Telephone Problem Solving for Service Members with Mild Traumatic Brain Injury: A Randomized, Clinical Trial

Kathleen R. Bell, Jesse R. Fann, Jo Ann Brockway, Wesley R. Cole, Nigel E. Bush, Sureyya Dikmen, Tessa Hart, Ariel J. Lang, Gerald Grant, Gregory Gahm, Mark A. Reger, Jef St De Lore, Joan Machamer, Karin Ernstrom, Rema Raman, Sonia Jain, Murray B. Stein, Nancy Temkin

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Mild traumatic brain injury (mTBI) is a common injury for service members in recent military conflicts. There is insufficient evidence of how best to treat the consequences of mTBI. In a randomized, clinical trial, we evaluated the efficacy of telephone-delivered problem-solving treatment (PST) on psychological and physical symptoms in 356 post-deployment active duty service members from Joint Base Lewis McChord, Washington, and Fort Bragg, North Carolina. Members with medically confirmed mTBI sustained during deployment to Iraq and Afghanistan within the previous 24 months received PST or education-only (EO) interventions. The PST group received up to 12 biweekly telephone calls from a counselor for subject-selected problems. Both groups received 12 educational brochures describing common mTBI and post-deployment problems, with follow-up for all at 6 months (end of PST), and at 12 months. At 6 months, the PST group significantly improved on a measure of psychological distress (Brief Symptom Inventory; BSI-18) compared to the EO group (p = 0.005), but not on post-concussion symptoms (Rivermead Post-Concussion Symptoms Questionnaire [RPQ]; p = 0.19), the two primary endpoints. However, these effects did not persist at 12-month follow-up (BSI, p = 0.54; RPQ, p = 0.45). The PST group also had significant short-term improvement on secondary endpoints, including sleep (p = 0.01), depression (p = 0.03), post-traumatic stress disorder (p = 0.04), and physical functioning (p = 0.03). Participants preferred PST over EO (p < 0.001). Telephone-delivered PST appears to be a well-accepted treatment that offers promise for reducing psychological distress after combat-related mTBI and could be a useful adjunct treatment post-mTBI. Further studies are required to determine how to sustain its effects. (Trial registration: ClinicalTrials.gov Identifier: NCT01387490 https://clinicaltrials.gov)

Original languageEnglish (US)
Pages (from-to)313-321
Number of pages9
JournalJournal of Neurotrauma
Volume34
Issue number2
DOIs
StatePublished - Jan 15 2017

Fingerprint

Brain Concussion
Telephone
Randomized Controlled Trials
Post-Concussion Syndrome
Therapeutics
Psychology
Education
Lewis Bases
Afghanistan
Iraq
Pamphlets
Post-Traumatic Stress Disorders
Sleep
Joints

Keywords

  • mild traumatic brain injury
  • problem-solving treatment (or training or therapy)
  • service members (or military)
  • telehealth

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Telephone Problem Solving for Service Members with Mild Traumatic Brain Injury : A Randomized, Clinical Trial. / Bell, Kathleen R.; Fann, Jesse R.; Brockway, Jo Ann; Cole, Wesley R.; Bush, Nigel E.; Dikmen, Sureyya; Hart, Tessa; Lang, Ariel J.; Grant, Gerald; Gahm, Gregory; Reger, Mark A.; St De Lore, Jef; Machamer, Joan; Ernstrom, Karin; Raman, Rema; Jain, Sonia; Stein, Murray B.; Temkin, Nancy.

In: Journal of Neurotrauma, Vol. 34, No. 2, 15.01.2017, p. 313-321.

