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Fisher LB, Tuchman S, Curreri A, Markgraf M, Nyer MB, Cassano P, Iverson G, Fava M, Zafonte R, Pedrelli P. Conducting Clinical Research Remotely for Individuals with Traumatic Brain Injury (TBI) and Depression during the COVID-19 Pandemic: Transitioning from In-Person to Remote Implementation. JMIR Form Res 2021; 5:e28734. [PMID: 34662285 PMCID: PMC8638786 DOI: 10.2196/28734] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 09/18/2021] [Accepted: 10/05/2021] [Indexed: 12/13/2022] Open
Abstract
Background Telehealth has provided many researchers, especially those conducting psychosocial research, with the tools necessary to transition from in-person to remote clinical trials during the COVID-19 pandemic. A growing body of research supports the effectiveness of telemental health for a variety of psychiatric conditions, but few studies have examined telemental health for individuals with comorbid medical diagnoses. Furthermore, little is known about the remote implementation of clinical trials examining telemental health interventions. Objective This paper outlines the procedural modifications used to facilitate conversion of an in-person randomized controlled trial of cognitive behavioral therapy (CBT) for depression in individuals with traumatic brain injury (TBI; CBT-TBI) to a telemental health study administered remotely. Methods Given the nature of remote implementation and specific challenges experienced by individuals with TBI, considerations related to treatment delivery, remote consent, data management, neuropsychological assessment, safety monitoring, and delivery of supportive material have been discussed. Feasibility, acceptability, and safety were evaluated by examining attendance and participant responses on self-report measures of treatment satisfaction and suicidal behavior. Results High rates of treatment attendance, assessment completion, study retention, and satisfaction with the intervention and modality were reported by participants who completed at least one telemental health CBT-TBI session. Conclusions Study modifications are necessary when conducting a study remotely, and special attention should be paid to comorbidities and population-specific challenges (eg, cognitive impairment). Preliminary data support the feasibility, acceptability, and safety of remotely conducting a randomized controlled trial of CBT-TBI. Trial Registration ClinicalTrials.gov NCT03307070; https://clinicaltrials.gov/ct2/show/NCT03307070
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Affiliation(s)
- Lauren B Fisher
- Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square6th Floor, Boston, US.,Department of Psychiatry, Harvard Medical School, Boston, US
| | - Sylvie Tuchman
- Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square6th Floor, Boston, US
| | - Andrew Curreri
- Center for Anxiety and Related Disorders, Boston University, Boston, US
| | - Maggie Markgraf
- Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square6th Floor, Boston, US
| | - Maren B Nyer
- Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square6th Floor, Boston, US.,Department of Psychiatry, Harvard Medical School, Boston, US
| | - Paolo Cassano
- Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square6th Floor, Boston, US.,Department of Psychiatry, Harvard Medical School, Boston, US
| | - Grant Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, US.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, US.,Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, US
| | - Maurizio Fava
- Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square6th Floor, Boston, US.,Department of Psychiatry, Harvard Medical School, Boston, US
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, US.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, US.,Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, US.,Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital and Brigham and Women's Hospital, Boston, US
| | - Paola Pedrelli
- Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square6th Floor, Boston, US.,Department of Psychiatry, Harvard Medical School, Boston, US
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Miller M, Williams R, Pagulayan K, Barber J, Ehde DM, Hoffman J. Correlates of sleep disturbance in Veterans with traumatic brain injury and chronic pain: A cross-sectional study. Disabil Health J 2021; 15:101203. [PMID: 34479850 DOI: 10.1016/j.dhjo.2021.101203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 07/24/2021] [Accepted: 08/23/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Few studies have investigated sleep in Veterans with comorbid traumatic brain injury (TBI) and chronic pain. OBJECTIVE To describe mood and cognitive correlates with sleep disturbance in a sample of Veterans with both TBI and chronic pain. RESEARCH METHOD Cross-sectional, correlational analyses were completed using baseline data from a randomized controlled trial comparing psychosocial treatments for pain in Veterans with TBI. Enrollment occurred between July 2015 and January 2017. Self-report measures of hours slept, insomnia severity, depression and PTSD symptoms were collected along with a brief neuropsychological assessment. RESULTS Participants (n = 221) were an average age of 37.2 years (SD = 8.2) and mostly male (89%). Participants reported sleeping an average of 4.9 h a night (SD = 1.4) with an average Insomnia Severity Index (ISI) score of 17.4 (SD = 5.4) suggesting moderate insomnia symptoms. Fewer hours slept was associated with higher depression scores (r = -0.28, p < 0.001) and slower processing speed (r = 0.23, p < 0.001). Increasing insomnia severity was associated with greater depression (r = 0.57, p < 0.001) and PTSD symptoms (r = 0.44, p < 0.001), and slower processing speed (r = -0.22, p < 0.001). CONCLUSIONS The average ISI score was above the clinical cut off for insomnia diagnosis. Results suggest that those with more severe insomnia symptoms report higher depression and PTSD symptoms as well as exhibit slower processing speed. Improving sleep in this population may be important for improving outcome following TBI.
