研究快报：认知康复治疗轻度创伤性脑损伤的长期结局：来自 SCORE 随机临床试验队列的 5 年随访。
Research Letter: Long-Term Outcomes Following Cognitive Rehabilitation for Mild Traumatic Brain Injury: A 5-Year Follow-Up of a Cohort From the SCORE Randomized Clinical Trial.
机构信息
Traumatic Brain Injury Center of Excellence (TBICOE), Neurology Service, Department of Medicine, Brooke Army Medical Center, Joint Base San Antonio, San Antonio, Texas (Dr Kennedy and Ms Shelton); Polytrauma Rehabilitation Center, Audie Murphy Veterans Hospital, and Departments of Psychiatry and Rehabilitation Medicine, UT Health San Antonio, San Antonio, Texas (Dr Cooper); Department of Psychology, University of South Florida, Tampa (Dr Curtiss); Brain Injury Rehabilitation Service, Department of Rehabilitation, Brooke Army Medical Center, Joint Base San Antonio, San Antonio, Texas (Dr Bowles); Department of Neurology, University of Utah School of Medicine, Salt Lake City (Dr Tate); Physical Medicine and Rehabilitation, VA Greater Los Angeles Healthcare System, Los Angeles, California (Dr Eapen); and Department of Psychiatry and Neurosciences, College of Medicine, University of South Florida, Tampa (Dr Vanderploeg).
出版信息
J Head Trauma Rehabil. 2022;37(6):390-395. doi: 10.1097/HTR.0000000000000800. Epub 2022 Jul 20.
OBJECTIVE
To examine the functioning of military service members 5 years after completing a randomized controlled trial (RCT) of cognitive rehabilitation for mild traumatic brain injury (mTBI).
SETTING
Home-based telephonic interview and internet-based self-ratings.
PARTICIPANTS
Sixty-nine of the 126 (55%) active-duty service members who were enrolled in a 4-arm RCT of cognitive rehabilitation 3 to 24 months after mTBI and were successfully contacted by phone 5 years later. Original and 5-year follow-up participants in each of 4 RCT treatment arms included: psychoeducation ( n = 32 original, n = 17 follow-up), computer ( n = 30 original, n = 11 follow-up), therapist-directed ( n = 30 original, n = 23 follow-up), integrated ( n = 34 original, n = 18 follow-up).
DESIGN
Inception cohort evaluated 5 years after completion of an RCT of cognitive rehabilitation.
MAIN MEASURES
Postconcussion symptoms (Neurobehavioral Symptom Inventory total score), psychological distress (Symptom Checklist-90-revised Global Severity Index score), and functional cognitive/behavioral symptoms (Key Behaviors Change Inventory total average score).
RESULTS
Participants' postconcussive symptoms and psychological distress improved at the 5-year follow-up. Functional cognitive/behavioral symptoms were not significantly improved, but therapeutic gains were maintained across time, to 5 years after completing the RCT.
CONCLUSION
In this sample of military personnel, postconcussive symptoms and psychological distress significantly improved from posttreatment to 5 years after cognitive rehabilitation, regardless of treatment arm. Functional cognitive/behavioral symptoms significantly improved with treatment while treatment gains were maintained at the 5-year follow-up. Replication of these results with a larger sample and interim data between 18 weeks and 5 years post-treatment is needed.
目的
研究参加轻度创伤性脑损伤（mTBI）认知康复随机对照试验（RCT）5 年后的现役军人的功能状况。
设置
家庭电话访谈和基于互联网的自我评估。
参与者
共有 126 名现役军人参加了 mTBI 后 3 至 24 个月的 4 臂 RCT 认知康复研究，其中 69 名（55%）成功通过电话联系，并在 5 年后进行了电话随访。每个 RCT 治疗组的原始和 5 年随访参与者包括：心理教育（n = 32 例原始，n = 17 例随访）、计算机（n = 30 例原始，n = 11 例随访）、治疗师指导（n = 30 例原始，n = 23 例随访）、综合（n = 34 例原始，n = 18 例随访）。
设计
完成 RCT 认知康复治疗后，评估患者 5 年。
主要指标
脑震荡后症状（神经行为症状量表总分）、心理困扰（症状清单-90 修订版总体严重程度指数评分）和功能认知/行为症状（关键行为改变量表总分平均评分）。
结果
随访 5 年后，患者的脑震荡后症状和心理困扰得到改善。功能认知/行为症状无显著改善，但治疗效果在时间上得以维持，直到完成 RCT 后 5 年。
结论
在该军事人员样本中，无论治疗组如何，脑震荡后症状和心理困扰从治疗后到认知康复后 5 年显著改善。功能认知/行为症状在治疗时显著改善，而治疗效果在 5 年随访时得到维持。需要用更大的样本和治疗后 18 周至 5 年的中间数据来复制这些结果。
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