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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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Suarilah I, Zulkarnain H, Saragih ID, Lee BO. Effectiveness of telehealth interventions among traumatic brain injury survivors: A systematic review and meta-analysis. J Telemed Telecare 2024; 30:781-794. [PMID: 35656767 DOI: 10.1177/1357633x221102264] [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] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Traumatic brain injury (TBI) represents a major cause of death and disability worldwide. Brain damage is associated with physical and psychological difficulties among TBI survivors. Diverse face-to-face and telehealth programs exist to help survivors cope with these burdens. However, the effectiveness of telehealth interventions among TBI survivors remains inconclusive. METHODS A systematic review and meta-analysis of randomized control trials were conducted. Relevant full-text articles were retrieved from seven databases, from database inception to January 2022, including Academic Search Complete, CINAHL, EMBASE, Cochrane, MEDLINE, PubMed, and Web of Science. Bias was assessed with the revised Cochrane risk-of-bias tool for randomized trials. A meta-analysis was performed using a random-effects model to calculate the pooled effect size of telehealth interventions for TBI survivors. STATA 16.0 was used for statistical analysis. RESULTS In total, 17 studies (N = 3158) applying telehealth interventions among TBI survivors were included in the analysis. Telehealth interventions decreased neurobehavioural symptom (standardized mean difference: -0.13; 95% confidence interval [CI]: -0.36 to 0.10), reduce depression (standardized mean difference: -0.32; 95% CI: -0.79 to 0.14), and increase symptom management self-efficacy (standardized mean difference: 0.22; 95% CI: 0.02-0.42). DISCUSSION Telehealth interventions are promising avenues for healthcare delivery due to advances in technology and information. Telehealth programs may represent windows of opportunity, combining traditional treatment with rehabilitation to increase symptom management self-efficacy among TBI patients during recovery. Future telehealth programs can focus on developing the contents of telehealth modules based on evidence from this study.
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Affiliation(s)
- Ira Suarilah
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
| | | | | | - Bih-O Lee
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
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3
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Boulos ME, Colella B, Meusel LA, Sharma B, Peter MK, Worthington T, Green REA. Feasibility of group telerehabilitation for individuals with chronic acquired brain injury: integrating clinical care and research. Disabil Rehabil 2024; 46:750-762. [PMID: 36855274 DOI: 10.1080/09638288.2023.2177357] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 02/02/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Acquired brain injury (ABI) is a leading cause of lifelong disability, but access to treatment in the chronic stages has significant barriers. Group-based, remotely delivered neurorehabilitation reduces costs, travel barriers, and infection risk; however, its feasibility for patients with ABI is not well-established. OBJECTIVES To investigate the feasibility of remotely group-based cognitive and mood therapies for persons with chronic ABI. METHODS Three hundred and eighty-eight adults with chronic ABI participated in group tele-neurorehabilitation modules comprising Cognitive Behavioral Therapy, Goal Management Training®, Relaxation and Mindfulness Skills Training, and/or a novel Concussion Education & Symptom Management program. Assessments comprised quantitative metrics, surveys, as well as qualitative semi-structured interviews in a subset of participants. RESULTS High retention, adherence, and satisfaction were observed. Facilitators of treatment included accessibility, cost-effectiveness, and convenience. Adoption of technology was high, but other people's technological interruptions were a barrier. Self-reported benefits specific to group-based format included improved mood, stress management, coping, interpersonal relationships, cognitive functioning, and present-mindedness. CONCLUSIONS The present study examined chronic ABI patients' perceptions of telerehabilitation. Patients found remotely delivered, group-based mood, and cognitive interventions feasible with easy technology adoption. Group format was considered a benefit. Recommendations are provided to inform design of remotely delivered ABI programs.
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Affiliation(s)
- Mary E Boulos
- Cognitive Neurorehabilitation Sciences Lab, KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Brenda Colella
- Cognitive Neurorehabilitation Sciences Lab, KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Liesel-Ann Meusel
- Cognitive Neurorehabilitation Sciences Lab, KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Bhanu Sharma
- Cognitive Neurorehabilitation Sciences Lab, KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Department of Medical Sciences, McMaster University, Hamilton, Canada
| | - Marika K Peter
- Cognitive Neurorehabilitation Sciences Lab, KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Thomas Worthington
- Cognitive Neurorehabilitation Sciences Lab, KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Robin E A Green
- Cognitive Neurorehabilitation Sciences Lab, KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
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Binet É, Ouellet MC, Lebel J, Békés V, Morin CM, Belleville G. Gender Differences in Usage and Subjective Appreciation of an Online Cognitive Behavioral Therapy for Wildfire Evacuees: Descriptive Study. J Clin Med 2022; 11:jcm11226649. [PMID: 36431126 PMCID: PMC9699434 DOI: 10.3390/jcm11226649] [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: 09/20/2022] [Revised: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Based on the most common psychological difficulties of the evacuees from the 2016 Fort McMurray wildfires in Alberta, Canada, a therapist-guided cognitive behavioral self-treatment was developed. This study aimed to explore how gender influences the usage and subjective appreciation of the RESILIENT online treatment. METHODS Our study included 81 English-speaking evacuees with significant posttraumatic symptoms, or with some posttraumatic symptoms accompanied by at least mild depression symptoms or subclinical insomnia, and who logged into the platform at least once. Various usage and subjective appreciation variables were analyzed, including number of completed sessions, number of logins, number of words per session, perceived efforts, perception of usefulness and intention to continue using the different strategies. RESULTS No difference was detected in most objective usage indicators. The number of words written in sessions 7 and 10 was significantly greater for women than for men. Regarding subjective appreciation, men had a greater perception of having put strong efforts in the cognitive restructuring strategy, while women reported in a greater proportion that they wanted to continue using physical exercise as a behavioral activation strategy. CONCLUSIONS Our study offers a first look into how women and men use online treatments, and what their preferences are.
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Affiliation(s)
- Émilie Binet
- School of Psychology, Laval University, 2325 Rue de l’Université, Quebec, QC G1V 0A6, Canada
| | - Marie-Christine Ouellet
- School of Psychology, Laval University, 2325 Rue de l’Université, Quebec, QC G1V 0A6, Canada
| | - Jessica Lebel
- School of Psychology, Laval University, 2325 Rue de l’Université, Quebec, QC G1V 0A6, Canada
| | - Vera Békés
- Ferkauf Graduate School, Yeshiva University, 1165 Morris Park Ave, The Bronx, New York, NY 10461, USA
| | - Charles M. Morin
- School of Psychology, Laval University, 2325 Rue de l’Université, Quebec, QC G1V 0A6, Canada
| | - Geneviève Belleville
- School of Psychology, Laval University, 2325 Rue de l’Université, Quebec, QC G1V 0A6, Canada
- Correspondence:
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Miao M, Rietdijk R, Brunner M, Debono D, Togher L, Power E. Implementation of Web-Based Psychosocial Interventions for Adults With Acquired Brain Injury and Their Caregivers: Systematic Review. J Med Internet Res 2022; 24:e38100. [PMID: 35881432 PMCID: PMC9328122 DOI: 10.2196/38100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 05/16/2022] [Accepted: 06/15/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND More than 135 million people worldwide live with acquired brain injury (ABI) and its many psychosocial sequelae. This growing global burden necessitates scalable rehabilitation services. Despite demonstrated potential to increase the accessibility and scalability of psychosocial supports, digital health interventions are challenging to implement and sustain. The Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework can offer developers and researchers a comprehensive overview of considerations to implement, scale, and sustain digital health interventions. OBJECTIVE This systematic review identified published, peer-reviewed primary evidence of implementation outcomes, strategies, and factors for web-based psychosocial interventions targeting either adults with ABI or their formal or informal caregivers; evaluated and summarized this evidence; synthesized qualitative and quantitative implementation data according to the NASSS framework; and provided recommendations for future implementation. Results were compared with 3 hypotheses which state that complexity (dynamic, unpredictable, and poorly characterized factors) in most or all NASSS domains increases likelihood of implementation failure; success is achievable, but difficult with many complicated domains (containing multiple interacting factors); and simplicity (straightforward, predictable, and few factors) in most or all domains increases the likelihood of success. METHODS From a comprehensive search of MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus, speechBITE, and neuroBITE, we reviewed primary implementation evidence from January 2008 to June 2020. For web-based psychosocial interventions delivered via standard desktop computer, mobile phone, tablet, television, and virtual reality devices to adults with ABI or their formal or informal caregivers, we extracted intervention characteristics, stakeholder involvement, implementation scope and outcomes, study design and quality, and implementation data. Implementation data were both narratively synthesized and descriptively quantified across all 7 domains (condition, technology, value proposition, adopters, organization, wider system, and their interaction over time) and all subdomains of the NASSS framework. Study quality and risk of bias were assessed using the 2018 Mixed Methods Appraisal Tool. RESULTS We identified 60 peer-reviewed studies from 12 countries, including 5723 adults with ABI, 1920 carers, and 50 health care staff. The findings aligned with all 3 hypotheses. CONCLUSIONS Although studies were of low methodological quality and insufficient number to statistically test relationships, the results appeared consistent with recommendations to reduce complexity as much as possible to facilitate implementation. Although studies excluded individuals with a range of comorbidities and sociocultural challenges, such simplification of NASSS domain 1 may have been necessary to advance intervention value propositions (domain 3). However, to create equitable digital health solutions that can be successfully implemented in real-world settings, it is recommended that developers involve people with ABI, their close others, and health care staff in addressing complexities in domains 2 to 7 from the earliest intervention design stages. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42020186387; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020186387. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1177/20552076211035988.
