title: Evaluation of the short-term executive plus intervention for executive dysfunction after traumatic brain injury: a randomized controlled trial with minimization.
abstract: OBJECTIVE
  To determine whether the Short-Term Executive Plus (STEP) cognitive rehabilitation program improves executive dysfunction after traumatic brain injury (TBI).
  
  
  METHODS
  Randomized, waitlist controlled trial with minimization and blinded outcome assessment.
  
  
  METHODS
  Community.
  
  
  METHODS
  Participants with TBI and executive dysfunction (N=98; TBI severity 50% moderate/severe; mean time since injury ± SD, 12±14y; mean age ± SD, 45±14y; 62% women; 76% white).
  
  
  METHODS
  STEP program: 12 weeks (9h/wk) of group training in problem solving and emotional regulation and individual sessions of attention and compensatory strategies training.
  
  
  METHODS
  Factor analysis was used to create a composite executive function measure using the Problem Solving Inventory, Frontal Systems Behavior Scale, Behavioral Assessment of the Dysexecutive Syndrome, and Self-Awareness of Deficits Interview. Emotional regulation was assessed with the Difficulties in Emotion Regulation Scale. The primary attention measure was the Attention Rating and Monitoring Scale. Secondary measures included neuropsychological measures of executive function, attention, and memory and measures of affective distress, self-efficacy, social participation, and quality of life.
  
  
  RESULTS
  Intention-to-treat mixed-effects analyses revealed significant treatment effects for the composite executive function measure (P=.008) and the Frontal Systems Behavior Scale (P=.049) and Problem Solving Inventory (P=.016). We found no between-group differences on the neuropsychological measures or on measures of attention, emotional regulation, self-awareness, affective distress, self-efficacy, participation, or quality of life.
  
  
  CONCLUSIONS
  The STEP program is efficacious in improving self-reported post-TBI executive function and problem solving. Further research is needed to identify the roles of the different components of the intervention and its effectiveness with different TBI populations.
authors.affiliation: Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Joshua
authors.initials: J
authors.lastname: Cantor
authors.affiliation: Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Teresa
authors.initials: T
authors.lastname: Ashman
authors.affiliation: Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Kristen
authors.initials: K
authors.lastname: Dams-O'Connor
authors.affiliation: Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Marcel P
authors.initials: MP
authors.lastname: Dijkers
authors.affiliation: Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: Wayne.gordon@mountsinai.org.
authors.forename: Wayne
authors.initials: W
authors.lastname: Gordon
authors.affiliation: Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Lisa
authors.initials: L
authors.lastname: Spielman
authors.affiliation: Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Theodore
authors.initials: T
authors.lastname: Tsaousides
authors.affiliation: Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Hafina
authors.initials: H
authors.lastname: Allen
authors.affiliation: Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Michael
authors.initials: M
authors.lastname: Nguyen
authors.affiliation: Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Oswald
mesh_terms: D000328:Adult; D001288:Attention; D001930:Brain Injuries / Q000534:rehabilitation*; D056344:Executive Function; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000453:epidemiology / Q000534:rehabilitation; D011340:Problem Solving; D011788:Quality of Life; D020377:Self Efficacy; D012647:Self-Assessment; D058992:Social Participation; D012959:Socioeconomic Factors; D015599:Trauma Severity Indices
keywords: APT-II; Attention Process Training, Second Edition; Brain injuries; Brain injury, chronic; Cognition disorders; Cognitive therapy; FrSBe; Frontal Systems Behavior Scale; Rehabilitation; STEP; Short-Term Executive Plus; TBI; WCST; WL; Wisconsin Card Sorting Test computer version 4; traumatic brain injury; waitlist