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Conklin JP, Wallace T, McCauley KL, Breitenstein J, Gore RK. Level of Evidence of Telehealth Rehabilitation and Behavioral Health Services for Traumatic Brain Injury: A Scoping Review. J Clin Psychol Med Settings 2024; 31:379-402. [PMID: 37903966 DOI: 10.1007/s10880-023-09981-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 11/01/2023]
Abstract
Traumatic brain injury (TBI) can result in significant impairments in functioning associated with partial or permanent disabilities. Examining the evidence for domain-specific telehealth interventions is necessary to guide the development of effective clinical and research programs for this population. The present scoping review characterizes the level of evidence across a range of TBI-related disabilities and impairments. A literature search was performed across comprehensive databases using search terms related to TBI, rehabilitation, telehealth, and outcome. A total of 19 publications from 17 studies met inclusion criteria. Articles focused on telehealth interventions to improve global, cognitive, emotional, and physical functioning post-TBI. Levels of evidence ranged from 1 to 4 across domains, with predominantly experimental designs (level 1). Outcomes demonstrating improvement or benefit from telehealth treatments were reported across all functional domains (50-80% of studies). Results highlight the potential of telehealth interventions across the span of comprehensive interdisciplinary rehabilitation care. Expanded research is needed on remote treatment options for physical symptoms, for subgroups within TBI populations (i.e., mild TBI, military populations), as well as on remote and hybrid comprehensive rehabilitation programs.
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Affiliation(s)
- Jessica P Conklin
- SHARE Military Initiative, Shepherd Center, 80 Peachtree Park Drive NE, Atlanta, GA, 30309, USA
| | - Tracey Wallace
- SHARE Military Initiative, Shepherd Center, 80 Peachtree Park Drive NE, Atlanta, GA, 30309, USA.
| | - Katherine L McCauley
- SHARE Military Initiative, Shepherd Center, 80 Peachtree Park Drive NE, Atlanta, GA, 30309, USA
| | - Jackie Breitenstein
- SHARE Military Initiative, Shepherd Center, 80 Peachtree Park Drive NE, Atlanta, GA, 30309, USA
| | - Russell K Gore
- SHARE Military Initiative, Shepherd Center, 80 Peachtree Park Drive NE, Atlanta, GA, 30309, USA
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Krese KA, Donnelly KZ, Etingen B, Bender Pape TL, Chaudhuri S, Aaronson AL, Shah RP, Bhaumik DK, Billups A, Bedo S, Wanicek-Squeo MT, Bobra S, Herrold AA. Feasibility of a Combined Neuromodulation and Yoga Intervention for Mild Traumatic Brain Injury and Chronic Pain: Protocol for an Open-label Pilot Trial. JMIR Res Protoc 2022; 11:e37836. [PMID: 35704372 PMCID: PMC9244651 DOI: 10.2196/37836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 03/16/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Mild traumatic brain injury (mTBI) and chronic pain often co-occur and worsen rehabilitation outcomes. There is a need for improved multimodal nonpharmacologic treatments that could improve outcomes for both conditions. Yoga is a promising activity-based intervention for mTBI and chronic pain, and neuromodulation through transcranial magnetic stimulation is a promising noninvasive, nonpharmacological treatment for mTBI and chronic pain. Intermittent theta burst stimulation (iTBS) is a type of patterned, excitatory transcranial magnetic stimulation. iTBS can induce a window of neuroplasticity, making it ideally suited to boost the effects of treatments provided after it. Thus, iTBS may magnify the impacts of subsequently delivered interventions as compared to delivering those interventions alone and accordingly boost their impact on outcomes. OBJECTIVE The aim of this study is to (1) develop a combined iTBS+yoga intervention for mTBI and chronic pain, (2) assess the intervention's feasibility and acceptability, and (3) gather preliminary clinical outcome data on quality of life, function, and pain that will guide future studies. METHODS This is a mixed methods, pilot, open-labeled, within-subject intervention study. We will enroll 20 US military veteran participants. The combined iTBS+yoga intervention will be provided in small group settings once a week for 6 weeks. The yoga intervention will follow the LoveYourBrain yoga protocol-specifically developed for individuals with TBI. iTBS will be administered immediately prior to the LoveYourBrain yoga session. We will collect preliminary quantitative outcome data before and after the intervention related to quality of life (TBI-quality of life), function (Mayo-Portland Adaptability Index), and pain (Brief Pain Inventory) to inform larger studies. We will collect qualitative data via semistructured interviews focused on intervention acceptability after completion of the intervention. RESULTS This study protocol was approved by Edward Hines Jr Veterans Administration Hospital Institutional Review Board (Hines IRB 1573116-4) and was prospectively registered on ClinicalTrials.gov (NCT04517604). This study includes a Food and Drug Administration Investigational Device Exemption (IDE: G200195). A 2-year research plan timeline was developed. As of March 2022, a total of 6 veterans have enrolled in the study. Data collection is ongoing and will be completed by November 2022. We expect the results of this study to be available by October 2024. CONCLUSIONS We will be able to provide preliminary evidence of safety, feasibility, and acceptability of a novel combined iTBS and yoga intervention for mTBI and chronic pain-conditions with unmet treatment needs. TRIAL REGISTRATION ClinicalTrials.gov NCT04517604; https://www.clinicaltrials.gov/ct2/show/NCT04517604. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/37836.