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Affiliation(s)
- Melissa Miao
- University of Technology Sydney, Sydney, Australia
| | | | | | | | | | - Emma Power
- University of Technology Sydney, Sydney, Australia
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Dowling NA, Merkouris SS, Rodda SN, Smith D, Aarsman S, Lavis T, Lubman DI, Austin DW, Cunningham JA, Battersby MW, O SC. GamblingLess: A Randomised Trial Comparing Guided and Unguided Internet-Based Gambling Interventions. J Clin Med 2021; 10:2224. [PMID: 34063826 PMCID: PMC8196610 DOI: 10.3390/jcm10112224] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/10/2021] [Accepted: 05/13/2021] [Indexed: 12/11/2022] Open
Abstract
There is little evidence relating to the effects of adding guidance to internet-based gambling interventions. The primary aim was to compare the effectiveness of an online self-directed cognitive-behavioural gambling program (GamblingLess) with and without therapist-delivered guidance. It was hypothesised that, compared to the unguided intervention, the guided intervention would result in superior improvements in gambling symptom severity, urges, frequency, expenditure, psychological distress, quality of life and help-seeking. A two-arm, parallel-group, randomised trial with pragmatic features and three post-baseline evaluations (8 weeks, 12 weeks, 24 months) was conducted with 206 gamblers (106 unguided; 101 guided). Participants in both conditions reported significant improvements in gambling symptom severity, urges, frequency, expenditure, and psychological distress across the evaluation period, even after using intention-to-treat analyses and controlling for other low- and high-intensity help-seeking, as well as clinically significant changes in gambling symptom severity (69% recovered/improved). The guided intervention resulted in additional improvements to urges and frequency, within-group change in quality of life, and somewhat higher rates of clinically significant change (77% cf. 61%). These findings, which support the delivery of this intervention, suggest that guidance may offer some advantages but further research is required to establish when and for whom human support adds value.
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Affiliation(s)
- Nicki A. Dowling
- School of Psychology, Deakin University, Geelong, VIC 3220, Australia; (S.S.M.); (S.A.); (D.W.A.)
- Melbourne Graduate School of Education, University of Melbourne, Parkville, VIC 3010, Australia
| | - Stephanie S. Merkouris
- School of Psychology, Deakin University, Geelong, VIC 3220, Australia; (S.S.M.); (S.A.); (D.W.A.)
| | - Simone N. Rodda
- School of Psychology, Deakin University, Geelong, VIC 3220, Australia; (S.S.M.); (S.A.); (D.W.A.)
- School of Population Health, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand;
- Turning Point, Eastern Health, 110 Church St, Richmond, VIC 3121, Australia
| | - David Smith
- College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia; (D.S.); (M.W.B.)
| | - Stephanie Aarsman
- School of Psychology, Deakin University, Geelong, VIC 3220, Australia; (S.S.M.); (S.A.); (D.W.A.)
| | - Tiffany Lavis
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5000, Australia;
| | - Dan I. Lubman
- Turning Point, Eastern Health and Monash Addiction Research Centre, Eastern Health Clinical School, Richmond, VIC 3121, Australia;
| | - David W. Austin
- School of Psychology, Deakin University, Geelong, VIC 3220, Australia; (S.S.M.); (S.A.); (D.W.A.)
| | - John A. Cunningham
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London WC2R 2LS, UK;
- Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
| | - Malcolm W. Battersby
- College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia; (D.S.); (M.W.B.)
| | - Seung Chul O
- Faculty of Health, Deakin University, Geelong, VIC 3220, Australia;
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Beedham W, Belli A, Ingaralingam S, Haque S, Upthegrove R. The management of depression following traumatic brain injury: A systematic review with meta-analysis. Brain Inj 2020; 34:1287-1304. [PMID: 32809854 DOI: 10.1080/02699052.2020.1797169] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) is prevalent. Declining mortality has led to increasing survivors with chronic sequalae, including depression. With a lack of guidelines, this review aims to provide a comprehensive, evidence-based summary of the management of depression following TBI. METHODS Systematic searches were conducted for quasi-experimental and randomized controlled trials (RCTs) assessing pharmacotherapy, psychological interventions, and transcranial magnetic stimulation (TMS). Databases searched CENTRAL, Medline, Embase, CINAHL, PsycINFO, Web of Science, and ProQuest dissertations. Data extraction and risk-of-bias tools were used. Where possible, outcomes were combined into meta-analyses. RESULTS 2719 studies were identified. After abstract screening and full-text reading, 34 remained. Prophylactic sertraline significantly reduced the odds of depression (OR (odds ratio) = 0.31 [95%CI (confidence interval) = 0.12 to 0.82]). Meta-analysis of RCT's showed TMS to have the greatest reduction in depression severity (SMD (Standardized-Mean-Difference) = 2.43 [95%CI = 1.24 to 3.61]). Stimulants were the only treatment superior to control (SMD = -1.03 [95%CI = - 1.6 to -0.47]). CONCLUSION Methylphenidate was the most effective pharmacotherapy. Sertraline appears effective for prevention. The efficacy of psychological interventions is unclear. TMS as a combination therapy appears promising. Heterogeneity of study populations and dearth of evidence means results should be interpreted cautiously.
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Affiliation(s)
- William Beedham
- College of Medical and Dental Sciences, University of Birmingham , Birmingham, UK
| | - Antonio Belli
- Consultant Neurosurgeon. Institute of Inflammation and Aging, University of Birmingham , Birmingham, UK
| | - Sathana Ingaralingam
- College of Medical and Dental Sciences, University of Birmingham , Birmingham, UK
| | - Sayeed Haque
- Senior Lecturer in Medical Statistics., University of Birmingham , Birmingham, UK
| | - Rachel Upthegrove
- Professor of Psychiatry and Youth Mental Health. Institute for Mental Health, University of Birmingham , Birmingham, UK
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Abstract
Advances in digital technology have a profound impact on conventional healthcare systems. We examine the trailblazing use of online interventions to enable autonomous psychological care which can greatly enhance individual- and population-level access to services. There is strong evidence supporting online cognitive-behavioural therapy and more engaging programmes are now appearing so as to reduce user 'attrition'. The next generation of autonomous psychotherapy programmes will implement adaptive and personalised responses, moving beyond impersonalised advice on cognitive and behavioural techniques. This will be a more authentic form of psychotherapy that integrates therapy with the actual relationship experiences of the individual user.
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Affiliation(s)
| | | | - Sanaz Fallahkhair
- School of Computing Engineering and Maths, University of Brighton, UK
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Shek AC, Biondi A, Ballard D, Wykes T, Simblett SK. Technology-based interventions for mental health support after stroke: A systematic review of their acceptability and feasibility. Neuropsychol Rehabil 2019; 31:432-452. [PMID: 31833819 DOI: 10.1080/09602011.2019.1701501] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Mental health disturbances are common after stroke and linked to a slower recovery. Current face-to-face treatment options are costly and often inaccessible. Technology advances have made it possible to overcome some of these barriers to deliver technology-based mental health interventions remotely, but we do not know how acceptable and feasible they are. This systematic review aims to provide an examination of the acceptability and feasibility of technology-based mental health interventions provided to stroke patients and evaluate any barriers to their adoption. A total of 13 studies were included investigating interventions targeting non-specific mental health, depression or anxiety. The delivery technologies were: video conferencing, computer programmes, telephones, DVDs, CDs, robot-assisted devices, and personal digital assistants. Rates of refusal to participate were low (7.9-25%). Where satisfaction was reported, this was generally high. Many studies achieved high levels of adherence (up to 89.6%). This was lower for some technologies (e.g., robotic assistive devices). Where dropout occurred, this was for reasons including a decline in health as well as technical difficulties. Overall, the literature displays early evidence of using technology to deliver mental health interventions to patients with stroke. This review has identified factors that the design of future studies should take into consideration.
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Affiliation(s)
- Anthony Chun Shek
- Department of Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Andrea Biondi
- Department of Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dominic Ballard
- Department of Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,NIHR Biomedical Research Centre for Mental Health, The South London and Maudsley NHS Foundation Trust, King's College London, London, UK
| | - Sara Katherine Simblett
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Liu Q, Li R, Qu W, Li B, Yang W, Cui R. Pharmacological and non-pharmacological interventions of depression after traumatic brain injury: A systematic review. Eur J Pharmacol 2019; 865:172775. [DOI: 10.1016/j.ejphar.2019.172775] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/26/2019] [Accepted: 11/01/2019] [Indexed: 12/27/2022]
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Internet-Based Management for Depressive Disorder. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1180:267-276. [PMID: 31784968 DOI: 10.1007/978-981-32-9271-0_14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The advances in the Internet and related technologies may lead to changes in professional roles of psychiatrists and psychotherapists. The application of artificial intelligence (AI) and electronic measurement-based care (eMBC) in the treatment of depressive disorder has addressed more interest. AI could play a role in population health management and patient administration as well as assist physicians to make a decision in the real-world clinical practice. The eMBC strengthens MBC through web/mobile devices and telephone consulting services, to monitor disease progression, and customizes the MBC interface in electronic medical record systems (EMRs).
