From the, Department of Emergency Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA.
the, Dissemination and Training Division, National Center for PTSD, Palo Alto, CA.
Acad Emerg Med. 2020 Nov;27(11):1126-1139. doi: 10.1111/acem.14000. Epub 2020 May 19.
Posttraumatic stress disorder (PTSD) symptoms (PTSS) are common after minor injuries and can impair recovery. We sought to understand whether an evidence-based mobile phone application with self-help tools (PTSD Coach) could be useful to improve recovery after acute trauma among injured emergency department (ED) patients. This pilot study examined the feasibility, acceptability, and potential benefit of using PTSD Coach among acutely injured motor vehicle crash (MVC) patients.
From September 2017 to September 2018, we recruited adult patients within 24 hours post-MVC from the EDs of two Level I trauma centers in the United States. We randomly assigned 64 injured adults to either the PTSD Coach (n = 33) or treatment as usual (TAU; n = 31) condition. We assessed PTSS and associated symptoms at 1 month (83% retained) and 3 months (73% retained) postenrollment.
Enrollment was feasible (74% of eligible subjects participated) but usability and engagement were low (67% used PTSD Coach at least once, primarily in week 1); 76% of those who used it rated the app as moderately to extremely helpful. No differences emerged between groups in PTSS outcomes. Exploratory analyses among black subjects (n = 21) indicated that those in the PTSD Coach condition (vs. TAU) reported marginally lower PTSS (95% CI = -0.30 to 37.77) and higher PTSS coping self-efficacy (95% CI = -58.20 to -3.61) at 3 months.
We demonstrated feasibility to recruit acutely injured ED patients into an app-based intervention study, yet mixed evidence emerged for the usability and benefit of PTSD Coach. Most patients used the app once and rated it favorably in regard to satisfaction with and helpfulness, but longitudinal engagement was low. This latter finding may explain the lack of overall effects on PTSS. Additional research is warranted regarding whether targeting more symptomatic patients and the addition of engagement and support features can improve efficacy.
创伤后应激障碍（PTSD）症状（PTSS）在轻伤后很常见，并且会妨碍康复。我们试图了解基于证据的带有自助工具的手机应用程序（PTSD Coach）是否可以帮助改善急诊科（ED）受伤患者的急性创伤后恢复。这项初步研究检查了在急性机动车碰撞（MVC）受伤患者中使用 PTSD Coach 的可行性、可接受性和潜在益处。
从 2017 年 9 月到 2018 年 9 月，我们从美国两个一级创伤中心的 ED 招募了 MVC 后 24 小时内的成年患者。我们将 64 名受伤的成年人随机分配到 PTSD Coach（n=33）或常规治疗（TAU；n=31）组。我们在 1 个月（83%保留）和 3 个月（73%保留）后评估 PTSD 症状和相关症状。
入组是可行的（74%的合格受试者参加了），但可用性和参与度低（67%的人至少使用了一次 PTSD Coach，主要是在第 1 周）；76%的使用者认为该应用程序“中度到非常有帮助”。在 PTSD 症状结果方面，两组之间没有差异。对黑人患者（n=21）的探索性分析表明，与 TAU 相比，PTSD Coach 组的 PTSD 症状（95%CI=-0.30 至 37.77）和 PTSD 症状应对自我效能感（95%CI=-58.20 至-3.61）在 3 个月时略有降低。
我们证明了将急诊科急性受伤患者招募到基于应用程序的干预研究中的可行性，但 PTSD Coach 的可用性和益处存在混合证据。大多数患者只使用了一次该应用程序，并且对其满意度和有用性评价良好，但长期参与度较低。这一发现可能解释了 PTSD 症状总体上没有效果的原因。需要进一步研究针对更有症状的患者以及增加参与度和支持功能是否可以提高疗效。
