Johns Hopkins Burn Center, Johns Hopkins Bayview Medical Center, Baltimore, Maryland; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Johns Hopkins Burn Center, Johns Hopkins Bayview Medical Center, Baltimore, Maryland; Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
Arch Phys Med Rehabil. 2020 Jan;101(1S):S16-S25. doi: 10.1016/j.apmr.2018.11.027. Epub 2019 Feb 15.
(1) To evaluate the feasibility of conducting a randomized controlled trial (RCT) of the Safety, Meaning, Activation and Resilience Training (SMART) intervention vs nondirective supportive psychotherapy (NDSP) in an acutely hospitalized adult survivor of burn injury sample; and (2) to assess the preliminary effect of SMART on acute stress disorder (ASD), posttraumatic stress disorder (PTSD), and major depressive disorder (MDD) symptom reduction as secondary prevention.
Proof-of-concept, parallel group RCT design.
Regional burn center.
Acutely injured, hospitalized adult survivors of burn injury (N=50) were randomly assigned to SMART (n=28) or nondirective supportive psychotherapy (n=22). Due to dropout and missing data, final sample size was 40, SMART (n=21) and nondirective supportive psychotherapy (n=19).
SMART is a manualized, 4-session cognitive behavioral therapy-based psychological intervention targeting ASD, PTSD, and MDD symptoms. NDSP is a manualized, 4-session protocol.
Davidson Trauma Scale ([DTS]; diagnostic proxy for ASD and PTSD; clinical cutoff=40, with higher score=higher severity) and the Patient Health Questionnaire-9 ([PHQ-9]; diagnostic proxy for MDD; clinical cutoff=10, with higher score=higher severity) at pretreatment, immediate posttreatment, and 1 month posttreatment.
At baseline, median DTS scores and PHQ-9 scores were above clinical cutoffs and did not differ across groups. At 1 week and 1 month posttreatment, median DTS and PHQ-9 scores were beneath clinical cutoffs in the SMART group; scores remained above clinical cutoffs in the NDSP group at these time points.
It is feasible to conduct an RCT of SMART in hospitalized adult survivors of burn injury. SMART has the potential to yield clinically significant outcomes. Additional studies are needed to replicate and extend these findings.
(1) 评估在急性住院烧伤成年幸存者样本中进行安全性、意义、激活和韧性训练 (SMART) 干预与非指导性支持性心理治疗 (NDSP) 的随机对照试验 (RCT) 的可行性；(2) 评估 SMART 对急性应激障碍 (ASD)、创伤后应激障碍 (PTSD) 和重度抑郁障碍 (MDD) 症状减轻的初步效果，作为二级预防。
概念验证、平行组 RCT 设计。
地区烧伤中心。
急性受伤、住院的烧伤成年幸存者 (N=50) 被随机分配到 SMART (n=28) 或非指导性支持性心理治疗 (n=22)。由于辍学和数据缺失，最终样本量为 40 例，SMART (n=21) 和非指导性支持性心理治疗 (n=19)。
SMART 是一种基于认知行为疗法的 4 节心理干预措施，针对 ASD、PTSD 和 MDD 症状。NDSP 是一种 4 节的方案。
戴维森创伤量表 ([DTS]；ASD 和 PTSD 的诊断代理；临床截止值=40，得分越高，严重程度越高) 和患者健康问卷-9 ([PHQ-9]；MDD 的诊断代理；临床截止值=10，得分越高，严重程度越高) 在治疗前、即刻治疗后和 1 个月治疗后。
在基线时，DTS 评分和 PHQ-9 评分中位数均高于临床截止值，且两组之间无差异。在治疗后 1 周和 1 个月时，SMART 组的 DTS 和 PHQ-9 评分中位数低于临床截止值；在这些时间点，NDSP 组的评分仍高于临床截止值。
在急性住院烧伤成年幸存者中进行 SMART 的 RCT 是可行的。SMART 有可能产生有临床意义的结果。需要进一步的研究来复制和扩展这些发现。