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Petrozzi MJ, Leaver A, Ferreira PH, Rubinstein SM, Jones MK, Mackey MG. Addition of MoodGYM to physical treatments for chronic low back pain: A randomized controlled trial. Chiropr Man Therap 2019; 27:54. [PMID: 31673330 PMCID: PMC6814139 DOI: 10.1186/s12998-019-0277-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 08/16/2019] [Indexed: 12/21/2022] Open
Abstract
Background Low back pain (LBP) is prevalent, costly and disabling. A biopsychosocial treatment approach involving physical and cognitive behavioural therapy (CBT) is recommended for those with chronic LBP. It is not known if online psychological coaching tools might have a role in the secondary prevention of LBP related disability. To assess the effectiveness of an internet-delivered psychological program (MoodGYM) in addition to standard physical treatment in patients with chronic non-specific LBP at medium risk of ongoing disability. Methods A multisite randomized controlled trial was conducted with 108 participants (aged mean 50.4 ± 13.6 years) with chronic LBP attending one of six private physiotherapy or chiropractic clinics. Disability (Roland Morris Disability Questionnaire) and self-efficacy (Patient Self-Efficacy Questionnaire), were assessed at baseline, post-treatment (8-weeks) with follow-up at six- and twelve-months. Participants were randomized into either the intervention group, MoodGYM plus physical treatments, or the control group which received physical treatments alone. Results No statistically significant between group differences were observed for either disability at post-treatment (Effect size (standardised mean difference) 95% CI) RMD - 0.06 (- 0.45,0.31), 6-months RMD 0.01 (- 0.38,0.39) and 12-months - 0.20 (- 0.62,0.17) or self-efficacy at post-treatment PSEQ 0.06 (- 0.31,0.45), 6-months 0.02 (- 0.36,0.41) and 12-months 0.21 (- 0.16,0.63). Conclusion There was no additional benefit of an internet-delivered CBT program (MoodGYM) to physical treatments in those with chronic non-specific LBP at medium risk of ongoing disability measured at post-treatment, or at 6 and 12 months. Trial registration This trial was prospectively registered with Australian New Zealand Clinical Trials Registry Number (ACTRN) 12615000269538.
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Affiliation(s)
- M. John Petrozzi
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Andrew Leaver
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Paulo H. Ferreira
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | | | - Mairwen K. Jones
- Discipline of Behavioural and Social Sciences in Health, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Martin G. Mackey
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
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Laine A, Välimäki M, Pekurinen V, Löyttyniemi E, Marttunen M, Anttila M. Feasibility, Acceptability, and Preliminary Impacts of Web-Based Patient Education on Patients With Schizophrenia Spectrum Disorder: Quasi-Experimental Cluster Study. J Med Internet Res 2019; 21:e13073. [PMID: 31625952 PMCID: PMC6913382 DOI: 10.2196/13073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 06/25/2019] [Accepted: 08/19/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Web-based interventions are promising tools for increasing the understanding of illness and treatment among patients with serious mental disorders. OBJECTIVE This study aimed to test the feasibility and acceptability of a Web-based patient education intervention using a quasi-experimental cluster design to report feedback on patient education sessions and the website used and to report preliminary evidence of the intervention's impact on patients with schizophrenia spectrum disorder. METHODS A single-blind, parallel, quasi-experimental cluster study over a 6-month period comparing Web-based education (n=33) with a nonequivalent control group (treatment as usual, n=24) for people with schizophrenia spectrum disorder was conducted. Participants (N=57) were recruited from one psychiatric hospital (6 wards). Feasibility was assessed by participants' commitment (refusal rate, dropout rate) to the study. Acceptability was assessed as participants' commitment to the intervention. Patient education sessions and website feedback were assessed by the patients and health care professionals. The preliminary impact of the sessions on patients' self-efficacy, self-esteem, illness cognition, and knowledge level was measured at baseline and follow-ups (8 weeks, 6 months) with self-rated questionnaires. RESULTS The refusal rate among patients was high with no statistically significant difference (69% [74/107] in the intervention group, 76% [76/100] in the control group; P=.21). The same result was found for the dropout rates (48% [16/33] vs 58% [14/24]; P=.46). The acceptability of the intervention was good; 31 participants out of 33 (94%) completed all five sessions. Feedback on the intervention was mainly positive; three out of four subscales of session were rated above the midpoint of 4.0. Feedback on the website was also positive, with a grade of good for content (69%, 20/29 patients; 75%, 21/28 professionals), layout (62%, 18/29 patients; 61%, 17/28 professionals), and usability (62%, 18/29 patients; and 68%, 19/28 professionals). The patients using the intervention had significantly higher scores 6 months after the sessions in self-efficacy (baseline mean 26.12, SD 5.64 vs 6-month mean 29.24, SD 6.05; P=.003) and regarding knowledge level about schizophrenia (mean 11.39, SD 4.65 vs 6-month mean 15.06, SD 5.26; P=.002), and lower scores in the subscale of helplessness in illness cognition (mean 2.26, SD 0.96 vs 6-month mean 1.85, SD 0.59; P=.03). Differences from the control group were not significant. No differences were found in patients' self-esteem or other subscales in illness cognition. CONCLUSIONS The patients were reluctant to participate in the study and tended to drop out before the follow-ups. Once they had participated, their acceptance of the intervention was high. A more effective recruitment strategy and monitoring method will be needed in future studies. To assess the impact of the intervention, a more rigorous study design with an adequately powered sample size will be used in cooperation with outpatient mental health services.
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Affiliation(s)
- Anna Laine
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Maritta Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Virve Pekurinen
- Department of Nursing Science, University of Turku, Turku, Finland
| | | | - Mauri Marttunen
- Institute of Criminology and Legal Policy, University of Helsinki, Helsinki, Finland
- Helsinki University Hospital, Helsinki, Finland
| | - Minna Anttila
- Department of Nursing Science, University of Turku, Turku, Finland
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Efficacy of Telerehabilitation for Adults With Traumatic Brain Injury: A Systematic Review. J Head Trauma Rehabil 2019; 33:E33-E46. [PMID: 29084100 DOI: 10.1097/htr.0000000000000350] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify and appraise studies evaluating the efficacy of telerehabilitation for adults with traumatic brain injury (TBI). METHODS A systematic search of Cochrane Library, MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and PsycINFO databases was conducted from January 1980 to April 23, 2017, for studies evaluating the efficacy of telerehabilitation for adults with TBI. Two reviewers independently assessed articles for eligibility and rated methodological quality using 16 criteria related to internal validity, descriptive, and statistical characteristics. RESULTS The review yielded 13 eligible studies, including 10 randomized controlled trials and 3 pre-/postgroup studies (n ≥ 10). These evaluated the feasibility and/or efficacy of telephone-based (10 studies) and Internet-based (3 studies) interventions. Overall, the evidence of efficacy was somewhat mixed. The most common study design evaluated the efficacy of telephone-based interventions relative to usual care, for which 4 of 5 randomized controlled trials reported positive effects at postintervention (d = 0.28-0.51). For these studies, improvements in global functioning, posttraumatic symptoms and sleep quality, and depressive symptoms were reported. The feasibility of Internet-based interventions was generally supported; however, the efficacy could not be determined because of insufficient studies. CONCLUSIONS Structured telephone interventions were found to be effective for improving particular outcomes following TBI. Controlled studies of Internet-based therapy and comparisons of the clinical and cost-effectiveness of in-person and telerehabilitation formats are recommended for future research.
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15
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Clunne SJ, Ryan BJ, Hill AJ, Brandenburg C, Kneebone I. Accessibility and Applicability of Currently Available e-Mental Health Programs for Depression for People With Poststroke Aphasia: Scoping Review. J Med Internet Res 2018; 20:e291. [PMID: 30514696 PMCID: PMC6299232 DOI: 10.2196/jmir.9864] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 07/19/2018] [Accepted: 08/21/2018] [Indexed: 02/07/2023] Open
Abstract
Background Depression affects approximately 60% of people with aphasia 1 year post stroke and is associated with disability, lower quality of life, and mortality. Web-delivered mental health (e-mental health) programs are effective, convenient, and cost-effective for the general population and thus are increasingly used in the management of depression. However, it is unknown if such services are applicable and communicatively accessible to people with poststroke aphasia. Objective The aim of this study was to identify freely available e-mental health programs for depression and determine their applicability and accessibility for people with poststroke aphasia. Methods A Web-based search was conducted to identify and review freely available e-mental health programs for depression. These programs were then evaluated in terms of their (1) general features via a general evaluation tool, (2) communicative accessibility for people with aphasia via an aphasia-specific communicative accessibility evaluation tool, and (3) empirical evidence for the general population and stroke survivors with and without aphasia. The program that met the most general evaluation criteria and aphasia-specific communicative accessibility evaluation criteria was then trialed by a small subgroup of people with poststroke aphasia. Results A total of 8 programs were identified. Of these, 4 had published evidence in support of their efficacy for use within the general population. However, no empirical evidence was identified that specifically supported any programs’ use for stroke survivors with or without aphasia. One evidence-based program scored at least 80% (16/19 and 16/20, respectively) on both the general and aphasia-specific communicative accessibility evaluation tools and was subject to a preliminary trial by 3 people with poststroke aphasia. During this trial, participants were either unable to independently use the program or gave it low usability scores on a post-trial satisfaction survey. On this basis, further evaluation was considered unwarranted. Conclusions Despite fulfilling majority of the general evaluation and aphasia-specific evaluation criteria, the highest rated program was still found to be unsuitable for people with poststroke aphasia. Thus, e-mental health programs require substantial redevelopment if they are likely to be useful to people with poststroke aphasia.
