May affect generalizability

• • Appraised by:Mike Bennett, University of NSW ; Thursday, 30 October 2014 Email: m.bennett@unsw.edu.au

Kill or Update By: November 2021

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