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In 2014, the Defense and Veterans Brain Injury Center (DVBIC) released newly-developed clinical recommendations (CRs) detailing the step-wise return to unrestricted activity following mild traumatic brain injury (mTBI)/concussion. The CRs and their tools provide the medical community clear guidance for safely returning patients to pre-injury activities and more generally, for fostering positive patient outcomes.


This study aims to evaluate the effectiveness and adherence to the DVBIC tools supporting the Progressive Return to Activity (PRA) clinical recommendations (CRs), and to identify the need or opportunity to revise the CRs and enhance the outcomes in patients. The target population of this prospective, multi-center study includes Service Members (SMs) who have sustained an acute mTBI/concussion within 72 hours, and primary care and rehabilitation providers working with the injured SMs. Injured SM participants will be enrolled before (Treatment As Usual, TAU/control group) or after (PRA/intervention group) providers have been formally trained on the PRA tools. For both TAU and PRA groups, data collection will occur during the initial assessment, and at 1 week, 1 month, 3 months and 6 months after injury. The PRA intervention will be evaluated through numerous measures including symptom questionnaires, rate/speed for return to full duty, and patient satisfaction and adherence questionnaires. In addition, data from provider participants will be collected through in-person semi-structured interviews at multiple time points to assess PRA CR knowledge and perception of patient change and of patient compliance. The results of this project will inform necessary improvements to the PRA clinical package to increase the effectiveness and utilization of the clinical support tools, which will ultimately improve the implementation and standardization of clinical practice for acute concussion in the Military Healthcare System.


Contact Person

Karen McCulloch (

Website Address

Investigators and Key Personnel

Felicia Qashu, Emma Gregory (Co-PIs) Karen McCulloch, Julianna Prim, co-investigators DVBIC investigators and staff at Fort Bragg, NC, Camp Pendleton, CA, Navy Medical Center San Diego, CA.

Primary Funding Source

Defense and Veterans Brain Injury Center