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Affiliation(s)
- Stephanie Jane Clunne
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Brooke Jade Ryan
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Annie Jane Hill
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Caitlin Brandenburg
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Ian Kneebone
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology, Sydney, Ultimo, Australia
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16
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Rietdijk R, Power E, Brunner M, Togher L. A single case experimental design study on improving social communication skills after traumatic brain injury using communication partner telehealth training. Brain Inj 2018; 33:94-104. [DOI: 10.1080/02699052.2018.1531313] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Rachael Rietdijk
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Emma Power
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
- Graduate School of Health, The University of Technology, Sydney, Australia
| | - Melissa Brunner
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
- Graduate School of Health, The University of Technology, Sydney, Australia
| | - Leanne Togher
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
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17
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Telehealth in Physical Medicine and Rehabilitation: A Narrative Review. PM R 2018; 9:S51-S58. [PMID: 28527504 DOI: 10.1016/j.pmrj.2017.02.013] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 02/17/2017] [Accepted: 02/24/2017] [Indexed: 12/11/2022]
Abstract
Telehealth refers to health care interactions that leverage telecommunication devices to provide medical care outside the traditional face-to-face, in-person medical encounter. Technology advances and research have expanded use of telehealth in health care delivery. Physical medicine and rehabilitation providers may use telehealth to deliver care to populations with neurologic and musculoskeletal conditions, commonly treated in both acute care and outpatient settings. Patients with impaired mobility and those living in locations with reduced access to care may particularly benefit. Video-teleconferencing has been shown to be effective for management of burn patients during acute rehabilitation, including reduced health care use expenses and less disruptions to care. Telehealth can facilitate developing interprofessional care plans. Patients with neurologic conditions including stroke, spinal cord injury, traumatic brain injury, and amyotrophic lateral sclerosis may use telehealth to monitor symptoms and response to treatment. Telehealth also may facilitate occupational and physical therapy programs as well as improve weight management and skin care in patients with chronic conditions. Other applications include imaging review in sports medicine, symptom management and counseling in concussion, traumatic brain injury, and pain management programs. Limitations of telehealth include barriers in establishing relationship between medical provider and patient, ability to perform limited physical examination, and differences in payment models and liability coverage. The expansion of telehealth services is expected to grow and has potential to improve patient satisfaction by delivering high quality and value of care.
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18
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Han K, Martinez D, Chapman SB, Krawczyk DC. Neural correlates of reduced depressive symptoms following cognitive training for chronic traumatic brain injury. Hum Brain Mapp 2018; 39:2955-2971. [PMID: 29573026 PMCID: PMC6055759 DOI: 10.1002/hbm.24052] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 02/12/2018] [Accepted: 03/09/2018] [Indexed: 12/24/2022] Open
Abstract
Depression is the most frequent comorbid psychiatric condition among individuals with traumatic brain injury (TBI). Yet, little is known about changes in the brain associated with reduced depressive symptoms following rehabilitation for TBI. We identified whether cognitive training alleviates comorbid depressive symptoms in chronic TBI (>6 months post-injury) as a secondary effect. Further, we elucidated neural correlates of alleviated depressive symptoms following cognitive training. A total of seventy-nine individuals with chronic TBI (53 depressed and 26 non-depressed individuals, measured using the Beck Depressive Inventory [BDI]), underwent either strategy- or information-based cognitive training in a small group for 8 weeks. We measured psychological functioning scores, cortical thickness, and resting-state functional connectivity (rsFC) for these individuals before training, immediately post-training, and 3 months post-training. After confirming that changes in BDI scores were independent of training group affiliation, we identified that the depressive-symptoms group showed reductions in BDI scores over time relative to the non-depressed TBI controls (p < .01). Within the depressive-symptoms group, reduced BDI scores was associated with improvements in scores for post-traumatic stress disorder, TBI symptom awareness, and functional status (p < .00625), increases in cortical thickness in four regions within the right prefrontal cortex (pvertex < .01, pcluster <.05), and decreases in rsFC with each of these four prefrontal regions (pvertex < .01, pcluster < .0125). Overall, these findings suggest that cognitive training can reduce depressive symptoms in TBI even when the training does not directly target psychiatric symptoms. Importantly, cortical thickness and brain connectivity may offer promising neuroimaging markers of training-induced improvement in mental health status in TBI.
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Affiliation(s)
- Kihwan Han
- Center for BrainHealth, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, Texas
| | - David Martinez
- Center for BrainHealth, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, Texas
| | - Sandra B Chapman
- Center for BrainHealth, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, Texas
| | - Daniel C Krawczyk
- Center for BrainHealth, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, Texas.,Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
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19
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Papadatou-Pastou M, Goozee R, Payne E, Barrable A, Tzotzoli P. A review of web-based support systems for students in higher education. Int J Ment Health Syst 2017; 11:59. [PMID: 29021822 PMCID: PMC5613335 DOI: 10.1186/s13033-017-0165-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 09/16/2017] [Indexed: 01/15/2023] Open
Abstract
Background Recent evidence suggests that there is an increasing need for accessible and anonymous services to support higher education (HE) students suffering from psychological and/or academic difficulties. Such difficulties can lead to several negative outcomes, including poor academic performance, sub-optimal mental health, reduced study satisfaction, and dropout from study. Currently, universities in the UK lack financial resources and the on-campus mental health services traditionally offered to students are increasingly economically unsustainable. Compounded by the perceived stigma of using such services, mental health providers have been driven to address the escalating needs of students through online services. Methods In this paper, we review online support systems identified through a literature search and a manual search of references in the identified papers. Further systems were identified through web searches, and systems still in development were identified by consultation with researchers in the field. We accessed systems online to extract relevant information, regarding the main difficulties addressed by the systems, the psychological techniques used and any relevant research evidence to support their effectiveness. Conclusion A large number of web-based support systems have been developed to support mental health and wellbeing, although few specifically target HE students. Further research is necessary to establish the effectiveness of such interventions in providing a cost-effective alternative to face-to-face therapy, particularly in certain settings such as HE institutions.
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Affiliation(s)
- Marietta Papadatou-Pastou
- School of Education, Research Centre for Psychophysiology and Education, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Erika Payne
- University of Derby, Kedleston Rd, Derby, UK
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20
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Richards D, Dowling M, O'Brien E, Viganò N, Timulak L. Significant events in an Internet-delivered (Space from Depression
) intervention for depression. COUNSELLING & PSYCHOTHERAPY RESEARCH 2017. [DOI: 10.1002/capr.12142] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Derek Richards
- E-mental Health Research Group; School of Psychology; University of Dublin; Trinity College Dublin; Dublin Ireland
- SilverCloud Health; Dublin Ireland
| | - Mairéad Dowling
- E-mental Health Research Group; School of Psychology; University of Dublin; Trinity College Dublin; Dublin Ireland
| | - Emma O'Brien
- E-mental Health Research Group; School of Psychology; University of Dublin; Trinity College Dublin; Dublin Ireland
| | - Noemi Viganò
- E-mental Health Research Group; School of Psychology; University of Dublin; Trinity College Dublin; Dublin Ireland
| | - Ladislav Timulak
- E-mental Health Research Group; School of Psychology; University of Dublin; Trinity College Dublin; Dublin Ireland
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21
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Improving Emotion Regulation Following Web-Based Group Intervention for Individuals With Traumatic Brain Injury. J Head Trauma Rehabil 2017; 32:354-365. [DOI: 10.1097/htr.0000000000000345] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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22
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Simblett SK, Yates M, Wagner AP, Watson P, Gracey F, Ring H, Bateman A. Computerized Cognitive Behavioral Therapy to Treat Emotional Distress After Stroke: A Feasibility Randomized Controlled Trial. JMIR Ment Health 2017; 4:e16. [PMID: 28566265 PMCID: PMC5471343 DOI: 10.2196/mental.6022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 03/10/2017] [Accepted: 03/14/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Depression and anxiety are common complications following stroke. Symptoms could be treatable with psychological therapy, but there is little research on its efficacy. OBJECTIVES The aim of this study was to investigate (1) the acceptability and feasibility of computerized cognitive behavioral therapy (cCBT) to treat symptoms of depression and anxiety and (2) a trial design for comparing the efficacy of cCBT compared with an active comparator. METHODS Of the total 134 people screened for symptoms of depression and anxiety following stroke, 28 were cluster randomized in blocks with an allocation ratio 2:1 to cCBT (n=19) or an active comparator of computerized cognitive remediation therapy (cCRT, n=9). Qualitative and quantitative feedback was sought on the acceptability and feasibility of both interventions, alongside measuring levels of depression, anxiety, and activities of daily living before, immediately after, and 3 months post treatment. RESULTS Both cCBT and cCRT groups were rated as near equally useful (mean = 6.4 vs 6.5, d=0.05), while cCBT was somewhat less relevant (mean = 5.5 vs 6.5, d=0.45) but somewhat easier to use (mean = 7.0 vs 6.3, d=0.31). Participants tolerated randomization and dropout rates were comparable with similar trials, with only 3 participants discontinuing due to potential adverse effects; however, dropout was higher from the cCBT arm (7/19, 37% vs 1/9, 11% for cCRT). The trial design required small alterations and highlighted that future-related studies should control for participants receiving antidepressant medication, which significantly differed between groups (P=.05). Descriptive statistics of the proposed outcome measures and qualitative feedback about the cCBT intervention are reported. CONCLUSIONS A pragmatic approach is required to deliver computerized interventions to accommodate individual needs. We report a preliminary investigation to inform the development of a full randomized controlled trial for testing the efficacy of computerized interventions for people with long-term neurological conditions such as stroke and conclude that this is a potentially promising way of improving accessibility of psychological support.
