The effect of a scheduled telephone intervention on outcome after moderate to severe traumatic brain injury: a randomized trial.
OBJECTIVE
To measure the effectiveness of a scheduled telephone intervention offering counseling and education to people with traumatic brain injury (TBI) on behavioral outcomes compared with standard follow-up at 1 year postinjury.


METHODS
Two-group randomized, prospective clinical trial throughout the first year after injury.


METHODS
Subjects' homes via telephone in an urban-rural catchment area from a level I trauma center.


METHODS
Subjects (N=171; age range, 18-70 y) with a primary diagnosis of TBI who were discharged from an acute rehabilitation unit. They were randomly assigned to the telephone intervention (n=85) or to standard follow-up (n=86) groups at discharge. Of these, 79 participated in the intervention and completed the outcome assessment (3 withdrew; 3 were lost to follow-up), and 78 participated in usual care and completed the outcome assessment (8 were lost to follow-up).


METHODS
Subjects were randomly assigned to receive telephone calls at 2 and 4 weeks and 2, 3, 5, 7, and 9 months after discharge. The calls consisted of brief motivational interviewing, counseling, and education, plus facilitating usual care or usual care alone through follow-up appointments and therapy prescriptions.


METHODS
A composite outcome was used as the primary endpoint on an intent-to-treat basis. Secondary analyses were conducted with individual measures, including the FIM instrument, Disability Rating Scale, Community Integration Questionnaire, Neurobehavioral Functioning Inventory, Functional Status Examination, Glasgow Outcome Scale-Extended, Medical Outcomes Study 36-Item Short-Form Health Survey, Brief Symptom Inventory, EuroQol, and Modified Perceived Quality of Life scale. The primary analysis was a blocked Mann-Whitney U test.


RESULTS
At 1-year follow-up, those who had received scheduled telephone intervention fared significantly better on the primary composite outcome index ( P =.002). In addition, this group fared better on specific composites such as functional status ( P =.003) and quality of well-being ( P =.006). There were no significant differences on vocational status ( P =.08) or community integration status ( P =.13).


CONCLUSIONS
Scheduled telephone counseling and education resulted in improved overall outcome, particularly for functional status and quality of well-being, when compared with usual outpatient care. Telephone counseling shows promise as a low-cost, widely available rehabilitation intervention for TBI.
Bell
Kathleen R
KR
Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA. krbell@u.washington.edu
Temkin
Nancy R
NR
Esselman
Peter C
PC
Doctor
Jason N
JN
Bombardier
Charles H
CH
Fraser
Robert T
RT
Hoffman
Jeanne M
JM
Powell
Janet M
JM
Dikmen
Sureyya
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000534:rehabilitation*; D003376:Counseling; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D011446:Prospective Studies; D011788:Quality of Life; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D013689:Telephone; D016896:Treatment Outcome