The effect of a scheduled telephone intervention on outcome after moderate to severe traumatic brain injury: A randomized trial

Kathleen R. Bell, Nancy R. Temkin, Peter C. Esselman, Jason N. Doctor, Charles H. Bombardier, Robert T. Fraser, Jeanne M. Hoffman, Janet M. Powell, Sureyya Dikmen

Research output: Contribution to journalArticlepeer-review

131 Scopus citations


Objective: To measure the effectiveness of a scheduled telephone intervention offering counseling and education to people with traumatic brain injury (TBI) on behavioral outcomes compared with standard follow-up at 1 year postinjury. Design: Two-group randomized, prospective clinical trial throughout the first year after injury. Setting: Subjects' homes via telephone in an urban-rural catchment area from a level I trauma center. Participants: Subjects (N=171; age range, 18-70y) with a primary diagnosis of TBI who were discharged from an acute rehabilitation unit. They were randomly assigned to the telephone intervention (n=85) or to standard follow-up (n=86) groups at discharge. Of these, 79 participated in the intervention and completed the outcome assessment (3 withdrew; 3 were lost to follow-up), and 78 participated in usual care and completed the outcome assessment (8 were lost to follow-up). Interventions: Subjects were randomly assigned to receive telephone calls at 2 and 4 weeks and 2, 3, 5, 7, and 9 months after discharge. The calls consisted of brief motivational interviewing, counseling, and education, plus facilitating usual care or usual care alone through follow-up appointments and therapy prescriptions. Main Outcome Measures: A composite outcome was used as the primary endpoint on an intent-to-treat basis. Secondary analyses were conducted with individual measures, including the FIM instrument, Disability Rating Scale, Community Integration Questionnaire, Neurobehavioral Functioning Inventory, Functional Status Examination, Glasgow Outcome Scale-Extended, Medical Outcomes Study 36-Item Short-Form Health Survey, Brief Symptom Inventory, EuroQol, and Modified Perceived Quality of Life scale. The primary analysis was a blocked Mann-Whitney U test. Results: At 1-year follow-up, those who had received scheduled telephone intervention fared significantly better on the primary composite outcome index (P=.002). In addition, this group fared better on specific composites such as functional status (P=.003) and quality of well-being (P=.006). There were no significant differences on vocational status (P=.08) or community integration status (P=.13). Conclusions: Scheduled telephone counseling and education resulted in improved overall outcome, particularly for functional status and quality of well-being, when compared with usual outpatient care. Telephone counseling shows promise as a low-cost, widely available rehabilitation intervention for TBI.

Original languageEnglish (US)
Pages (from-to)851-856
Number of pages6
JournalArchives of physical medicine and rehabilitation
Issue number5
StatePublished - May 2005


  • Brain injuries
  • Rehabilitation
  • Telephone
  • Treatment outcome

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation


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