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Affiliation(s)
- Sara K Simblett
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, King's College London, London, United Kingdom.,Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.,National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridgeshire & Peterborough Foundation NHS Trust, Cambridge, United Kingdom
| | - Matthew Yates
- Oliver Zangwill Centre for Neuropsychological Rehabilitation, Ely, United Kingdom
| | - Adam P Wagner
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.,National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridgeshire & Peterborough Foundation NHS Trust, Cambridge, United Kingdom.,Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Peter Watson
- MRC Cognition and Brain Sciences Unit, Cambridge, United Kingdom
| | - Fergus Gracey
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridgeshire & Peterborough Foundation NHS Trust, Cambridge, United Kingdom.,Oliver Zangwill Centre for Neuropsychological Rehabilitation, Ely, United Kingdom.,Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Howard Ring
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridgeshire & Peterborough Foundation NHS Trust, Cambridge, United Kingdom
| | - Andrew Bateman
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.,National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridgeshire & Peterborough Foundation NHS Trust, Cambridge, United Kingdom.,Oliver Zangwill Centre for Neuropsychological Rehabilitation, Ely, United Kingdom
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Beatty L, Binnion C, Kemp E, Koczwara B. A qualitative exploration of barriers and facilitatorsto adherence to an online self-help intervention for cancer-related distress. Support Care Cancer 2017; 25:2539-2548. [PMID: 28299458 DOI: 10.1007/s00520-017-3663-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 03/06/2017] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This study qualitatively explored barriers and facilitators of adherence to an online psychological intervention for cancer-related distress. METHODS Semi-structured interviews were conducted with 13 adults with cancer, randomised to receive either a 6-week intervention (n = 8) or attention control (n = 5) as part of a larger RCT. Transcripts were coded for themes and subthemes, and recruitment ceased when saturation of themes occurred. RESULTS Adherence overall was high: six participants completed all six modules, three completed five modules, two completed four modules, one completed one module, and one did not access the program. The total numbers of barriers (n = 19) and facilitators (n = 17) identified were equivalent and were categorised into five overarching themes: illness factors, psychological factors, personal factors, intervention factors and computer factors. However, the prevalence with which themes were discussed differed: illness factors (specifically cancer treatment side effects) were the main reported barrier to adherence; intervention factors (email reminders, program satisfaction, ease of use, program content) were the most common facilitators. CONCLUSION While some factors were cited as both facilitating and barring adherence, and therefore reflective of personal preferences and circumstances, a number of recommendations were derived regarding (i) the best timing for online interventions and (ii) the need for multi-platform programs.
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Affiliation(s)
- Lisa Beatty
- School of Psychology, Flinders University, Adelaide, Australia.
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, Australia.
| | - Claire Binnion
- School of Psychology, Flinders University, Adelaide, Australia
| | - Emma Kemp
- School of Psychology, Flinders University, Adelaide, Australia
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, Australia
| | - Bogda Koczwara
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, Australia
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24
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Evaluation and Treatment of Mild Traumatic Brain Injury Through the Implementation of Clinical Video Telehealth: Provider Perspectives From the Veterans Health Administration. PM R 2016; 9:231-240. [DOI: 10.1016/j.pmrj.2016.07.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 06/28/2016] [Accepted: 07/09/2016] [Indexed: 11/30/2022]
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25
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Feather JS, Howson M, Ritchie L, Carter PD, Parry DT, Koziol-McLain J. Evaluation Methods for Assessing Users' Psychological Experiences of Web-Based Psychosocial Interventions: A Systematic Review. J Med Internet Res 2016; 18:e181. [PMID: 27363519 PMCID: PMC4945819 DOI: 10.2196/jmir.5455] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 05/03/2016] [Accepted: 05/24/2016] [Indexed: 12/15/2022] Open
Abstract
Background The use of Web-based interventions to deliver mental health and behavior change programs is increasingly popular. They are cost-effective, accessible, and generally effective. Often these interventions concern psychologically sensitive and challenging issues, such as depression or anxiety. The process by which a person receives and experiences therapy is important to understanding therapeutic process and outcomes. While the experience of the patient or client in traditional face-to-face therapy has been evaluated in a number of ways, there appeared to be a gap in the evaluation of patient experiences of therapeutic interventions delivered online. Evaluation of Web-based artifacts has focused either on evaluation of experience from a computer Web-design perspective through usability testing or on evaluation of treatment effectiveness. Neither of these methods focuses on the psychological experience of the person while engaged in the therapeutic process. Objective This study aimed to investigate what methods, if any, have been used to evaluate the in situ psychological experience of users of Web-based self-help psychosocial interventions. Methods A systematic literature review was undertaken of interdisciplinary databases with a focus on health and computer sciences. Studies that met a predetermined search protocol were included. Results Among 21 studies identified that examined psychological experience of the user, only 1 study collected user experience in situ. The most common method of understanding users’ experience was through semistructured interviews conducted posttreatment or questionnaires administrated at the end of an intervention session. The questionnaires were usually based on standardized tools used to assess user experience with traditional face-to-face treatment. Conclusions There is a lack of methods specified in the literature to evaluate the interface between Web-based mental health or behavior change artifacts and users. Main limitations in the research were the nascency of the topic and cross-disciplinary nature of the field. There is a need to develop and deliver methods of understanding users’ psychological experiences while using an intervention.
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Affiliation(s)
- Jacqueline Susan Feather
- Centre for Interdisciplinary Trauma Research, Department of Psychology, Auckland University of Technology, Auckland, New Zealand.
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Wheeler S, Acord-Vira A, Davis D. Effectiveness of Interventions to Improve Occupational Performance for People With Psychosocial, Behavioral, and Emotional Impairments After Brain Injury: A Systematic Review. Am J Occup Ther 2016; 70:7003180060p1-9. [PMID: 27089290 DOI: 10.5014/ajot.115.020677] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This systematic review evaluates the effectiveness of interventions to improve occupational performance for people with psychosocial, behavioral, or emotional impairments after traumatic brain injury (TBI). METHOD Medline, PsycINFO, CINAHL, OTseeker, and the Cochrane Database of Systematic Reviews were searched. Of the 1,512 articles initially identified, 35 met the inclusion criteria. RESULTS Six types of interventions were identified: (1) education, (2) peer mentoring, (3) goal-directed therapy, (4) physical activity, (5) skills training, and (6) cognitive-behavioral therapy (CBT). Strong evidence from well-conducted research supports the use of CBT in individual and group settings. Moderate evidence supports goal-directed interventions, aquatic exercise, and functional skills training. Limited evidence supports peer mentoring, aerobic exercise, educational interventions, and various skills training. CONCLUSION An increasing body of evidence supports specific interventions to improve occupational performance and participation for people with psychosocial, behavioral, or emotional impairments after TBI.
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Affiliation(s)
- Steven Wheeler
- Steven Wheeler, PhD, OTR/L, CBIS, is Associate Professor and Associate Chair, Division of Occupational Therapy, Department of Human Performance and Applied Exercise Science, West Virginia University School of Medicine, Morgantown;
| | - Amanda Acord-Vira
- Amanda Acord-Vira, MOT, OTR/L, CBIS, is Assistant Professor, Division of Occupational Therapy, Department of Human Performance and Applied Exercise Science, West Virginia University School of Medicine, Morgantown
| | - Diana Davis
- Diana Davis, PhD, OTR/L, is Assistant Professor, Division of Occupational Therapy, Department of Human Performance and Applied Exercise Science, West Virginia University School of Medicine, Morgantown
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Beatty L, Binnion C. A Systematic Review of Predictors of, and Reasons for, Adherence to Online Psychological Interventions. Int J Behav Med 2016; 23:776-794. [PMID: 26957109 DOI: 10.1007/s12529-016-9556-9] [Citation(s) in RCA: 177] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Lisa Beatty
- School of Psychology, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
| | - Claire Binnion
- School of Psychology, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
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Wiart L, Luauté J, Stefan A, Plantier D, Hamonet J. Non pharmacological treatments for psychological and behavioural disorders following traumatic brain injury (TBI). A systematic literature review and expert opinion leading to recommendations. Ann Phys Rehabil Med 2016; 59:31-41. [PMID: 26776320 DOI: 10.1016/j.rehab.2015.12.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 12/01/2015] [Accepted: 12/01/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The non pharmacological approach is an important issue in the treatment of psychological and behavioural disorders in traumatic brain injury (TBI) patients. It remains nevertheless insufficiently known and defined. The objective of this work was to develop precise recommendations for caregivers and relatives. METHOD The elaboration of these guidelines followed the procedure validated by the French health authority for good practice recommendations, close to the Prisma statement, involving a systematic, critical review of the literature and the expert opinions of the French Society of Physical Medicine and Rehabilitation (SOFMER) group. RESULTS 458 articles were identified, among which 98 were selected for their relevance to the theme of the research. None of the studies reached the highest level of evidence. Fifteen controlled studies reached a relatively high level of evidence (level 2); other studies were case series or expert opinions, and other articles again were reviews of the literature and theoretical points of view. The holistic approach structured into programmes, cognitive-behavioural therapy, and family and systemic therapy, despite the low levels of proof, are recommended in first intention at all stages in the evolution of TBI. Relational and adaptive approaches, rehabilitation and vocational approaches, and psychoanalytical therapies may be useful, provided that therapists are familiar with and trained in traumatic brain injury. CONCLUSION Despite the small number of publications and a low level of proof, a number of recommendations for the non-pharmacological approach to psychological and behavioural disorders in TBI is proposed by the consensus conference of experts. Scientific research in this domain is needed to confirm and complete these first recommendations.
