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Fann JR, Hart T, Ciol MA, Moore M, Bogner J, Corrigan JD, Dams-O'Connor K, Driver S, Dubiel R, Hammond FM, Kajankova M, Watanabe TK, Hoffman JM. Improving transition from inpatient rehabilitation following traumatic brain injury: Protocol for the BRITE pragmatic comparative effectiveness trial. Contemp Clin Trials 2021; 104:106332. [PMID: 33652127 DOI: 10.1016/j.cct.2021.106332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/15/2021] [Accepted: 02/22/2021] [Indexed: 01/03/2023]
Abstract
Moderate to severe traumatic brain injury (TBI) is a common cause of long-term disability. Due to challenges that include inconsistent access to follow-up care, persons with TBI being discharged from inpatient rehabilitation facilities (IRFs) are at risk for rehospitalization, poor reintegration into the community, family stress, and other unfavorable outcomes resulting from unmet needs. In a six-center randomized pragmatic comparative effectiveness study, the BRITE trial (Brain Injury Rehabilitation: Improving the Transition Experience, ClinicalTrials.govNCT03422276), we compare the effectiveness of two existing methods for transition from IRF to community living or long-term nursing care. The Rehabilitation Discharge Plan (RDP) includes patient/family education and referrals for continued care. The Rehabilitation Transition Plan (RTP) provides RDP plus individualized, manualized care management via phone or videoconference, for 6 months. Nine hundred patients will be randomized (1:1) to RDP or RTP, with caregivers also invited to participate and contribute caregiver-reported outcomes. Extensive stakeholder input, including active participation of persons with TBI and their families, has informed all aspects of trial design and implementation planning. We hypothesize that RTP will result in better patient- and caregiver-reported outcomes (societal participation, quality of life, caregiver well-being) and more efficient use of healthcare resources at 6-months (primary outcome) and 12-months post-discharge, compared to RDP alone. Planned analyses will explore which participants benefit most from each transition model. With few exclusion criteria and other pragmatic features, the findings of this trial are expected to have a broad impact on improving transitions from inpatient TBI rehabilitation. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT03422276.
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Affiliation(s)
- Jesse R Fann
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195, United States of America.
| | - Tessa Hart
- Moss Rehabilitation Research Institute, 50 Township Line Road, Elkins Park, PA 19027, United States of America.
| | - Marcia A Ciol
- Department of Rehabilitation Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356490, Seattle, WA 98195, United States of America.
| | - Megan Moore
- School of Social Work and Harborview Injury Prevention and Research Center, University of Washington, 4101 15(th) Avenue NE, Seattle, WA 98105, United States of America.
| | - Jennifer Bogner
- Department of Physical Medicine and Rehabilitation, The Ohio State University, 480 Medical Center Drive, Columbus, OH 43210, United States of America.
| | - John D Corrigan
- Department of Physical Medicine and Rehabilitation, The Ohio State University, 480 Medical Center Drive, Columbus, OH 43210, United States of America.
| | - Kristen Dams-O'Connor
- Department of Rehabilitation Medicine, Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place Box 1163, New York, NY 10029, United States of America. Kristen.dams-o'
| | - Simon Driver
- Department of Sports Therapy and Research, Baylor Scott and White Research Institute, 3434 Live Oak, Dallas, TX 75204, United States of America.
| | - Rosemary Dubiel
- Department of Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, 909 N. Washington Avenue, Dallas, TX 75246, United States of America.
| | - Flora M Hammond
- Department of Physical Medicine and Rehabilitation, Indian University School of Medicine, 4141 Shore Drive, Indianapolis, IN 46254, United States of America.
| | - Maria Kajankova
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place Box 1163, New York, NY 10029, United States of America.
| | - Thomas K Watanabe
- Department of Physical Medicine and Rehabilitation, MossRehab at Elkins Park/Einstein Healthcare Network, 60 Township Line Road, Elkins Park, PA 19027, United States of America.
| | - Jeanne M Hoffman
- Department of Rehabilitation Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356490, Seattle, WA 98195, United States of America.
