Raj Stacey P, Zhang Nanhua, Kirkwood Michael W, Taylor H Gerry, Stancin Terry, Brown Tanya M, Wade Shari L
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (Drs Raj, Zhang, and Wade); Children's Hospital Colorado and Colorado School of Medicine, Aurora, Colorado (Dr Kirkwood); Case Western Reserve University, Ohio (Drs Taylor and Stancin); University Hospitals of Cleveland, Ohio (Dr Taylor); MetroHealth Medical Center, Ohio (Dr Stancin) Mayo Clinic and Mayo Medical School, Rochester, Minnesota (Dr Brown); and College of Medicine, University of Cincinnati, Cincinnati, Ohio (Drs Zhang and Wade).
J Head Trauma Rehabil. 2018 May/Jun;33(3):158-166. doi: 10.1097/HTR.0000000000000331.
To examine the moderating effects of parent marital status and participation on efficacy of an online family problem-solving intervention for pediatric traumatic brain injury (TBI).
Participants were 132 adolescents (12-17 years) who had sustained a recent (<6 months) TBI and their parents. Participants were randomly assigned to the intervention (Counselor-Assisted Problem Solving, CAPS) or an Internet resource comparison (IRC) condition. CAPS was designed to support families in the initial phase following TBI, by teaching problem-solving skills and addressing common challenges. To examine the moderating effect of parent marital status, participants were divided into 4 groups (ie, CAPS married household, CAPS unmarried household, IRC married household, and IRC unmarried household). Family income and caregiver education were controlled in analyses.
Parent marital status moderated treatment effects on adolescent externalizing behavior problems. Adolescents from married households in CAPS displayed fewer behavior problems at 6 and 18 months postbaseline compared with adolescents from unmarried households in CAPS. Among married CAPS families, there were no differences in outcomes among families where 1 or 2 parents actively participated.
Web-based interventions for pediatric TBI, such as CAPS, are a viable option for some although not all families. Further research is needed to investigate factors that influence efficacy to match families to the most beneficial treatments.
探讨父母婚姻状况和参与度对小儿创伤性脑损伤（TBI）在线家庭问题解决干预效果的调节作用。
研究对象为132名近期（<6个月）发生TBI的青少年（12 - 17岁）及其父母。参与者被随机分配到干预组（辅导员辅助问题解决，CAPS）或互联网资源对照组（IRC）。CAPS旨在通过教授问题解决技巧和应对常见挑战，在TBI后的初始阶段为家庭提供支持。为检验父母婚姻状况的调节作用，参与者被分为4组（即CAPS已婚家庭组、CAPS未婚家庭组、IRC已婚家庭组和IRC未婚家庭组）。分析中控制了家庭收入和照顾者教育程度。
父母婚姻状况调节了对青少年外化行为问题的治疗效果。与CAPS未婚家庭的青少年相比，CAPS已婚家庭的青少年在基线后6个月和18个月时表现出的行为问题更少。在已婚的CAPS家庭中，父母一方或双方积极参与的家庭在结果上没有差异。
对于小儿TBI的基于网络的干预措施，如CAPS，虽然并非对所有家庭都适用，但对一些家庭来说是一种可行的选择。需要进一步研究以调查影响疗效的因素，从而为家庭匹配最有益的治疗方法。