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Affiliation(s)
- Laurent Wiart
- Service de MPR, CHU Pellegrin, 33076 Bordeaux Cedex, France.
| | - Jacques Luauté
- Service de MPR, Hôpital Henri-Gabrielle, 69230 Saint Genis Laval, France
| | | | - David Plantier
- Service de MPR, Hôpital René-Sabran, 83400 Giens, France
| | - Julia Hamonet
- Service de MPR, Hôpital Dupuytren, 87042 Limoges cedex, France
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Comparison of cognitive behavioral therapy and supportive psychotherapy for the treatment of depression following traumatic brain injury: a randomized controlled trial. J Head Trauma Rehabil 2015; 29:467-78. [PMID: 25370439 DOI: 10.1097/htr.0000000000000098] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the efficacy of 2 different interventions (cognitive behavioral therapy [CBT] and supportive psychotherapy [SPT]) to treat post-traumatic brain injury (TBI) depression. PARTICIPANTS A sample of 77 community-dwelling individuals with a TBI, and a diagnosis of depression. Participants were randomized into treatment conditions either CBT or SPT and received up to 16 sessions of individual psychotherapy. MEASURES Participants completed the Structured Clinical Interview for DSM-IV and self-report measures of depression (Beck Depression Inventory-Second Edition), anxiety (State-Trait Anxiety Inventory), perceived social support (Interpersonal Support Evaluation List), stressful life events (Life Experiences Survey), and quality of life (QOL) before beginning and immediately following treatment. RESULTS No significant differences were found at baseline between CBT and SPT groups on demographic factors (sex, age, education, race, and time since injury) or baseline measures of depression, anxiety, participation, perceived social support, stressful life events, or QOL. Analyses of variance revealed significant time effects for the Beck Depression Inventory-Second Edition, State-Trait Anxiety Inventory, and QOL outcome measures but no group effects. Intention-to-treat mixed effects analyses did not find any significant difference in patterns of scores of the outcome measures between the CBT and SPT intervention groups. CONCLUSIONS Both forms of psychotherapy were efficacious in improving diagnoses of depression and anxiety and reducing depressive symptoms. These findings suggest that in this sample of individuals with TBI, CBT was not more effective in treating depression than SPT, though further research is needed with larger sample sizes to identify different components of these interventions that may be effective with different TBI populations. ClinicalTrials.gov Identifier: NCT00211835.
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Fann JR, Bombardier CH, Vannoy S, Dyer J, Ludman E, Dikmen S, Marshall K, Barber J, Temkin N. Telephone and in-person cognitive behavioral therapy for major depression after traumatic brain injury: a randomized controlled trial. J Neurotrauma 2015; 32:45-57. [PMID: 25072405 DOI: 10.1089/neu.2014.3423] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Major depressive disorder (MDD) is prevalent after traumatic brain injury (TBI); however, there is a lack of evidence regarding effective treatment approaches. We conducted a choice-stratified randomized controlled trial in 100 adults with MDD within 10 years of complicated mild to severe TBI to test the effectiveness of brief cognitive behavioral therapy administered over the telephone (CBT-T) (n = 40) or in-person (CBT-IP) (n = 18), compared with usual care (UC) (n = 42). Participants were recruited from clinical and community settings throughout the United States. The main outcomes were change in depression severity on the clinician-rated 17 item Hamilton Depression Rating Scale (HAMD-17) and the patient-reported Symptom Checklist-20 (SCL-20) over 16 weeks. There was no significant difference between the combined CBT and UC groups over 16 weeks on the HAMD-17 (treatment effect = 1.2, 95% CI: -1.5-4.0; p = 0.37) and a nonsignificant trend favoring CBT on the SCL-20 (treatment effect = 0.28, 95% CI: -0.03-0.59; p = 0.074). In follow-up comparisons, the CBT-T group had significantly more improvement on the SCL-20 than the UC group (treatment effect = 0.36, 95% CI: 0.01-0.70; p = 0.043) and completers of eight or more CBT sessions had significantly improved SCL-20 scores compared with the UC group (treatment effect = 0.43, 95% CI: 0.10-0.76; p = 0.011). CBT participants reported significantly more symptom improvement (p = 0.010) and greater satisfaction with depression care (p < 0.001), than did the UC group. In-person and telephone-administered CBT are acceptable and feasible in persons with TBI. Although further research is warranted, telephone CBT holds particular promise for enhancing access and adherence to effective depression treatment.
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Affiliation(s)
- Jesse R Fann
- 1 Department of Psychiatry and Behavioral Sciences, University of Washington , Seattle, Washington
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Li K, Alonso J, Chadha N, Pulido J. Does Generalization Occur Following Computer-Based Cognitive Retraining?-An Exploratory Study. Occup Ther Health Care 2015; 29:283-296. [PMID: 25993264 DOI: 10.3109/07380577.2015.1010246] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Computer-based cognitive retraining (CBCR) intervention has gained great popularity in recent years. This study aimed to investigate the occurrence of skill generalization to daily living task for individuals with acquired brain injury (ABI) after completion of eight modules of a commercially available CBCR program, the Parrot Software. The study investigated changes in individuals' global cognition as measured by the Montreal Cognitive Assessment, and changes in individuals' performance during a medication-box sorting task, a novel instrumental activity of daily living. The medication-box sorting task resembled real life medication management with daily prescribed and over-the-counter medications. Twelve individuals with ABI from a community-based program completed the study. Results indicated that CBCR intervention brought about improvement in global cognition, but the improvement did not appear in any particular cognitive domain. Additionally, the gains in global cognition failed to enhance performance in the medication-box sorting task. This exploratory study demonstrated that while CBCR may be a promising intervention for improving global cognition in individuals with ABI, additional intervention might be needed for generalization to occur to a novel daily task. Future studies should look for the ultimate therapeutic outcome from CBCR interventions or include interventions that could bridge the gap between CBCR intervention and performance improvement in daily living occupations.
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Affiliation(s)
- Kitsum Li
- Department of Occupational Therapy, School of Health and Natural Sciences, Dominican University of California, San Rafael, CA, USA
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Reti IM, Schwarz N, Bower A, Tibbs M, Rao V. Transcranial magnetic stimulation: A potential new treatment for depression associated with traumatic brain injury. Brain Inj 2015; 29:789-97. [PMID: 25950260 DOI: 10.3109/02699052.2015.1009168] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Each year, more than 1.7 million Americans suffer a traumatic brain injury (TBI) and the lifetime prevalence of major depressive disorder following TBI is between 25-50%. There are no validated established strategies to treat TBI depression. Repetitive transcranial magnetic stimulation (rTMS) is a novel putative treatment option for post-TBI depression, which, compared with standard pharmacological agents, may provide a more targeted treatment with fewer side-effects. However, TBI is associated with an increased risk of both early and late spontaneous seizures, a significant consideration in evaluating rTMS as a potential treatment for TBI depression. Whilst the risk of seizure from rTMS is low, underlying neuropathology may somewhat increase that risk. REVIEW This review focuses on the safety aspects of rTMS in TBI patients. The authors review why low frequency rTMS might be less likely to trigger a seizure than high frequency rTMS and propose low frequency rTMS as a safer option in TBI patients. Because there is little data on the safety of rTMS in TBI, the authors also review the safety of rTMS in patients with other brain pathology. CONCLUSION It is concluded that pilot safety and tolerability studies should be first conducted in persons with TBI and neuropsychiatric comorbidities. These results could be used to help design larger randomized controlled trials.
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Affiliation(s)
- Irving M Reti
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University , Baltimore, MD , USA
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Technology-adaptable interventions for treating depression in adults with cognitive impairments: protocol for a systematic review. Syst Rev 2015; 4:42. [PMID: 25875655 PMCID: PMC4393573 DOI: 10.1186/s13643-015-0032-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 03/12/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Depression is a common comorbidity in individuals with cognitive impairment. Those with cognitive impairments face unique challenges in receiving the benefits of many conventional therapies for depression, and may have poorer outcomes in areas such as recovery and quality of life. However, the stigmatization of mental health disorders, cost barriers and physical disabilities may prevent these individuals from seeking mental health care. An online, self-help intervention specifically developed for adults with cognitive deficits and depression may be particularly beneficial to this population. We aim to inform the design of such an intervention through a systematic review by answering the following research question: among adults with cognitive impairment (including those with acquired brain injuries or neurodegenerative diseases), which technology-amenable interventions have been shown to effectively decrease symptoms of depression? Specifically, psychotherapeutic and/or behavioural interventions that could be delivered in a self-guided, online system will be included. METHODS Comprehensive electronic searches will be conducted in MEDLINE, EMBASE, PsycINFO and CINAHL. Additional studies will be obtained through manually searching the references of relevant systematic reviews, contacting primary authors of select articles and tracking conference proceedings and trial registries. Article titles and abstracts will be screened using predefined eligibility criteria, and then judged for their amenability to the proposed self-help, technology-based intervention. The full text of those articles with selected interventions will then be screened to determine final eligibility for inclusion. Included articles will be categorized by intervention type and assessed for risk of bias using the Cochrane Effective Practice and Organization of Care Risk of Bias tool for non-randomized trials, controlled before-after studies and interrupted time series. The primary outcome will be a change in score on a validated depression scale, and adverse events will be documented as a secondary outcome. After data extraction from selected articles, pooling of data and meta-analysis will be conducted if a sufficient pool of studies with comparable methodology and quality are identified. Alternatively, plain language summaries will be developed. The quality of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42014014417.
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Charova E, Dorstyn D, Tully P, Mittag O. Web-based interventions for comorbid depression and chronic illness: a systematic review. J Telemed Telecare 2015; 21:189-201. [PMID: 25712111 DOI: 10.1177/1357633x15571997] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Accepted: 01/13/2015] [Indexed: 11/17/2022]
Abstract
Web-based interventions offer potential benefits for managing and treating depression in the context of chronic physical illness, however their use with this population has yet to be quantitatively assessed. The present systematic review examined the biopsychosocial data from 11 independent studies (N = 1348 participants), including randomised controlled and quasi-experimental designs most commonly performed with diabetes and multiple sclerosis. Study quality was evaluated using the Downs and Black (1998) index, with most studies being statistically underpowered although internal validity was demonstrated. Treatment outcomes were quantified using Cohen's d effect sizes. Results indicated significant short-term improvements in depression severity (d w = 0.36, CI = 0.20-0.52, p < 0.01), in addition to quality of life, problem-solving skills, functional ability, anxiety and pain-related cognitions (d range = 0.23 to 1.10). Longer-term outcomes could not be determined based on the limited data. Further robust studies are required before wider adoption of web techniques takes place.
