title: Issues in the design of a randomized noninferiority clinical trial of telemental health psychotherapy for rural combat veterans with PTSD.
abstract: This methodological article provides a description of the design, methods, and rationale of the first prospective, noninferiority designed randomized clinical trial evaluating the clinical and cost implications of delivering an evidence-based cognitive-behavioral group intervention specifically treating posttraumatic stress disorder (PTSD) with a trauma-focused intervention via video teleconferencing (VTC). PTSD is a prevalent mental health problem found among returning Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) military populations. These returning military personnel often live in rural areas and therefore have limited access to care and specialized psychological treatments. In the field of mental health, telemental health (TMH) technology has introduced a potential solution to the persistent problem of access to care in remote areas. This study is enrolling approximately 126 returning veterans with current combat-related PTSD who are receiving services through the Veteran Administration (VA) mental health care clinics on 4 Hawaiian Islands. Cognitive Processing Therapy (CPT), an empirically supported manualized treatment for PTSD, is being delivered across 9 cohorts. Participants are assigned to either the experimental VTC condition or the in-person control condition. Assessments measuring clinical, process, and cost outcomes are being conducted at baseline, mid-treatment, post-treatment, and 3 and 6 months post-treatment. The study employs a noninferiority design to determine if the group treatment delivered via VTC is as good as the traditional in-person modality. In addition, a cost analysis will be performed in order to compare the cost of the 2 modalities. Novel aspects of this trial and specific challenges are discussed.
authors: National Center for PTSD - Pacific Islands Division, Department of Veterans Affairs Pacific Islands Healthcare System, Honolulu, HI 96819, USA. Leslie.Morland@va.gov
authors: Leslie A
authors: LA
authors: Morland
authors: Carolyn J
authors: CJ
authors: Greene
authors: Craig
authors: C
authors: Rosen
authors: Patrick D
authors: PD
authors: Mauldin
authors: B Christopher
authors: BC
authors: Frueh
mesh_terms: D006254:Hawaii; D006801:Humans; D008605:Mental Health Services; D011446:Prospective Studies; D011613:Psychotherapy / Q000379:methods*; D012107:Research Design; D019035:Rural Health Services; D013313:Stress Disorders, Post-Traumatic / Q000628:therapy*; D017216:Telemedicine / Q000379:methods*; D014728:Veterans