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Affiliation(s)
- Megan Miller
- VA Puget Sound Health Care System, Seattle, WA, USA.
| | - Rhonda Williams
- VA Puget Sound Health Care System, Seattle, WA, USA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Kathleen Pagulayan
- VA Puget Sound Health Care System, Seattle, WA, USA; Department of Psychiatry and Behavioural Sciences, University of Washington, Seattle, WA, USA
| | - Jason Barber
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Dawn M Ehde
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Jeanne Hoffman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
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Santini A, Petruzzo A, Giannetta N, Ruggiero A, Di Muzio M, Latina R. Management of chronic musculoskeletal pain in veterans: a systematic review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021011. [PMID: 33855991 PMCID: PMC8138808 DOI: 10.23750/abm.v92is2.11352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 03/04/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM OF THE WORK Veterans are military with health problems due to military conditions. The improved body armor and operational conditions has reduced the number of deaths, but increased the number of veterans with severe injuries, affected by musculoskeletal pain and associated syndromes, such as post-traumatic stress disorder. Multimodal approaches are considered in USA the gold standard for the treatment of these problems, while in Europe and Italy the data are unknown. The aim of this review was to describe and summarize multimodal therapeutic approaches that apply to the veteran population for chronic musculoskeletal pain and relate syndromes management. METHODS A comprehensive systematic review of the literature on Cochrane Library, PubMed, CINAHL e PsycINFO databases was conducted, from 2001 to 2020. RESULTS 228 papers have been found, 134 were selected after the first screening. 24 quantitative studies were included in the review, all from USA. Different multimodal interventions with different kind of treatment types emerged. The analyzed studies' sample size was 11 million (mean age = 57.67 years; SD=±11.94). The multimodal approaches showed a significant improvement in all outcomes (pain reduction and control, opioid therapy reduction, psychosocial outcomes) compared to traditional therapy. CONCLUSIONS Multimodal therapeutic approaches seem to guarantee a good management chronic musculoskeletal pain and related mental disorders, and the reduction and control to opioid use. Military nurses emerged as professionals who have a central role in this approach. European and Italian authorities should consider veterans, in order to assess their expected increase in the future.
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Affiliation(s)
| | - Antonio Petruzzo
- School of Nursing Science and Midwifery, Sapienza University of Rome, A.O. S. Camillo-Forlanini Hospital, Rome, Italy.
| | - Noemi Giannetta
- Vita-Salute San Raffaele University, Tor Vergata, University of Rome, Italy.
| | - Antonio Ruggiero
- School of Nursing Science and Midwifery, Sapienza University of Rome, A.O. S. Camillo-Forlanini Hospital, Rome, Italy.
| | - Marco Di Muzio
- Department of Molecular Medicine, Sapienza University of Rome, Italy.
| | - Roberto Latina
- School of Nursing Science and Midwifery, Sapienza University of Rome, A.O. S. Camillo-Forlanini Hospital, Rome, Italy.
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McGeary C, Nabity P, Reed D, Cobos B, Eapen B, Pugh MJ, Jaramillo C, Potter J, Houle T, Young-McCaughan S, Peterson A, McGeary D. A test of the fear avoidance model to predict chronic pain outcomes in a polytrauma sample. NeuroRehabilitation 2020; 47:35-43. [PMID: 32675428 DOI: 10.3233/nre-203084] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Chronic musculoskeletal pain is a complex problem, particularly for individuals with head injury and comorbid psychiatric conditions. The Fear Avoidance Model offers one of the strongest opportunities to conceptualize comorbid traumatic injury and pain, but this model is largely untested. OBJECTIVE This study tests the Fear Avoidance Model of chronic pain using a sample from a study of polytrauma patients in a large Department of Veterans Affairs facility who participated in a federally-funded study of interdisciplinary chronic pain management. METHODS The present study comprises a secondary analysis of 93 veterans with chronic pain, head injury, posttraumatic stress symptoms and a history of persistent opioid use. Standardized measures of Fear Avoidance Model risk factors (e.g., pain catastrophizing, fear avoidance beliefs, anxiety, depression) were examined as cross-sectional predictors of pain-related disability. RESULTS Secondary data analysis revealed that Fear Avoidance Model factors accounted for almost 40% of the variance in pain-related disability, with pain catastrophizing and depression demonstrating the strongest relationships with disability. A summary variable combining all four factors revealed a 6% increase in disability for each factor that was clinically significant for the sample patients. CONCLUSIONS This study represents the first attempt to examine a complex, theoretical model of pain in a comorbid pain and TBI sample. Findings revealed a strong relationship between this model and pain-related disability that outperforms pain intensity ratings. This model could be used to guide better treatment for comorbid pain and TBI.
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Affiliation(s)
- Cindy McGeary
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, USA
| | - Paul Nabity
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, USA
| | - David Reed
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, USA
| | - Briana Cobos
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, USA
| | - Blessen Eapen
- Department of Physical Medicine and Rehabilitation, University of California, Los Angeles, USA
| | - Mary Jo Pugh
- Department of Medicine, University of Utah Health Sciences Center, USA
| | - Carlos Jaramillo
- Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, USA
| | - Jennifer Potter
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, USA
| | - Timothy Houle
- Department of Anesthesia, Massachusetts General Hospital, USA
| | | | - Alan Peterson
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, USA
| | - Don McGeary
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, USA.,Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, USA
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