Kreutzer Jeffrey S, Marwitz Jennifer H, Sima Adam P, Mills Ana, Hsu Nancy H, Lukow Herman R
a Department of Physical Medicine and Rehabilitation , Virginia Commonwealth University , Richmond , VA , USA.
b Department of Biostatistics , Virginia Commonwealth University , Richmond , VA , USA.
Brain Inj. 2018;32(8):963-971. doi: 10.1080/02699052.2018.1468577. Epub 2018 May 24.
Examine a psychoeducational and skill-building intervention's effectiveness for individuals after traumatic brain injury (TBI), using a two-arm, parallel, randomized, controlled trial with wait-listed control.
The Resilience and Adjustment Intervention (RAI) targets adjustment challenges and emphasizes education, skill-building and psychological support. Overall, 160 outpatients were randomly assigned to a treatment or wait-list control (WLC) group. The manualized treatment was delivered in seven 1-h sessions. The Connor-Davidson Resilience Scale (CD-RISC) was the primary outcome measure. Secondary measures included the Mayo Portland Adaptability Inventory-4 (MPAI-4), Brief Symptom Inventory-18 (BSI-18) and 13-Item Stress Test.
After adjusting for injury severity, education and time postinjury, the RAI group (N = 75) demonstrated a significantly greater increase in resilience (effect size = 1.03) compared to the WLC group (N = 73). Participants in the RAI group demonstrated more favourable scores on the MPAI-4 Adjustment and Ability Indices, BSI-18 and the 13-item Stress Test. However, only the CD-RISC and BSI-18 demonstrated a clinically significant difference. In addition, RAI participants demonstrated maintenance of gains from pre-treatment to 3-month follow-up; however, only the BSI-18 maintained a clinically significant difference.
Investigation provided evidence that a resilience-focused intervention can improve psychological health and adjustment after TBI. Additional research is needed to ascertain the longer term benefits of intervention and the efficacy of alternative delivery methods (e.g., via telephone, Internet).
采用双臂平行随机对照试验并设置等待列表对照组，检验一种心理教育与技能培养干预措施对创伤性脑损伤（TBI）患者的有效性。
复原力与适应干预（RAI）针对适应方面的挑战，强调教育、技能培养和心理支持。总共160名门诊患者被随机分配至治疗组或等待列表对照组（WLC）。采用手册化治疗，共进行7次，每次1小时。主要结局指标为康纳-戴维森复原力量表（CD-RISC）。次要指标包括梅奥波特兰适应性量表-4（MPAI-4）、简明症状量表-18（BSI-18）和13项压力测试。
在对损伤严重程度、教育程度和伤后时间进行校正后，与WLC组（N = 73）相比，RAI组（N = 75）的复原力显著提高（效应量 = 1.03）。RAI组的参与者在MPAI-4调整与能力指数、BSI-18和13项压力测试中表现出更有利的分数。然而，只有CD-RISC和BSI-18显示出临床显著差异。此外，RAI组的参与者从治疗前到3个月随访期间保持了改善；然而，只有BSI-18保持了临床显著差异。
研究提供了证据表明，以复原力为重点的干预措施可改善TBI后的心理健康和适应能力。需要进一步研究以确定干预措施的长期益处以及替代实施方式（如通过电话、互联网）的疗效。
