2.1 Ethical Foundation
Permission for initiating the study was granted from The Danish National
Committee on Health Research Ethics prior to the beginning of the
project, concluding that cases were not at risk of harm, and the ethical
aspects of the project were assessed according to the Helsinki
Declaration.42 Cases were given oral and written
information about the protocols and signed an informed consent form with
the right to withdraw at any time. All cases were anonymized, and
qualitative data collection was handled with discretion with no sharing
of personal information.
2.2 Case and Study
DescriptionsÂ
Case characteristics are presented in Table 1 and 2. The four cases were
recruited through a collaboration with a center of rehabilitation in the
capital region of Denmark and separated into two different case studies,
Study A and Study B, examining two different intervention protocols.
Cases in Study A participated in a submaximal graded aerobic exercise
intervention supplemented by postural correction of the cervical spine
and cases in Study B participated in a modified body awareness
intervention with additional group feedback sessions.
TABLE 1
Study A Inclusion criteria; Persistent symptoms of mTBI for more than 12
months following initial trauma, above the age of 18 and able to sit on
a stationary bike without referred pain.
Study B inclusion criteria; Persistent symptoms of mTBI for more than 12
months following initial trauma, above the age of 18, able to stand for
a duration up to 20 minutes, able to lie flat on their backs.
Excluding criteria; Unable to communicate in Danish, unable to attend
twice a week and contraindicated disorders making the planned
interventions impossible.
TABLE 2
2.3 Data and Analysis
All four cases underwent a clinical examination before the interventions
covering relevant injury history, current and previous work history,
social participation, daily activities and bodily functions in relation
to the International Classification of Functioning Disability and Health
(ICF) model.43 All cases were scored on the
Rivermead-Post Concussion Questionnaire (RPQ), a standardized
post-concussion questionnaire with two subscores,44pre- and post-intervention, as well as a semi-structured qualitative
interview post intervention. Additionally, cases in Study A underwent a
Craniocervical Flexion Test (CCFT)45 pre and post
intervention, and cases in Study B were scored on the SF-36v2 Quality of
Life (QOL) questionnaire46 pre and post intervention.
RPQ, SF-36 and CFFT have shown to be valid testing tools in measuring
prolonged symptoms of mTBI, QOL and cervical function in different
population groups with moderate to high construct validity and
reliability.47–50 Questionnaires followed the
guidelines for analysis of RPQ47 and
SF-36v251,52 using simple comparative statistics in
calculating averages and the semi-structured interviews were recorded,
transcribed and analysed by identifying codes and sub-codes, which were
clustered ad modum Kvale.53 The CFFT was administered
as per standardized guidelines.45
2.4 Interventions