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Serafini RA, Powell SK, Frere JJ, Saali A, Krystal HL, Kumar V, Yashaswini C, Hernandez J, Moody K, Aronson A, Meah Y, Katz CL. Psychological distress in the face of a pandemic: An observational study characterizing the impact of COVID-19 on immigrant outpatient mental health. Psychiatry Res 2021; 295:113595. [PMID: 33296817 PMCID: PMC7805919 DOI: 10.1016/j.psychres.2020.113595] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 11/23/2020] [Indexed: 01/16/2023]
Abstract
Undocumented immigrants have disproportionately suffered during the novel coronavirus disease 2019 (COVID-19) pandemic due to factors including limited medical access and financial insecurity, which can exacerbate pandemic-associated distress. Psychological outcomes for immigrant outpatients were assessed after transition to telepsychiatry in March 2020. Mental health was assessed with Patient Health Questionnaire (PHQ-2) and Generalized Anxiety Disorder (GAD-2) inventories, a novel coronavirus-specific survey, and the Kessler Psychological Distress Scale (K10+). Feedback on telepsychiatry sessions and access to non-clinical resources were also gathered, after which multivariable linear regression modeling identified psychosocial factors underlying changes in distress levels. 48.57% and 45.71% of participants reported worsened anxiety and depression levels due to the pandemic, respectively. From March to April, PHQ-2 and GAD-2 scores significantly increased by 0.81 and 0.63 points, respectively. The average total psychological distress score was 23.8, with 60% of scores reflecting serious mental illness. Factors that most influenced K10+ scores included a pre-existing depressive disorder, food insecurity, and comfort during telepsychiatry visits. 93.75% of participants believed access to remote psychiatry helped their mental health during COVID-19. The negative impact of COVID-19 on mental health in vulnerable populations stems from medical and psychosocial factors such as pre-existing psychiatric conditions and unmet essential needs.
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Affiliation(s)
- Randal A Serafini
- East Harlem Health Outreach Partnership, Icahn School of Medicine at Mount Sinai, 17 E 102(nd) St, New York, NY, 10029; Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box #1002, New York, NY, 10029; Nash Department of Neuroscience and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box #1022, New York, NY, 10029.
| | - Samuel K Powell
- East Harlem Health Outreach Partnership, Icahn School of Medicine at Mount Sinai, 17 E 102(nd) St, New York, NY, 10029; Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box #1002, New York, NY, 10029; Nash Department of Neuroscience and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box #1022, New York, NY, 10029.
| | - Justin J Frere
- East Harlem Health Outreach Partnership, Icahn School of Medicine at Mount Sinai, 17 E 102(nd) St, New York, NY, 10029; Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box #1002, New York, NY, 10029; Department of Microbiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box #1124 New York, NY, 10029.
| | - Alexandra Saali
- East Harlem Health Outreach Partnership, Icahn School of Medicine at Mount Sinai, 17 E 102(nd) St, New York, NY, 10029; Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box #1002, New York, NY, 10029.
| | - Hannah L Krystal
- East Harlem Health Outreach Partnership, Icahn School of Medicine at Mount Sinai, 17 E 102(nd) St, New York, NY, 10029; Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box #1002, New York, NY, 10029.
| | - Vedika Kumar
- East Harlem Health Outreach Partnership, Icahn School of Medicine at Mount Sinai, 17 E 102(nd) St, New York, NY, 10029; Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box #1002, New York, NY, 10029.
| | - Chittampalli Yashaswini
- East Harlem Health Outreach Partnership, Icahn School of Medicine at Mount Sinai, 17 E 102(nd) St, New York, NY, 10029; Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box #1002, New York, NY, 10029.
| | - Josimar Hernandez
- East Harlem Health Outreach Partnership, Icahn School of Medicine at Mount Sinai, 17 E 102(nd) St, New York, NY, 10029; Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box #1002, New York, NY, 10029.
| | - Kate Moody
- East Harlem Health Outreach Partnership, Icahn School of Medicine at Mount Sinai, 17 E 102(nd) St, New York, NY, 10029; Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box #1002, New York, NY, 10029.
| | - Anne Aronson
- East Harlem Health Outreach Partnership, Icahn School of Medicine at Mount Sinai, 17 E 102(nd) St, New York, NY, 10029; Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box #1002, New York, NY, 10029.
| | - Yasmin Meah
- East Harlem Health Outreach Partnership, Icahn School of Medicine at Mount Sinai, 17 E 102(nd) St, New York, NY, 10029; Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box #1002, New York, NY, 10029; Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box #1118 New York, NY, 10029; Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box #1070, New York, NY, 10029.
| | - Craig L Katz
- East Harlem Health Outreach Partnership, Icahn School of Medicine at Mount Sinai, 17 E 102(nd) St, New York, NY, 10029; Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box #1002, New York, NY, 10029; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box #1230, New York, NY, 10029.
