Appraising CFX Treatment for Concussion

Worldwide, an estimated 54-60 million individuals sustain traumatic brain injury (TBI) annually. Mild TBI (or concussion) represents 90% of TBIs. Concussion can cause a wide range of symptoms that typically recover within weeks. However, approximately 10-30% of cases develop persistent symptoms beyond three months post-injury (~7,000 – 21,000 Dutch individuals), causing severe reduction in societal participation. Currently, there are no evidence-based treatments under the Dutch Health Care Insurance that aim to cure persistent symptoms. Recently, there has been a surge in attention from Dutch patients for a specific concussion clinic, Cognitive FX (CFX, Utah, USA). Thanks to promising patient experiences that circulate on social media, 200-300 Dutch patients travel to Utah yearly for ‘Enhanced Performance in Cognition’ (EPIC) treatment. However, effectiveness remains unclear from an evidence-based point of view. This pilot study will investigate the value of EPIC treatment in two work packages. The exploratory work package will systematically explore the content of the treatment, justification by CFX experts and patient experience. In addition, an inventory of potential working mechanisms will be made by a panel of independent experts. The quantitative work package will objectively determine short-term and longer-term functional change in relevant domains and statistically explore factors in recovery. Thereby, this study will provide better understanding for clinicians, facilitate patients in better informed decisions and indicate the need for follow-up research to researchers, policy makers and health care insurance providers.

This study will investigate the potential value of CFX treatment, by prospective monitoring of functioning in patients that undergo this treatment. Likewise, aspects of the treatment that are important for patient experience will be systematically explored. Furthermore, this study aims to provide better understanding of the aetiology of potential recovery effects (with re-use of existing clinical brain scans). The results of this study will be reported in open-access summaries and published in peer-reviewed journals. Thereby, this study will provide better understanding for clinicians, facilitate patients in better informed decisions and indicate the need for follow-up research to researchers, policy makers and health care insurance providers. 

This study has a quantitative approach with a prospective longitudinal observational design. In addition, a qualitative approach will be applied for a subsample of patients (n = 15) using in-depth interviews.