Online Family Problem-Solving Therapy (F-PST) for Executive and Behavioral Dysfunction After Traumatic Brain Injury in Adolescents: A Randomized, Multicenter, Comparative Effectiveness Clinical Trial.

The face-to-face group was smaller than the online groups because randomization depended on distance, which may have limited power to detect differences involving face-to-face treatment. The study was powered for the comparison of the two online groups, not for all three delivery modes. Parents and adolescents knew which treatment they received, so their ratings could have been influenced by expectations or preference. The behavior rating scale was chosen to be brief and may have been less sensitive to change than scales used in earlier problem-solving therapy studies. Follow-up was limited to 9 months, so longer-term effects were not tested. The study included few families from rural areas, so it could not test whether urban versus rural residence changed treatment effects. Treatment sessions were not recorded and coded for fidelity, so details of how consistently the therapy was delivered were limited. A lower proportion of white participants was in the face-to-face group than in the online groups, so the groups were not identical on race.

The authors disclosed no potential conflicts of interest.

Do not conclude that self-guided online therapy is proven better than face-to-face therapy. The primary comparison among treatment groups found no differences, and the positive self-guided findings were secondary or within-group. The face-to-face group was smaller, and participants were not blinded.