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Abstract
Context: Considering the pivotal role of telemedicine in providing healthcare services for remote areas, some of the military medical centers, especially in developed countries, use different types of telemedicine programs. Objectives: The present study aimed at identifying the implemented telemedicine projects in military medicine worldwide and introducing their features. Evidence Acquisition: The current systematic review was performed in 2018. PubMed, Scopus, Embase, and Web of Science databases were searched for articles published from 2014 to 2018 by a combination of related keywords, and the related original articles were then selected based on the inclusion and exclusion criteria. Data were collected by a data extraction form, and then the data were summarized and reported based on the study objectives. Results: Of the 173 articles retrieved from the first round of search, 12 were included in the study; five (41.66%) studies had used the synchronous (real-time telemedicine) method. The United States, with nine studies, had the highest number of projects in military telemedicine. Most studies (n = 7) were performed on tele-psychology and the application of telemedicine in psychology. All selected studies reported the positive effects of telemedicine on providing healthcare for military forces. Conclusions: The proper utilization of telemedicine equipment is effective in saving time for both patients and healthcare providers, reducing costs, supporting in natural disasters, and satisfying patients with military medicine. To achieve telemedicine program objectives, they should be set precisely. Considering the importance of timely healthcare services, it is suggested to utilize synchronous methods and tools such as video conferencing.
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Juengst SB, Osborne CL, Holavanahalli R, Silva V, Kew CL, Nabasny A, Bell KR. Feasibility Study of Problem-Solving Training for Care Partners of Adults With Traumatic Brain Injury, Spinal Cord Injury, Burn Injury, or Stroke During the Inpatient Hospital Stay. Arch Rehabil Res Clin Transl 2019; 1:100009. [PMID: 33543049 PMCID: PMC7853336 DOI: 10.1016/j.arrct.2019.100009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To determine the feasibility of delivering an evidence-based self-management intervention, problem-solving training (PST), to care partners of individuals with traumatic brain injury (TBI), spinal cord injury (SCI), burn injury, or stroke during the inpatient hospital stay. DESIGN In this single group pre-post intervention pilot feasibility study. SETTING Inpatient rehabilitation or acute care and community. PARTICIPANTS Care partners (spouse or partner, family member, friend who is in any way responsible for the health or well-being of the care recipient) of individuals with TBI, SCI, burn injury, or stroke (N=39). INTERVENTION PST is a metacognitive self-management intervention that teaches individuals a global strategy for addressing self-selected problems. Participants received up to 6 sessions of PST in person or via telephone during their care recipient's inpatient stay. MAIN OUTCOME MEASURES We measured feasibility of recruitment, intervention delivery, and postintervention use of a smartphone app (Care Partner Problem Solving [CaPPS]) and participant satisfaction (Client Satisfaction Questionnaire [CSQ]) and engagement (Pittsburgh Rehabilitation Participation Scale [PRPS]) with the intervention. RESULTS Of 39 care partners approached, n=10 (25.6%) were ineligible. Of n=29 (74.4%) who were eligible, n=17 (58.6%) refused, and n=12 (41.4%) consented, of whom n=8 (66.7%) completed ≥3 PST sessions. Not perceiving any benefit was the most common reason for refusal, followed by no interest in research. Participants were very satisfied with PST (CSQ mean=3.35, SD=0.60), reported strong working alliance (Working Alliance Inventory mean=6.8, SD=3.1), and demonstrated very good engagement (PRPS mean=4.75, SD=1.41). CaPPS was downloaded and used by only n=3 participants. CONCLUSIONS Delivering a self-management intervention to care partners during the care recipient's acute hospital stay is feasible for a subset of potential participants. Short lengths of stay, language fluency, and perceiving no potential benefit were noted barriers. Boosters via smartphone app have potential, but several barriers must first be overcome.