Research output: Contribution to journalArticle

Bell, KR, Fann, JR, Brockway, JA, Cole, WR, Bush, NE, Dikmen, S, Hart, T, Lang, AJ, Grant, G, Gahm, G, Reger, MA, St De Lore, J, Machamer, J, Ernstrom, K, Raman, R, Jain, S, Stein, MB & Temkin, N 2017, 'Telephone Problem Solving for Service Members with Mild Traumatic Brain Injury: A Randomized, Clinical Trial', Journal of Neurotrauma, vol. 34, no. 2, pp. 313-321. https://doi.org/10.1089/neu.2016.4444
Bell, Kathleen R. ; Fann, Jesse R. ; Brockway, Jo Ann ; Cole, Wesley R. ; Bush, Nigel E. ; Dikmen, Sureyya ; Hart, Tessa ; Lang, Ariel J. ; Grant, Gerald ; Gahm, Gregory ; Reger, Mark A. ; St De Lore, Jef ; Machamer, Joan ; Ernstrom, Karin ; Raman, Rema ; Jain, Sonia ; Stein, Murray B. ; Temkin, Nancy. / Telephone Problem Solving for Service Members with Mild Traumatic Brain Injury : A Randomized, Clinical Trial. In: Journal of Neurotrauma. 2017 ; Vol. 34, No. 2. pp. 313-321.
@article{436a45185f124021baa0c01c6bd21547,
title = "Telephone Problem Solving for Service Members with Mild Traumatic Brain Injury: A Randomized, Clinical Trial",
abstract = "Mild traumatic brain injury (mTBI) is a common injury for service members in recent military conflicts. There is insufficient evidence of how best to treat the consequences of mTBI. In a randomized, clinical trial, we evaluated the efficacy of telephone-delivered problem-solving treatment (PST) on psychological and physical symptoms in 356 post-deployment active duty service members from Joint Base Lewis McChord, Washington, and Fort Bragg, North Carolina. Members with medically confirmed mTBI sustained during deployment to Iraq and Afghanistan within the previous 24 months received PST or education-only (EO) interventions. The PST group received up to 12 biweekly telephone calls from a counselor for subject-selected problems. Both groups received 12 educational brochures describing common mTBI and post-deployment problems, with follow-up for all at 6 months (end of PST), and at 12 months. At 6 months, the PST group significantly improved on a measure of psychological distress (Brief Symptom Inventory; BSI-18) compared to the EO group (p = 0.005), but not on post-concussion symptoms (Rivermead Post-Concussion Symptoms Questionnaire [RPQ]; p = 0.19), the two primary endpoints. However, these effects did not persist at 12-month follow-up (BSI, p = 0.54; RPQ, p = 0.45). The PST group also had significant short-term improvement on secondary endpoints, including sleep (p = 0.01), depression (p = 0.03), post-traumatic stress disorder (p = 0.04), and physical functioning (p = 0.03). Participants preferred PST over EO (p < 0.001). Telephone-delivered PST appears to be a well-accepted treatment that offers promise for reducing psychological distress after combat-related mTBI and could be a useful adjunct treatment post-mTBI. Further studies are required to determine how to sustain its effects. (Trial registration: ClinicalTrials.gov Identifier: NCT01387490 https://clinicaltrials.gov)",
keywords = "mild traumatic brain injury, problem-solving treatment (or training or therapy), service members (or military), telehealth",
author = "Bell, {Kathleen R.} and Fann, {Jesse R.} and Brockway, {Jo Ann} and Cole, {Wesley R.} and Bush, {Nigel E.} and Sureyya Dikmen and Tessa Hart and Lang, {Ariel J.} and Gerald Grant and Gregory Gahm and Reger, {Mark A.} and {St De Lore}, Jef and Joan Machamer and Karin Ernstrom and Rema Raman and Sonia Jain and Stein, {Murray B.} and Nancy Temkin",
year = "2017",
month = "1",
day = "15",
doi = "10.1089/neu.2016.4444",
language = "English (US)",
volume = "34",
pages = "313--321",
journal = "Journal of Neurotrauma",
issn = "0897-7151",
publisher = "Mary Ann Liebert Inc.",
number = "2",

}

TY - JOUR

T1 - Telephone Problem Solving for Service Members with Mild Traumatic Brain Injury

T2 - A Randomized, Clinical Trial

AU - Bell, Kathleen R.

AU - Fann, Jesse R.

AU - Brockway, Jo Ann

AU - Cole, Wesley R.

AU - Bush, Nigel E.

AU - Dikmen, Sureyya

AU - Hart, Tessa

AU - Lang, Ariel J.

AU - Grant, Gerald

AU - Gahm, Gregory

AU - Reger, Mark A.

AU - St De Lore, Jef

AU - Machamer, Joan

AU - Ernstrom, Karin

AU - Raman, Rema

AU - Jain, Sonia

AU - Stein, Murray B.

