1 Department of Neuropsychology, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands .
2 Department of Neurology, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands .
J Neurotrauma. 2017 Oct 1;34(19):2713-2720. doi: 10.1089/neu.2016.4885. Epub 2017 May 17.
Many patients do not return to work (RTW) after mild traumatic brain injury (mTBI) because of persistent complaints that are often resistant to therapy in the chronic phase. Recent studies suggest that psychological interventions should be implemented early post-injury to prevent patients from developing chronic complaints. This study is a randomized, controlled trial that examines the effectiveness of a newly developed cognitive behavioral therapy (CBT) intervention (CBTi) compared to telephonic counseling (TC) in at-risk mTBI patients (patients with high reports of early complaints). Patients underwent either five sessions of CBT treatment or five phone conversations starting 4-6 weeks post-trauma. The main outcome measure was RTW 6 and 12 months post-trauma. Secondary measures comprised functional outcome at 6 and 12 months, and depression, anxiety, and reported post-traumatic complaints at 3, 6, and 12 months post-injury. After excluding dropouts, CBTi consisted of 39 patients and TC of 45 patients. No significant differences were found with regard to RTW, with 65% of CBTi patients and 67% of TC patients reporting a RTW at previous level. However, TC patients reported fewer complaints at 3 (8 vs. 6; p = 0.010) and 12 months post-injury (9 vs. 5; p = 0.006), and more patients in the TC group showed a full recovery 12 months post-injury compared to the CBTi group (62% vs. 39%). The results of this study suggest that early follow-up of at-risk patients can have a positive influence on patients' well-being, and that a low-intensive, low-cost telephonic intervention might be more effective than a CBT intervention at improving outcome in at-risk patients.
许多轻度创伤性脑损伤 (mTBI) 患者在康复后无法重返工作岗位 (RTW)，因为他们在慢性期常常会持续出现治疗抵抗的症状。最近的研究表明，应在受伤后早期实施心理干预，以防止患者出现慢性症状。本研究为一项随机对照试验，旨在比较新开发的认知行为疗法 (CBT) 干预 (CBTi) 与电话咨询 (TC) 在高危 mTBI 患者 (早期报告有较高症状的患者)中的效果。患者接受了 5 次 CBT 治疗或 5 次电话咨询，起始时间为创伤后 4-6 周。主要结局测量指标为创伤后 6 和 12 个月的 RTW。次要结局指标包括 6 和 12 个月时的功能结局，以及 3、6 和 12 个月时的抑郁、焦虑和创伤后报告症状。排除脱落病例后，CBTi 组包括 39 例患者，TC 组包括 45 例患者。两组患者在 RTW 方面无显著差异，65%的 CBTi 患者和 67%的 TC 患者报告在以前的水平上恢复 RTW。然而，TC 组患者在受伤后 3 个月（8 分 vs. 6 分；p=0.010）和 12 个月（9 分 vs. 5 分；p=0.006）时的症状较少，且在受伤后 12 个月时，TC 组中有更多的患者完全康复（62% vs. 39%）。本研究结果表明，对高危患者进行早期随访可能会对患者的幸福感产生积极影响，并且与 CBT 干预相比，低强度、低成本的电话干预可能更有效地改善高危患者的预后。