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Affiliation(s)
- Ekaterina Charova
- University of Adelaide School of Psychology, Adelaide, South Australia, Australia
| | - Diana Dorstyn
- University of Adelaide School of Psychology, Adelaide, South Australia, Australia
| | - Phillip Tully
- University of Adelaide, Discipline of Medicine, Adelaide, South Australia, Australia
| | - Oskar Mittag
- Medical Center - University of Freiburg, Institute for Quality Management and Social Medicine, Germany
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Tsaousides T, D'Antonio E, Varbanova V, Spielman L. Delivering group treatment via videoconference to individuals with traumatic brain injury: a feasibility study. Neuropsychol Rehabil 2014; 24:784-803. [PMID: 24810148 DOI: 10.1080/09602011.2014.907186] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The objective was to assess the feasibility of delivering a group treatment to improve emotional regulation via videoconferencing to individuals with traumatic brain injury (TBI). A pre-post feasibility study was undertaken. Seven individuals with TBI were recruited at a brain injury research centre in an urban medical centre. The main measures were therapist assessment of session-by-session progress and feasibility, Difficulties in Emotion Regulation Scale (DERS), Brain Injury Rehabilitation Trust Regulation of Emotions Questionnaire (BREQ), Satisfaction with Therapy and Therapist Scale (STTS), and exit interview. Attendance across sessions and participants was over 90%. Adequate skill acquisition and ease of use of the technology were demonstrated. Self-reported satisfaction with treatment was high. Participants noted several benefits in terms of the treatment delivery modality. There was no change is self-reported emotional dysregulation. This is the first study to report the use of videoconferencing for the delivery of group treatment to individuals with TBI. The exceptional compliance and self-reported satisfaction suggest that this treatment delivery option could be a viable alternative for increasing access to healthcare in this population. The findings of the study supported the development of a large clinical trial to assess treatment effectiveness.
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Affiliation(s)
- Theodore Tsaousides
- a Department of Rehabilitation Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
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Abstract
OBJECTIVE Clinical significance determines whether an intervention makes a real difference in the everyday life of a client. One of the most recommended approaches for conducting group-level analyses of clinical significance is to evaluate whether the treated clinical group is equivalent to a normal comparison group (normative comparisons). The purpose of this study was to demonstrate the analytical and practical power of assessing clinical significance using normative comparisons that are robust to violations of normality and homogeneity of variance assumptions. METHOD Six datasets were gleaned from published intervention studies for depression. RESULTS We found that normative comparisons using a robust Schuirmann-Yuen test determined equivalency for 11% fewer clinical samples compared to original normative comparisons that use a Schuirmann test of equivalence. CONCLUSIONS We recommend that researchers conducting normative comparisons utilize the Schuirmann-Yuen procedure as it provides the most reliable method available for determining if a treated clinical group is equivalent to a normative comparison group.
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Affiliation(s)
- Haykaz Mangardich
- a Department of Psychology , York University , Toronto , Ontario , Canada
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Barker-Collo S, Starkey N, Theadom A. Treatment for depression following mild traumatic brain injury in adults: a meta-analysis. Brain Inj 2013; 27:1124-33. [PMID: 23895287 DOI: 10.3109/02699052.2013.801513] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE Development of depression after TBI is linked to poorer outcomes. The aim of this manuscript is to review evidence for the effectiveness of current treatments. RESEARCH DESIGN Two meta-analyses were undertaken to examine the effectiveness of both pharmacological and non-pharmacological interventions for depression after mild TBI. METHOD AND PROCEDURES PubMed, Medline, PsychInfo, Web of Science and Digital Dissertations were searched and 13 studies located. Meta Analyst Beta 3.13 was used to conduct analyses of pre- vs post-effects then to examine treatment group vs control group effects. MAIN OUTCOMES AND RESULTS Studies using a pre-post design produced an overall effect size of 1.89 (95% CI = 1.20-2.58, p < 0.001), suggesting that treatments were effective; however, the overall effect for controlled trials was 0.46 (95% CI = -0.44-1.36, p < 0.001), which favoured the control rather than treatment groups. CONCLUSIONS This study highlights the need for additional large well-controlled trials of effective treatments for depression post-TBI.
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Affiliation(s)
- Suzanne Barker-Collo
- Department of Psychology, Faculty of Sciences, University of Auckland, Auckland, New Zealand.
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Bhalerao SU, Geurtjens C, Thomas GR, Kitamura CR, Zhou C, Marlborough M. Understanding the neuropsychiatric consequences associated with significant traumatic brain injury. Brain Inj 2013; 27:767-74. [DOI: 10.3109/02699052.2013.793396] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Depression is one of the most common psychiatric diagnoses among individuals with traumatic brain injury (TBI). Prevalence of post-TBI depression (PTBID) ranges from 12 to 60% and is generally higher than rates reported in the general population. The wide range in reported rates is attributed to methodological variability across studies, including measurement and sampling differences. Several systematic reviews have been published in the past 5 years, reporting on outcomes for depression across different classes of interventions, including pharmacological, biomedical and behavioural. The consensus across reviews is that more research is necessary to develop evidence-based practice guidelines. The present narrative review synthesises the findings of previous studies, focusing on the nature of the interventions, the eligibility criteria for inclusion and the assessment of outcome. Pharmacological studies are generally more rigorous methodologically, but provide mixed findings. Other biomedical interventions are only at the initial stages of research development, including case and pilot studies. The results of behavioural studies are positive regarding improvements in mood. However, the number of efficacy studies of behavioural interventions for depression is extremely limited. Recommendations for designing interventions are provided.
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Richards D, Timulak L. Satisfaction with therapist-delivered vs. self-administered online cognitive behavioural treatments for depression symptoms in college students. BRITISH JOURNAL OF GUIDANCE & COUNSELLING 2013. [DOI: 10.1080/03069885.2012.726347] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Stalder-Lüthy F, Messerli-Bürgy N, Hofer H, Frischknecht E, Znoj H, Barth J. Effect of psychological interventions on depressive symptoms in long-term rehabilitation after an acquired brain injury: a systematic review and meta-analysis. Arch Phys Med Rehabil 2013; 94:1386-97. [PMID: 23439410 DOI: 10.1016/j.apmr.2013.02.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 02/07/2013] [Accepted: 02/12/2013] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To summarize empirical studies on the effectiveness of psychological interventions in long-term rehabilitation after an acquired brain injury (ABI) in reducing depressive symptoms. DATA SOURCES A systematic literature search was conducted on MEDLINE, PsycINFO, Embase, and CINAHL to identify articles published between January 1990 and October 2011. Search terms included the 3 concepts (1) "brain injur*" or "stroke," (2) "psychotherap*" or "therapy" or "intervention" or "rehabilitation," and (3) "depress*." STUDY SELECTION Studies evaluating psychological interventions in patients after ABI were included. Time since injury was on average more than 1 year. Trials reported data on validated depression questionnaires before and after the psychological intervention. DATA EXTRACTION Two independent reviewers extracted information from the sample, the intervention, and the outcome of the included studies and calculated effect sizes (ESs) from depression questionnaires. Thirteen studies were included in a pre-post analysis. Seven studies were eligible for a meta-analysis of ESs in active interventions and control conditions. DATA SYNTHESIS Pre-post ESs were significant in 4 of 13 studies. The overall ES of .69 (95% confidence interval [CI], .29-1.09) suggests a medium effectiveness of psychological interventions on depressive symptoms compared with control conditions. Moderator analysis of the number of sessions and adequate randomization procedure did not show significant ES differences between strata. Studies with adequate randomization did not, however, suggest the effectiveness of psychological interventions on depressive symptoms after ABI. CONCLUSIONS Psychological interventions are a promising treatment option for depressive symptoms in long-term rehabilitation after ABI. Since only a few adequately randomized controlled trials (RCTs) exist, more RCTs are required to confirm this initial finding.
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Affiliation(s)
- Franziska Stalder-Lüthy
- Department of Clinical Psychology and Psychotherapy, University of Bern, Gesellschaftsstrasse 49, Bern, Switzerland.
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Waldron B, Casserly LM, O'Sullivan C. Cognitive behavioural therapy for depression and anxiety in adults with acquired brain injury. What works for whom? Neuropsychol Rehabil 2013; 23:64-101. [DOI: 10.1080/09602011.2012.724196] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Catroppa C, Soo C, Crowe L, Woods D, Anderson V. Evidence-based approaches to the management of cognitive and behavioral impairments following pediatric brain injury. FUTURE NEUROLOGY 2012. [DOI: 10.2217/fnl.12.64] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Much is now known about the short- and long-term sequelae of pediatric acquired brain injury, with impairments found in general intellectual ability and in more specific domains, including attention, memory, executive functioning (e.g., planning and organization) and educational achievement (e.g., spelling and arithmetic). More recently, researchers have investigated behavioral, adaptive, social and mental health outcomes, and similarly, difficulties have been reported in these domains. While the availability of evidence-based treatments is currently limited, the need for the management of such sequelae has led to an emergence of research with a focus on the development and evaluation of management strategies and intervention programs in order to provide such treatment options.
