Purpose Renewal in Adults With Persisting Symptoms After Concussion: Results of a Non-Randomized Feasibility Trial

Background: Living with a sense of purpose in life is associated with numerous health benefits; however, some individuals with persisting symptoms after concussion are at risk for purpose disruption. The Compass Course is a group-based tele-practice intervention that supports purpose renewal after major health transitions. Objectives: To assess the feasibility, acceptability, and implementability of the Compass Course for adults with persisting symptoms after concussion, in preparation for a future randomized controlled trial. Setting: Large healthcare system in the Midwestern United States. Participants: Convenience sample of 37 adults with persisting symptoms after concussion. Design: Non-randomized pilot prospective cohort design. Intervention: Compass Course purpose renewal intervention delivered in a group setting via Zoom by an interdisciplinary team of allied health clinician-researchers (occupational therapy, speech-language pathology, psychology). Main Outcome Measures: Participants completed Likert scales to rate acceptability of the Compass Course intervention. Treatment fidelity was assessed by tracking the number of key intervention elements presented in each treatment session. Potential benefits of the intervention were assessed using validated measures of purpose and meaning in life. Results: Acceptability ratings were strong across the vast majority of participants. Treatment fidelity was strong with nearly perfect adherence to prespecified intervention elements. Participants who completed the intervention had gains across all purpose in life outcomes, with improvements maintained at 2-month follow-up. Conclusions: The Compass Course was highly acceptable to participants who completed the intervention; however, there was significant attrition suggesting a need for adaptations to the intervention and to trial procedures. Future work includes further intervention development, and a controlled feasibility trial to estimate treatment effects for a future well-powered clinical trial.