TY - JOUR
T1 - The effect of a scheduled telephone intervention on outcome after moderate to severe traumatic brain injury
T2 - A randomized trial
AU - Bell, Kathleen R.
AU - Temkin, Nancy R.
AU - Esselman, Peter C.
AU - Doctor, Jason N.
AU - Bombardier, Charles H.
AU - Fraser, Robert T.
AU - Hoffman, Jeanne M.
AU - Powell, Janet M.
AU - Dikmen, Sureyya
N1 - Funding Information:
Supported by the National Institute of Disability and Rehabilitation Research, US Department of Education (grant no. H133A020508).
PY - 2005/5
Y1 - 2005/5
N2 - 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.
AB - 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.
KW - Brain injuries
KW - Rehabilitation
KW - Telephone
KW - Treatment outcome
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U2 - 10.1016/j.apmr.2004.09.015
DO - 10.1016/j.apmr.2004.09.015
M3 - Article
C2 - 15895327
AN - SCOPUS:18844408868
SN - 0003-9993
VL - 86
SP - 851
EP - 856
JO - Archives of physical medicine and rehabilitation
JF - Archives of physical medicine and rehabilitation
IS - 5
ER -