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Affiliation(s)
- Cathy Catroppa
- Murdoch Childrens Research Institute, Flemington Road, Parkville, Victoria, 3052, Australia
| | - Cheryl Soo
- Murdoch Childrens Research Institute, Flemington Road, Parkville, Victoria, 3052, Australia
| | - Louise Crowe
- Murdoch Childrens Research Institute, Flemington Road, Parkville, Victoria, 3052, Australia
- University of Melbourne, Victoria, 3010, Australia
| | - Damith Woods
- Department of Paediatric Rehabilitation, Women’s & Children’s Hospital, 72 King William Road, North Adelaide, SA 5006, Australia
| | - Vicki Anderson
- Murdoch Childrens Research Institute, Flemington Road, Parkville, Victoria, 3052, Australia
- Royal Children’s Hospital, Flemington Road, Parkville, Victoria, 3052, Australia
- University of Melbourne, Victoria, 3010, Australia
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Feasibility and effect of aerobic exercise for lowering depressive symptoms among individuals with traumatic brain injury: a pilot study. J Head Trauma Rehabil 2012; 27:99-103. [PMID: 21386712 DOI: 10.1097/htr.0b013e31820e6858] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE : To establish the feasibility and effect of an aerobic exercise intervention on symptoms of depression among individuals with traumatic brain injury. DESIGN : A pre-post single group. PARTICIPANTS : our community dwelling participants (>11 months postinjury) with residual physical impairment recruited from an outpatient clinic. INTERVENTION : 12-week aerobic exercise program. OUTCOME MEASURES : The Hamilton Rating Scale for Depression; aerobic capacity (cycle ergometer, heart rate at reference resistance, perceived exertion); Rosenberg Self-Esteem Scale and program perception (survey). ANALYSIS : Descriptive statistics to depict change in outcome measure scores. Answers from the survey were collated and presented as summary statements. RESULTS : All participants had fewer symptoms of depression, improved aerobic capacity and higher self esteem after the intervention. High satisfaction with the program was reported with no adverse effects. CONCLUSION : The aerobic exercise program was feasible and effective for individuals with traumatic brain injury, leading to improved mood, cardiovascular fitness, and self-esteem. Future research is needed to determine the intensity, frequency, and duration required to reach and maintain improvement.
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Hsieh MY, Ponsford J, Wong D, Schönberger M, Taffe J, McKay A. Motivational interviewing and cognitive behaviour therapy for anxiety following traumatic brain injury: a pilot randomised controlled trial. Neuropsychol Rehabil 2012; 22:585-608. [PMID: 22632385 DOI: 10.1080/09602011.2012.678860] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Although cognitive-behavioural therapy (CBT) is the treatment of choice for anxiety, its delivery needs to be adapted for individuals with traumatic brain injury (TBI). It also requires clients' active engagement for maximum benefit. This study was a pilot randomised controlled trial involving an anxiety treatment programme adapted for people with TBI, based on CBT and motivational interviewing (MI). Twenty-seven participants with moderate/severe TBI (aged 21-73 years, 78% males) recruited from a brain injury rehabilitation hospital were randomly allocated to receive MI + CBT (n = 9), non-directive counselling (NDC) + CBT (n = 10) and treatment-as-usual (TAU) (n = 8). CBT and MI were manualised and delivered in 12 weekly individual sessions. Primary outcome was self-reported anxiety symptoms assessed at baseline, at the end of NDC/MI and immediately following CBT. Assessment was conducted by assessors blinded to group assignment. Intention-to-treat analyses showed that the two active treatment groups demonstrated significantly greater anxiety reduction than TAU. Participants receiving MI showed greater response to CBT, in terms of reduction in anxiety, stress and non-productive coping, compared to participants who received NDC. The results provided preliminary support for the adapted CBT programme, and the potential utility of MI as treatment prelude. Longer follow-up data are required to evaluate the maintenance of treatment effects.
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Affiliation(s)
- Ming-Yun Hsieh
- School of Psychology and Psychiatry, Monash University, Melbourne, Victoria, Australia
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Richards D, Richardson T. Computer-based psychological treatments for depression: a systematic review and meta-analysis. Clin Psychol Rev 2012; 32:329-42. [PMID: 22466510 DOI: 10.1016/j.cpr.2012.02.004] [Citation(s) in RCA: 913] [Impact Index Per Article: 76.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Revised: 02/03/2012] [Accepted: 02/16/2012] [Indexed: 11/18/2022]
Abstract
The aim of the paper was to systematically review the literature on computer-based psychological treatments for depression and conduct a meta-analysis of the RCT studies, including examining variables which may effect outcomes. Database and hand searches were made using specific search terms and inclusion criteria. The review included a total of 40 studies (45 published papers), and 19 RCTs (23 published papers) were included in a standard meta-analysis. The review describes the different computer-based treatments for depression, their design, communication types employed: synchronous, asynchronous, and face-to-face (F:F); alongside various types and frequency of support delivered. The evidence supports their effectiveness and highlights participant satisfaction. However, pertinent limitations are noted. Across 19 studies the meta-analysis revealed a moderate post-treatment pooled effect size d=.56 (95% confidence interval [CI] -.71, -.41), Z=7.48, p<.001). Supported interventions yielded better outcomes, along with greater retention. The results reported statistically significant clinical improvement and recovery post-treatment. The review and meta-analysis support the efficacy and effectiveness of computer-based psychological treatments for depression, in diverse settings and with different populations. Further research is needed, in particular to investigate the influence of therapist factors in supported treatments, the reasons for dropout, and the maintenance of gains post-treatment.
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Hsieh MY, Ponsford J, Wong D, Schönberger M, McKay A, Haines K. A cognitive behaviour therapy (CBT) programme for anxiety following moderate–severe traumatic brain injury (TBI): Two case studies. Brain Inj 2012; 26:126-38. [DOI: 10.3109/02699052.2011.635365] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
It is important for clinicians to recognize major depression following traumatic brain injury (TBI) because of its association with poor global and psychosocial outcome, postconcussive symptoms and cognitive deficits. The purpose of this review is to provide an up-to-date selective review of the current understanding of epidemiology, risk factors and management of major depression following TBI. Many studies of prevalence of depression following TBI have not used accepted structured criteria for the diagnoses, but those that did found wide ranges of rates, from 17% to 61%. The risk factors for development of depression following TBI are poorly understood, but past psychiatric history, frontal lesions and atrophy, and family dysfunction have been shown in more than one study to play important roles. There are few controlled trials of the treatment of major depression in patients with TBI using accepted diagnostic criteria for major depression, as well as defined criteria for response and remission. As such, it is important for clinicians to use best practice guidelines for the treatment of major depression in the absence of TBI.
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Affiliation(s)
- Mark J Rapoport
- Sunnybrook Health Sciences Centre, Geriatric Traumatic Brain Injury Clinic, Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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Simblett SK, Ring H, Bateman A. Computerised cognitive behavioural therapy (cCBT): a possible treatment for mood disorders experienced by people with neurological conditions? Neuropsychol Rehabil 2011; 21:925-8. [PMID: 21919559 DOI: 10.1080/09602011.2011.592099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Mood disorders such as depression occur relatively often following the diagnosis of a range of neurological conditions. Recent studies reviewing the prevalence of depression amongst people with a neurological condition have shown that approximately one third report clinically significant levels of depression (Carson, Ringbauer, MacKenzie, Warlow, & Sharpe, 2000; Williams et al., 2003). In particular, people with a diagnosis of a cerebrovascular disorder or a neurological condition with additional cognitive impairments, have been found to be the most likely to report symptoms of depression (Williams et al., 2003). However, despite the evidence that a large proportion of people with neurological conditions experience mood disorders, there are currently limited resources available to treat them.
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Affiliation(s)
- Sara K Simblett
- National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRC) for Cambridgeshire and Peterborough, UK
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Cernich AN, Kurtz SM, Mordecai KL, Ryan PB. Cognitive rehabilitation in traumatic brain injury. Curr Treat Options Neurol 2011; 12:412-23. [PMID: 20842598 DOI: 10.1007/s11940-010-0085-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OPINION STATEMENT Traumatic brain injury (TBI) is a major public health problem with neurobehavioral sequelae contributing to the long-term disability that is often associated with the moderate to severe levels of injury. Rehabilitation of cognitive skills is central to encouraging the full participation of the individual in home, vocational, and social roles. The review of available evidence points to four major recommendations for the rehabilitation of cognition following brain injury: 1) Access to subacute rehabilitation that is holistic in nature and involves a multidisciplinary or transdisciplinary team to work in an integrated fashion to support physical, cognitive, and social skill retraining is vital to support positive outcome following TBI. The collaborative effort of these individuals allows for continual reinforcement and evaluation of treatment goals and will often involve the family and/or important others in the individual's life to prepare for community re-entry. 2) Trials of medication, especially methylphenidate, to assist individuals with significant attention and memory impairment appear well supported by the available evidence. Though some data suggest that the use of cholinesterase inhibitors may be of use for individuals with memory impairments, there is less support for this practice and there are indications that it may worsen the behavioral sequelae of the injury. 3) Randomized controlled trials demonstrate the utility of specific rehabilitation approaches to attention retraining and retraining of executive functioning skills. Future research is needed on rehabilitation techniques in other domains of cognition. 4) Training in the use of supportive devices (either a memory book or more technologically enhanced compensatory devices) to support the individual's daily activities remains central to the independent function of the individual in the community. Though emerging treatments (eg, virtual reality environments) show relative degrees of promise for inclusion in the rehabilitation of the individual with TBI, these need further evaluation in systematic trials.
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Affiliation(s)
- Alison N Cernich
- VA Maryland Health Care System, 10 North Greene Street, BT/116/MH, Baltimore, MD, 21201, USA,
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