Hyperbaric oxygen does not significantly improve post-concussion symptoms

1. After a mild traumatic brain injury, patients may experience a myriad of symptoms including cognitive changes, anxiety, fatigue, and pain.

2. While anecdotally hyperbaric oxygen therapy has improved post-concussion symptoms, this study found that patients receiving hyperbaric oxygen therapy did not have significant improvement in symptom scores.

Evidence Rating Level: 1 (Excellent)      

Study Rundown: Following a concussion, patients may experience a range of long-term sequelae largely related to pain, cognition, and mood. It is unclear if such symptoms as forgetfulness, inattention, and fatigue are related to pain, stress, or injury. Regardless of etiology, these problems plague a significant proportion of patients who have experienced mild traumatic brain injury and can affect quality of life. Anecdotally, hyperbaric oxygen therapy (HBO) has been useful in managing these symptoms. This study represents a randomized, double-blinded, sham-controlled trial jointly conducted by the Department of Defense and Department of Veteran’s Affairs. The primary outcome of this study was change in concussion symptom scores on the Rivermead Post-Concussion Symptoms Questionnaire (RPQ).

Both the group who received hyperbaric oxygen therapy and the group who received a sham intervention in the same chamber reported improvements on the RPQ over the course of three months that were significantly different from the no intervention group. However, there was no significant difference between the oxygen group and the sham group. The study hypothesizes that benefits are related to placebo effects or daily interactions with a care team. While this was a small multicenter study with a limited patient population, which limits generalizability, this data lends credence to the idea that routine care of post-concussion syndrome need not be augmented with hyperbaric oxygen therapy.

Click to read the study, published today in JAMA Internal Medicine

Relevant Reading: Hyperbaric Oxygen Therapy Can Improve Post Concussion Syndrome Years after Mild Traumatic Brain Injury – Randomized Prospective Trial

In-Depth [randomized controlled trial]: Participants in this study were over the age of 18 and serving in the military. The median age was 31 years, and 96% of participants were male. Inclusion criteria included a minor traumatic brain injury occurring while deployed on one of two US Army missions, within the four months immediately prior to the study, and lack of claustrophobia. A total of 72 subjects were randomized into three groups. One group received hyperbaric oxygen therapy at 1.5 atmospheres for 60 minutes on weekdays, for a total of 40 sessions. The second received 40 sham sessions in the same chamber as the hyperbaric oxygen group. The third group received the standard of care for post-concussive syndrome.

The primary outcome measure was the Rivermead Post-Concussion Symptoms Questionnaire (RPQ). The authors defined a change of two points on the RPQ-3 subscale as being clinically meaningful. The group receiving hyperbaric oxygen therapy improved with mean changes of 1.2 points (95%CI 0-2.4, p=0.04) on a subscale and 5.4 on the overall RPQ scale (95%CI -0.5-11.3, p=0.008). The sham group also improved on the RPQ-3 subscale by 1.5 points (95%CI 0.1-2.9, p=0.03) and 7 points on the overall RPQ scale (95%CI 1.0-12.9, p=0.02). Two adverse events were noted, including claustrophobia and worsening of headaches.

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