Belanger Heather G, Toyinbo Peter, Barrett Blake, King Emily, Sayer Nina A
Research and Development Service, James A. Haley Veterans' Hospital, Tampa, FL, USA.
United States Special Operations Command (USSOCOM), Tampa, FL, USA.
Clin Neuropsychol. 2022 Nov;36(8):2093-2119. doi: 10.1080/13854046.2021.1936188. Epub 2021 Jun 29.
Investigate the effectiveness of Concussion Coach, an interactive smartphone application, as a treatment for residual neurobehavioral symptoms and distress in Veterans with a history of mild traumatic brain injury (mild TBI). Veterans with mild TBI were randomized to Concussion Coach (n = 238) or Treatment-as-Usual (TAU) (n = 241) in a 3-month randomized controlled trial. Primary outcome measures included postconcussive symptom (PCS) severity as measured by the Neurobehavioral Symptom Inventory (NSI), and psychological distress as measured by the Brief Symptom Inventory-18 (BSI-18). Measures of self-efficacy, social support, and comfort with technology were administered as potential moderators and mediators. An intention-to-treat (ITT) analysis was performed (N = 461: Concussion Coach = 231 and TAU = 230) using Bayesian Network (BN)modeling. The probability of decreased PCS severity was significantly greater for those assigned to Concussion Coach, .35 [.32,.37], than for TAU, .29 (.27, .32), with an odds ratio (OR) of 1.29. Also, Concussion Coach showed a significantly greater probability of increased self-efficacy (.36 [.32, .39]) than did TAU (.28 [.25, .30], OR = 1.42). In turn, self-efficacy (increased vs. decreased) showed a significantly greater probability of decreased PCS severity (.51 [.47, .54] vs. .27 [.24, .30], OR = 2.71) and decreased psychological distress (.53 [.49, .56] vs. .32 [.29, .35], OR = 2.35), suggesting that self-efficacy may have mediated Concussion Coach effects. Concussion Coach is effective at reducing PCS severity and psychological distress. Increased self-efficacy/perception of self-management of symptoms may be key to successful treatment of residual symptoms in those with history of concussion.
研究一款交互式智能手机应用程序“脑震荡教练”对有轻度创伤性脑损伤（轻度TBI）病史的退伍军人残留神经行为症状和痛苦的治疗效果。在一项为期3个月的随机对照试验中，将患有轻度TBI的退伍军人随机分为“脑震荡教练”组（n = 238）或常规治疗（TAU）组（n = 241）。主要结局指标包括通过神经行为症状量表（NSI）测量的脑震荡后症状（PCS）严重程度，以及通过简明症状量表-18（BSI-18）测量的心理痛苦程度。自我效能感、社会支持和对技术的舒适度等指标作为潜在的调节因素和中介因素进行测量。使用贝叶斯网络（BN）建模进行意向性分析（N = 461：脑震荡教练组 = 231，TAU组 = 230）。分配到“脑震荡教练”组的患者PCS严重程度降低的概率显著高于TAU组，分别为0.35[0.32, 0.37]和0.29（0.27, 0.32），优势比（OR）为1.29。此外，“脑震荡教练”组自我效能感提高的概率显著高于TAU组，分别为0.36[0.32, 0.39]和0.28[0.25, 0.30]，OR = 1.42。反过来，自我效能感（提高与降低）显示PCS严重程度降低的概率显著更高（0.51[0.47, 0.54]对0.27[0.24, 0.30]，OR = 2.71），心理痛苦程度降低的概率也显著更高（0.53[0.49, 0.56]对0.32[0.29, 0.35]，OR = 2.35），这表明自我效能感可能介导了“脑震荡教练”的效果。“脑震荡教练”在降低PCS严重程度和心理痛苦方面有效。提高自我效能感/对症状自我管理的认知可能是成功治疗有脑震荡病史者残留症状的关键。