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Affiliation(s)
- Shannon B. Juengst
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Rehabilitation Counseling, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Candice L. Osborne
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Radha Holavanahalli
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Valeria Silva
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Chung Lin Kew
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Rehabilitation Counseling, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Andrew Nabasny
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Rehabilitation Counseling, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kathleen R. Bell
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
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Cole WR, Brockway JA, Fann JR, Ahrens AP, Hurst S, Hart T, Vuletic S, Bush N, Bell KR. Expressions of emotional distress in active duty military personnel with mild traumatic brain injury: A qualitative content analysis. MILITARY PSYCHOLOGY 2019. [DOI: 10.1080/08995605.2018.1503022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Wesley R. Cole
- Defense and Veterans Brain Injury Center, GDHS, Intrepid Spirit, Fort Bragg, North Carolina
| | - Jo Ann Brockway
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Jesse R. Fann
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Angelica P. Ahrens
- Defense and Veterans Brain Injury Center, GDHS, Intrepid Spirit, Fort Bragg, North Carolina
| | - Samantha Hurst
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California
| | - Tessa Hart
- Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania
| | - Simona Vuletic
- National Center for Telehealth and Technology (T2), Joint Base Lewis-McChord, Washington
| | - Nigel Bush
- National Center for Telehealth and Technology (T2), Joint Base Lewis-McChord, Washington
- Psychological Health Center of Excellence, Defense Health Agency, Joint Base Lewis-McChord, Washington
| | - Kathleen R. Bell
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, Texas
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Cooper DC, Bates MJ. Military Health Provider Training and Evaluation of a Problem-Solving Intervention to Reduce Distress and Enhance Readiness Among Service Members. Mil Med 2018; 184:e303-e311. [DOI: 10.1093/milmed/usy229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/14/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Denise C Cooper
- Psychological Health Center of Excellence (PHCoE), Defense Health Headquarters, 7700 Arlington Blvd, Suite 5101, Box #22 (Silver Spring Office), Falls Church, VA
| | - Mark J Bates
- Psychological Health Center of Excellence (PHCoE), Defense Health Headquarters, 7700 Arlington Blvd, Suite 5101, Box #22 (Silver Spring Office), Falls Church, VA
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Asi YM, Williams C. The role of digital health in making progress toward Sustainable Development Goal (SDG) 3 in conflict-affected populations. Int J Med Inform 2017; 114:114-120. [PMID: 29126701 DOI: 10.1016/j.ijmedinf.2017.11.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 10/30/2017] [Accepted: 11/04/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE The progress of the Millennium Development Goals (MDGs) shows that sustained global action can achieve success. Despite the unprecedented achievements in health and education, more than one billion people, many of them in conflict-affected areas, were unable to reap the benefits of the MDG gains. The recently developed Sustainable Development Goals (SDGs) are even more ambitious then their predecessor. SDG 3 prioritizes health and well-being for all ages in specific areas such as maternal mortality, communicable diseases, mental health, and healthcare workforce. However, without a shift in the approach used for conflict-affected areas, the world's most vulnerable people risk being left behind in global development yet again. We must engage in meaningful discussions about employing innovative strategies to address health challenges fragile, low-resource, and often remote settings. In this paper, we will argue that to meet the ambitious health goals of SDG 3, digital health can help to bridge healthcare gaps in conflict-affected areas. METHODS First, we describe the health needs of populations in conflict-affected environments, and how they overlap with the SDG 3 targets. Secondly, we discuss how digital health can address the unique needs of conflict-affected areas. Finally, we evaluate the various challenges in deploying digital technologies in fragile environments, and discuss potential policy solutions. DISCUSSION Persons in conflict-affected areas may benefit from the diffusive nature of digital health tools. Innovations using cellular technology or cloud-based solutions overcome physical barriers. Additionally, many of the targets of SDG 3 could see significant progress if efficacious education and outreach efforts were supported, and digital health in the form of mHealth and telehealth offers a relatively low-resource platform for these initiatives. Lastly, lack of data collection, especially in conflict-affected or otherwise fragile states, was one of the primary limitations of the MDGs. Greater investment in data collection efforts, supported by digital health technologies, is necessary if SDG 3 targets are to be measured and progress assessed. Standardized EMR systems as well as context-specific data warehousing efforts will assist in collecting and managing accurate data. Stakeholders such as patients, providers, and NGOs, must be proactive and collaborative in their efforts for continuous progress toward SDG 3. Digital health can assist in these inter-organizational communication efforts. CONCLUSION The SDGS are complex, ambitious, and comprehensive; even in the most stable environments, achieving full completion towards every goal will be difficult, and in conflict-affected environments, this challenge is much greater. By engaging in a collaborative framework and using the appropriate digital health tools, we can support humanitarian efforts to realize sustained progress in SDG 3 outcomes.