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Affiliation(s)
- Kelly A Krese
- Brain Innovation Center, Shirley Ryan AbilityLab, Chicago, IL, United States
- Research and Development Service, Edward Hines Jr Veterans Administration Hospital, Hines, IL, United States
| | | | - Bella Etingen
- Center for Innovation in Complex Chronic Healthcare & Research Service, Edward Hines Jr Veterans Administration Hospital, Hines, IL, United States
| | - Theresa L Bender Pape
- Research and Development Service, Edward Hines Jr Veterans Administration Hospital, Hines, IL, United States
- Center for Innovation in Complex Chronic Healthcare & Research Service, Edward Hines Jr Veterans Administration Hospital, Hines, IL, United States
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Sarmistha Chaudhuri
- Department of Physical Medicine and Rehabilitation, Edward Hines Jr Veterans Administration Hospital, Hines, IL, United States
| | - Alexandra L Aaronson
- Mental Health Service Line, Edward Hines Jr Veterans Administration Hospital, Hines, IL, United States
- Department of Psychiatry, Feinberg School of Medicine, Northwestern University, Hines, IL, United States
| | - Rachana P Shah
- Department of Physical Medicine and Rehabilitation, Edward Hines Jr Veterans Administration Hospital, Hines, IL, United States
| | - Dulal K Bhaumik
- Research and Development Service, Edward Hines Jr Veterans Administration Hospital, Hines, IL, United States
- Department of Psychiatry, University of Illinois Chicago, Chicago, IL, United States
| | - Andrea Billups
- Research and Development Service, Edward Hines Jr Veterans Administration Hospital, Hines, IL, United States
| | - Sabrina Bedo
- Department of Physical Medicine and Rehabilitation, Edward Hines Jr Veterans Administration Hospital, Hines, IL, United States
- Recreation Therapy, Edward Hines Jr Veterans Administration Hospital, Hines, IL, United States
| | - Mary Terese Wanicek-Squeo
- Recreation Therapy, Edward Hines Jr Veterans Administration Hospital, Hines, IL, United States
- Edward Hines Jr Veterans Administration Hospital, Hines, IL, United States
| | - Sonia Bobra
- Department of Radiology, Edward Hines Jr Veterans Administration Hospital, Hines, IL, United States
- Department of Radiology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States
| | - Amy A Herrold
- Research and Development Service, Edward Hines Jr Veterans Administration Hospital, Hines, IL, United States
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Pierre K, Clark A, Felisma P, Weisman S, Lucke-Wold B. Neurologic Injury and Dementia: Update on Current Physiotherapeutic Intervention. ARCHIVES OF EMERGENCY MEDICINE AND CRITICAL CARE 2022; 6:1050. [PMID: 36468938 PMCID: PMC9717692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Neurologic injury and dementia can lead to devastating outcomes for patients with extended course of disease. Secondary and tertiary injury can progress and lead to continued deficits and rapid neurodegeneration. In this review, we highlight alternative strategies that can target recovery for these patients and prevent further neurologic decline. We discuss the benefit of music therapy and acupuncture. We then look at transcranlal magnetic stimulation and transcranial direct current stimulation. Finally, we look at the role of yoga and virtual reality. While several of these modalities are in their infancy, some have been used for generations. We argue for higher quality evidence to confirm effectiveness and clinical utility.
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Affiliation(s)
- Kevin Pierre
- Department of Neurosurgery, University of Florida, USA
| | - Alec Clark
- College of Medicine, University of Central Florida, USA
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Donovan ML, Forster JE, Betthauser LM, Stamper C, Penzenik M, Hernández TD, Bahraini N, Brenner LA. Association between perceived distress and salivary cortisol in veterans with mTBI. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2022; 10:100123. [PMID: 35755197 PMCID: PMC9216265 DOI: 10.1016/j.cpnec.2022.100123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/31/2022] [Accepted: 01/31/2022] [Indexed: 11/29/2022] Open
Abstract
Mild traumatic brain injury (mTBI) is one of the most common injuries experienced by Veterans and can frequently result in a variety of post-concussive symptoms. Post-concussive headaches (PCH), one of the most common symptoms, can persist for years after the injury occurred. The long-lasting impacts of PCH can be extremely distressing for Veterans, thus necessitating the need to find reliable biomarkers that directly relate to subjective feelings of distress. Yoga-based interventions have been shown to improve both subjective and objective markers of stress. Techniques used in yoga, such as the focus on releasing muscular tension, are also recommended as strategies for treating PCH. Thus, yoga-based interventions provide a unique context for the comparison of subjective and objective measures of distress in Veterans with PCH. In this secondary, exploratory analysis, we examined the relationship between perceived distress and cortisol in sixteen Veterans with mTBI and long-term PCH within the context of a yoga intervention feasibility study. The Visual Analogue Scale (VAS), a validated tool for measuring subjective distress, was administered to participants immediately before and after 75-min yoga classes, which occurred twice weekly over eight weeks. Participants also provided salivary cortisol (pre- and post-yoga) at in-person sessions (eight) to compare to changes in VAS scores. We found that VAS scores were significantly reduced within five of the eight assessed yoga classes, but there were no significant changes in cortisol levels. No significant correlations were found between VAS scores and salivary cortisol levels. When looking at how cortisol levels changed over time (i.e., over the series of eight yoga sessions), there was a significant downward trajectory in post-yoga cortisol, but not after taking pre-class cortisol into account (i.e., within yoga session cortisol change over time). Taken together, we found that subjective distress, but not cortisol was reduced by yoga classes. These data suggest that salivary cortisol did not match changes in perceived distress, thus emphasizing the ongoing challenges of relating subjective and objective measures. Perceived distress can negatively impact post-concussive symptoms. Efforts are needed to relate objective and subjective measures of distress. Subjective distress and salivary cortisol were examined within yoga sessions. Subjective distress, but not cortisol was reduced within 5 of 8 yoga classes. These data highlight the challenges of relating subjective and objective measures.