AU - Temkin, Nancy

PY - 2017/1/15

Y1 - 2017/1/15

N2 - Mild traumatic brain injury (mTBI) is a common injury for service members in recent military conflicts. There is insufficient evidence of how best to treat the consequences of mTBI. In a randomized, clinical trial, we evaluated the efficacy of telephone-delivered problem-solving treatment (PST) on psychological and physical symptoms in 356 post-deployment active duty service members from Joint Base Lewis McChord, Washington, and Fort Bragg, North Carolina. Members with medically confirmed mTBI sustained during deployment to Iraq and Afghanistan within the previous 24 months received PST or education-only (EO) interventions. The PST group received up to 12 biweekly telephone calls from a counselor for subject-selected problems. Both groups received 12 educational brochures describing common mTBI and post-deployment problems, with follow-up for all at 6 months (end of PST), and at 12 months. At 6 months, the PST group significantly improved on a measure of psychological distress (Brief Symptom Inventory; BSI-18) compared to the EO group (p = 0.005), but not on post-concussion symptoms (Rivermead Post-Concussion Symptoms Questionnaire [RPQ]; p = 0.19), the two primary endpoints. However, these effects did not persist at 12-month follow-up (BSI, p = 0.54; RPQ, p = 0.45). The PST group also had significant short-term improvement on secondary endpoints, including sleep (p = 0.01), depression (p = 0.03), post-traumatic stress disorder (p = 0.04), and physical functioning (p = 0.03). Participants preferred PST over EO (p < 0.001). Telephone-delivered PST appears to be a well-accepted treatment that offers promise for reducing psychological distress after combat-related mTBI and could be a useful adjunct treatment post-mTBI. Further studies are required to determine how to sustain its effects. (Trial registration: ClinicalTrials.gov Identifier: NCT01387490 https://clinicaltrials.gov)

AB - Mild traumatic brain injury (mTBI) is a common injury for service members in recent military conflicts. There is insufficient evidence of how best to treat the consequences of mTBI. In a randomized, clinical trial, we evaluated the efficacy of telephone-delivered problem-solving treatment (PST) on psychological and physical symptoms in 356 post-deployment active duty service members from Joint Base Lewis McChord, Washington, and Fort Bragg, North Carolina. Members with medically confirmed mTBI sustained during deployment to Iraq and Afghanistan within the previous 24 months received PST or education-only (EO) interventions. The PST group received up to 12 biweekly telephone calls from a counselor for subject-selected problems. Both groups received 12 educational brochures describing common mTBI and post-deployment problems, with follow-up for all at 6 months (end of PST), and at 12 months. At 6 months, the PST group significantly improved on a measure of psychological distress (Brief Symptom Inventory; BSI-18) compared to the EO group (p = 0.005), but not on post-concussion symptoms (Rivermead Post-Concussion Symptoms Questionnaire [RPQ]; p = 0.19), the two primary endpoints. However, these effects did not persist at 12-month follow-up (BSI, p = 0.54; RPQ, p = 0.45). The PST group also had significant short-term improvement on secondary endpoints, including sleep (p = 0.01), depression (p = 0.03), post-traumatic stress disorder (p = 0.04), and physical functioning (p = 0.03). Participants preferred PST over EO (p < 0.001). Telephone-delivered PST appears to be a well-accepted treatment that offers promise for reducing psychological distress after combat-related mTBI and could be a useful adjunct treatment post-mTBI. Further studies are required to determine how to sustain its effects. (Trial registration: ClinicalTrials.gov Identifier: NCT01387490 https://clinicaltrials.gov)

KW - mild traumatic brain injury

KW - problem-solving treatment (or training or therapy)

KW - service members (or military)

KW - telehealth

UR - http://www.scopus.com/inward/record.url?scp=85009112318&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85009112318&partnerID=8YFLogxK

U2 - 10.1089/neu.2016.4444

DO - 10.1089/neu.2016.4444

M3 - Article

C2 - 27579992

AN - SCOPUS:85009112318

VL - 34

SP - 313

EP - 321

JO - Journal of Neurotrauma

JF - Journal of Neurotrauma

SN - 0897-7151

IS - 2

ER -