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Affiliation(s)
- Yara M Asi
- Department of Health Management and Informatics, College of Health and Public Affairs, University of Central Florida, Orlando, FL, United States.
| | - Cynthia Williams
- Department of Public Health, Brooks College of Health, University of North Florida, Jacksonville, FL, United States.
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Impact of Telephone-Based Problem-Solving Treatment on the Use of Medical and Psychological Services in the Military. J Head Trauma Rehabil 2017; 33:E1-E6. [PMID: 28422894 DOI: 10.1097/htr.0000000000000299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To explore the impact of problem-solving treatment (PST) for mild traumatic brain injury in active duty service members on the use of medical and psychological services. PARTICIPANTS Service members who had a mild traumatic brain injury during their last deployment and enrolled in the CONcussion Treatment After Combat Trauma (CONTACT) study. DESIGN Secondary analysis of a randomized clinical trial. Participants were assigned to telephone-based PST, or e-mailed or mailed education only over the course of 6 months. MAIN MEASURE Self-reported health service utilization from months 4 through 6 and 10 through 12 after initiation of treatment, using the Cornell Service Index. RESULTS In months 4 to 6, participants receiving PST had 6.17 times the odds of an emergency department visit or hospitalization than those receiving education only (95% confidence interval = 1.92-19.8; P value = .0023). These estimates, however, were not significant using a conservative Bonferroni correction (P value threshold < .0014). There were no other significant differences for other medical or psychological services received in months 4 to 6 or 10 to 12. CONCLUSION Telephone-based PST was designed to complement clinical care, and this study showed that it may increase emergency department utilization. Future evaluations of PST with more accurate and complete measures of health service utilization are needed.
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Bell KR, Fann JR, Brockway JA, Cole WR, Bush NE, Dikmen S, Hart T, Lang AJ, Grant G, Gahm G, Reger MA, St De Lore J, Machamer J, Ernstrom K, Raman R, Jain S, Stein MB, Temkin N. Telephone Problem Solving for Service Members with Mild Traumatic Brain Injury: A Randomized, Clinical Trial. J Neurotrauma 2016; 34:313-321. [PMID: 27579992 DOI: 10.1089/neu.2016.4444] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Mild traumatic brain injury (mTBI) is a common injury for service members in recent military conflicts. There is insufficient evidence of how best to treat the consequences of mTBI. In a randomized, clinical trial, we evaluated the efficacy of telephone-delivered problem-solving treatment (PST) on psychological and physical symptoms in 356 post-deployment active duty service members from Joint Base Lewis McChord, Washington, and Fort Bragg, North Carolina. Members with medically confirmed mTBI sustained during deployment to Iraq and Afghanistan within the previous 24 months received PST or education-only (EO) interventions. The PST group received up to 12 biweekly telephone calls from a counselor for subject-selected problems. Both groups received 12 educational brochures describing common mTBI and post-deployment problems, with follow-up for all at 6 months (end of PST), and at 12 months. At 6 months, the PST group significantly improved on a measure of psychological distress (Brief Symptom Inventory; BSI-18) compared to the EO group (p = 0.005), but not on post-concussion symptoms (Rivermead Post-Concussion Symptoms Questionnaire [RPQ]; p = 0.19), the two primary endpoints. However, these effects did not persist at 12-month follow-up (BSI, p = 0.54; RPQ, p = 0.45). The PST group also had significant short-term improvement on secondary endpoints, including sleep (p = 0.01), depression (p = 0.03), post-traumatic stress disorder (p = 0.04), and physical functioning (p = 0.03). Participants preferred PST over EO (p < 0.001). Telephone-delivered PST appears to be a well-accepted treatment that offers promise for reducing psychological distress after combat-related mTBI and could be a useful adjunct treatment post-mTBI. Further studies are required to determine how to sustain its effects. (Trial registration: ClinicalTrials.gov Identifier: NCT01387490 https://clinicaltrials.gov ).
