Feasibility and Potential Benefits of a Web-Based Intervention Delivered Acutely After Mild Traumatic Brain Injury in Adolescents: A Pilot Study.
Brad G Kurowski, Shari L Wade, Judith W Dexheimer and 3 others
PMID 26360000WHAT IT FOUND
Adolescents with mild head injury using a web-based program combining symptom monitoring, anticipatory guidance, psychoeducation, activity pacing and cognitive-behavioral principles saw daily symptom scores fall by 2.0 points per day early on, but no control group means benefit cannot be attributed.
Key findings
01Daily post-concussion symptom scores decreased at a rate of 2.0 points per day soon after the intervention, with p<0.01, and stabilized after about two weeks.
02Self-reported time in physical, mental, screen time and overall daily activities increased by 0.03, 0.04, 0.04 and 0.06 hours per day, with p values of 0.05, 0.30, 0.15 and 0.09.
03Of 21 enrolled adolescents, 13 completed the program, and all eleven parents and nine youth who completed the end survey agreed or strongly agreed that the program met their goals, their questions had been answered, they had a plan for future problems, and they understood the injury better.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
There was no control group, so the authors could not compare SMART with standard care or other treatments. The study was small and non-comparative, so the symptom trajectory cannot show that SMART caused improvement. Forty-seven potential participants were approached and only 21 were recruited; 13 completed and 8 did not. The eight non-completers were unable to be contacted after enrollment, so the reasons for dropout are unknown. The authors could not tell whether dropouts had recovered or were too symptomatic to continue. All completers were Caucasian, and the sample was 11 to 18 years old, so results may not apply to other groups. The program combined several elements, including symptom monitoring, psychoeducation, activity pacing and cognitive-behavioral principles, so the contribution of any single component cannot be separated. Participants received reminders and monetary incentives, which may have affected engagement.
The easy way to misread this
Do not conclude that SMART caused the 2.0 points per day drop in symptom scores. The study had no control group, and the authors stated they could not draw conclusions on efficacy compared with standard care or other treatments.