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Affiliation(s)
- Meghan L. Donovan
- VA Rocky Mountain Mental Illness Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, 1700 N Wheeling St, Aurora, CO, 80045, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO, 80045, USA
- Corresponding author. VA Rocky Mountain Mental Illness Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, 1700 N Wheeling St, Aurora, CO, 80045, USA.
| | - Jeri E. Forster
- VA Rocky Mountain Mental Illness Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, 1700 N Wheeling St, Aurora, CO, 80045, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO, 80045, USA
| | - Lisa M. Betthauser
- VA Rocky Mountain Mental Illness Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, 1700 N Wheeling St, Aurora, CO, 80045, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO, 80045, USA
| | - Christopher Stamper
- VA Rocky Mountain Mental Illness Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, 1700 N Wheeling St, Aurora, CO, 80045, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO, 80045, USA
| | - Molly Penzenik
- VA Rocky Mountain Mental Illness Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, 1700 N Wheeling St, Aurora, CO, 80045, USA
| | - Theresa D. Hernández
- VA Rocky Mountain Mental Illness Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, 1700 N Wheeling St, Aurora, CO, 80045, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO, 80045, USA
- Department of Psychology and Neuroscience, University of Colorado at Boulder, Muenzinger D244, 345 UCB, Boulder, CO, 80309, USA
| | - Nazanin Bahraini
- VA Rocky Mountain Mental Illness Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, 1700 N Wheeling St, Aurora, CO, 80045, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO, 80045, USA
- Department of Psychiatry, University of Colorado, Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO, 80045, USA
| | - Lisa A. Brenner
- VA Rocky Mountain Mental Illness Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, 1700 N Wheeling St, Aurora, CO, 80045, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO, 80045, USA
- Department of Psychiatry, University of Colorado, Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO, 80045, USA
- Department of Neurology, University of Colorado, Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO, 80045, USA
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Mitchell RJ, Goggins R, Lystad RP. Synthesis of evidence on the use of ecological momentary assessments to monitor health outcomes after traumatic injury: rapid systematic review. BMC Med Res Methodol 2022; 22:119. [PMID: 35459086 PMCID: PMC9027879 DOI: 10.1186/s12874-022-01586-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 03/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With the increasing use of mobile technology, ecological momentary assessments (EMAs) may enable routine monitoring of patient health outcomes and patient experiences of care by health agencies. This rapid review aims to synthesise the evidence on the use of EMAs to monitor health outcomes after traumatic unintentional injury. METHOD A rapid systematic review of nine databases (MEDLINE, Web of Science, Embase, CINAHL, Academic Search Premier, PsychINFO, Psychology and Behavioural Sciences Collection, Scopus, SportDiscus) for English-language articles from January 2010-September 2021 was conducted. Abstracts and full-text were screened by two reviewers and each article critically appraised. Key information was extracted by population characteristics, age and sample size, follow-up time period(s), type of EMA tools, physical health or pain outcome(s), psychological health outcome(s), general health or social outcome(s), and facilitators or barriers of EMA methods. Narrative synthesis was undertaken to identify key EMA facilitator and barrier themes. RESULTS There were 29 articles using data from 25 unique studies. Almost all (84.0%) were prospective cohort studies and 11 (44.0%) were EMA feasibility trials with an injured cohort. Traumatic and acquired brain injuries and concussion (64.0%) were the most common injuries examined. The most common EMA type was interval (40.0%). There were 10 key facilitator themes (e.g. feasibility, ecological validity, compliance) and 10 key barrier themes (e.g. complex technology, response consistency, ability to capture a participant's full experience, compliance decline) identified in studies using EMA to examine health outcomes post-injury. CONCLUSIONS This review highlighted the usefulness of EMA to capture ecologically valid participant responses of their experiences post-injury. EMAs have the potential to assist in routine follow-up of the health outcomes of patients post-injury and their use should be further explored.
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Affiliation(s)
- Rebecca J Mitchell
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia.
| | - Rory Goggins
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - Reidar P Lystad
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
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