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Affiliation(s)
- Kathleen R Bell
- 1 Department of Rehabilitation Medicine, University of Washington , Seattle, Washington
| | - Jesse R Fann
- 1 Department of Rehabilitation Medicine, University of Washington , Seattle, Washington.,2 Department of Psychiatry and Behavioral Sciences, University of Washington , Seattle, Washington
| | - Jo Ann Brockway
- 1 Department of Rehabilitation Medicine, University of Washington , Seattle, Washington
| | - Wesley R Cole
- 3 Defense and Veterans Brain Injury Center, Intrepid Spirit, Womack Army Medical Center , Fort Bragg, North Carolina
| | - Nigel E Bush
- 4 National Center for Telehealth and Technology , Joint Base Lewis McChord, Tacoma, Washington
| | - Sureyya Dikmen
- 1 Department of Rehabilitation Medicine, University of Washington , Seattle, Washington.,5 Department of Neurological Surgery, University of Washington , Seattle, Washington
| | - Tessa Hart
- 6 Moss Rehabilitation Research Institute , Elkins Park, Pennsylvania
| | - Ariel J Lang
- 7 Department of Psychiatry, University California San Diego and VA San Diego Healthcare System Center of Excellence for Stress and Mental Health , La Jolla, California
| | - Gerald Grant
- 8 Department of Surgery, Duke University , Durham, North Carolina
| | - Gregory Gahm
- 4 National Center for Telehealth and Technology , Joint Base Lewis McChord, Tacoma, Washington
| | - Mark A Reger
- 4 National Center for Telehealth and Technology , Joint Base Lewis McChord, Tacoma, Washington
| | - Jef St De Lore
- 5 Department of Neurological Surgery, University of Washington , Seattle, Washington
| | - Joan Machamer
- 1 Department of Rehabilitation Medicine, University of Washington , Seattle, Washington
| | - Karin Ernstrom
- 9 Department of Family Medicine and Public Health, University of California San Diego , La Jolla, California
| | - Rema Raman
- 9 Department of Family Medicine and Public Health, University of California San Diego , La Jolla, California
| | - Sonia Jain
- 9 Department of Family Medicine and Public Health, University of California San Diego , La Jolla, California
| | - Murray B Stein
- 7 Department of Psychiatry, University California San Diego and VA San Diego Healthcare System Center of Excellence for Stress and Mental Health , La Jolla, California.,9 Department of Family Medicine and Public Health, University of California San Diego , La Jolla, California
| | - Nancy Temkin
- 1 Department of Rehabilitation Medicine, University of Washington , Seattle, Washington.,5 Department of Neurological Surgery, University of Washington , Seattle, Washington.,10 Department of Biostatistics, University of Washington , Seattle, Washington
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10
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Hart T, Fann JR, Chervoneva I, Juengst SB, Rosenthal JA, Krellman JW, Dreer LE, Kroenke K. Prevalence, Risk Factors, and Correlates of Anxiety at 1 Year After Moderate to Severe Traumatic Brain Injury. Arch Phys Med Rehabil 2016; 97:701-7. [DOI: 10.1016/j.apmr.2015.08.436] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 08/21/2015] [Accepted: 08/26/2015] [Indexed: 10/22/2022]
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Telephone Problem-Solving Treatment Improves Sleep Quality in Service Members With Combat-Related Mild Traumatic Brain Injury. J Head Trauma Rehabil 2016; 31:147-57. [DOI: 10.1097/htr.0000000000000221] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Sturrock BA, Holloway E, Keefe J, Hegel M, Casten R, Mellor D, Rees G. Rehabilitation staff perspectives on training for problem-solving therapy for primary care in a low vision service. BRITISH JOURNAL OF VISUAL IMPAIRMENT 2015. [DOI: 10.1177/0264619615610159] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Vision rehabilitation staff were trained to deliver problem-solving therapy for primary care (PST-PC) over the telephone to adults with depressive symptoms and low vision. Training was a 2-day workshop, completion of training cases, and assessment of treatment fidelity. Staff perspectives of training and challenges in PST-PC delivery were explored. Telephone-administered semi-structured interviews were conducted pre- and post-workshop and following PST-PC competency. In all, 14 staff (mean age = 47.64 years, SD = 12.68 years, 93% females) achieved competency and 6 withdrew. Results showed an increased understanding of PST-PC from pre- to post-workshop ( Z = −2.71, p = .007) and pre-workshop to post-competency ( Z = −3.09, p = .002). A high level of satisfaction with training was reported. Staff challenges included the clients’ ability to define problems and brainstorm solutions. Training enabled staff to competently deliver PST-PC and may serve as a model for integrating depression care into vision rehabilitation services recommended by international guidelines.
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