title: Telephone-based goal management training for adults with mild traumatic brain injury: study protocol for a randomized controlled trial.
abstract: BACKGROUND
  Approximately 1 million individuals experience a mild traumatic brain injury (TBI) and cost the United States nearly $17 billion each year. Many trauma survivors with mild TBI have debilitating and long-term physical, emotional, and cognitive impairments that are unrecognized at trauma centers. Early intervention studies are needed to address these impairments, especially cognitive deficits in executive functioning. Goal management training (GMT) is a structured cognitive rehabilitation program that has been found to improve executive functioning in patients with moderate to severe TBI. The current study adapted the GMT program for telephone delivery in order to improve the accessibility of rehabilitation services in a patient population with multiple barriers to care and significant yet unrecognized cognitive impairment. The primary objective of this study is to examine the efficacy of telephone-based GMT for improving executive functioning, functional status, and psychological health in trauma survivors with mild TBI.
  
  
  METHODS
  This study is a three-group randomized controlled trial being conducted at a Level I trauma center. Ninety trauma survivors with mild TBI and cognitive deficits in executive functioning will be randomized to receive telephone-based GMT, telephone-based education, or usual care. GMT and education programs will be delivered by a physical therapist. The first in-person session is 1 h and the remaining six telephone sessions are 30 min. A battery of well-established cognitive tests will be conducted and validated questionnaires will be collected that measure executive functioning, functional status, and depressive and posttraumatic stress disorder symptoms at 6 weeks, 4 months, and 7 months following hospital discharge.
  
  
  CONCLUSIONS
  This study supports a telephone-delivery approach to rehabilitation services in order to broaden the availability of evidence-based cognitive strategies.
  
  
  BACKGROUND
  This trial was registered with Clinicaltrials.gov on 10 October 2012, registration number: NCT01714531.
authors.affiliation: Department of Orthopaedic Surgery, Vanderbilt University School of Medicine, 1215 21st Avenue South, Medical Center East, South Tower, Nashville, TN, 37232, USA. kristin.archer@vanderbilt.edu.|Department of Physical Medicine and Rehabilitation, Vanderbilt University School of Medicine, 2201 Children's Way, Suite 1318, Nashville, TN, 37212, USA. kristin.archer@vanderbilt.edu.
authors.forename: Kristin R
authors.initials: KR
authors.lastname: Archer
authors.affiliation: Department of Orthopaedic Surgery, Vanderbilt University School of Medicine, 1215 21st Avenue South, Medical Center East, South Tower, Nashville, TN, 37232, USA. rogelio.coronado@vanderbilt.edu.
authors.forename: Rogelio A
authors.initials: RA
authors.lastname: Coronado
authors.affiliation: Department of Orthopaedic Surgery, Vanderbilt University School of Medicine, 1215 21st Avenue South, Medical Center East, South Tower, Nashville, TN, 37232, USA. lori.haislip@vanderbilt.edu.
authors.forename: Lori R
authors.initials: LR
authors.lastname: Haislip
authors.affiliation: Department of Orthopaedic Surgery, Vanderbilt University School of Medicine, 1215 21st Avenue South, Medical Center East, South Tower, Nashville, TN, 37232, USA. christine.m.abraham@vanderbilt.ed.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Abraham
authors.affiliation: Department of Orthopaedic Surgery, Vanderbilt University School of Medicine, 1215 21st Avenue South, Medical Center East, South Tower, Nashville, TN, 37232, USA. susan.w.vanston@vanderbilt.edu.
authors.forename: Susan W
authors.initials: SW
authors.lastname: Vanston
authors.affiliation: School of Medicine, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Boulevard, Nashville, TN, 37208, USA. alazaro13@email.mmc.edu.
authors.forename: Anthony E
authors.initials: AE
authors.lastname: Lazaro
authors.affiliation: Division of Allergy, Pulmonary, and Critical Care, Department of Medicine, Center for Health Services Research, Vanderbilt University School of Medicine, 1215 21st Avenue South, Medical Center East, North Tower, Nashville, TN, 37232, USA. james.c.jackson@vanderbilt.edu.|Department of Psychiatry, Vanderbilt University School of Medicine, 1601 23rd Avenue, Nashville, TN, 37212, USA. james.c.jackson@vanderbilt.edu.|Geriatric Research, Veteran's Affairs Tennessee Valley Geriatric Research Education and Clinical Center (GRECC), Tennessee Valley Healthcare System, 1310 24th Avenue South, Nashville, TN, 37212, USA. james.c.jackson@vanderbilt.edu.
authors.forename: James C
authors.initials: JC
authors.lastname: Jackson
authors.affiliation: Division of Allergy, Pulmonary, and Critical Care, Department of Medicine, Center for Health Services Research, Vanderbilt University School of Medicine, 1215 21st Avenue South, Medical Center East, North Tower, Nashville, TN, 37232, USA. wes.ely@vanderbilt.edu.|Geriatric Research, Veteran's Affairs Tennessee Valley Geriatric Research Education and Clinical Center (GRECC), Tennessee Valley Healthcare System, 1310 24th Avenue South, Nashville, TN, 37212, USA. wes.ely@vanderbilt.edu.
authors.forename: E Wesley
authors.initials: EW
authors.lastname: Ely
authors.affiliation: Division of Trauma and Surgical Critical Care, Department of Medicine, Vanderbilt University School of Medicine, 1215 21st Avenue South, 404 MAB 1750, Nashville, TN, 37232, USA. oscar.guillamondegui@vanderbilt.edu.
authors.forename: Oscar D
authors.initials: OD
authors.lastname: Guillamondegui
authors.affiliation: Department of Orthopaedic Surgery, Vanderbilt University School of Medicine, 1215 21st Avenue South, Medical Center East, South Tower, Nashville, TN, 37232, USA. william.obremskey@vanderbilt.edu.
authors.forename: William T
authors.initials: WT
authors.lastname: Obremskey
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D002985:Clinical Protocols; D003071:Cognition; D015928:Cognitive Behavioral Therapy / Q000295:instrumentation*; D056344:Executive Function; D005260:Female; D006040:Goals; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008603:Mental Health; D064866:Mindfulness; D009483:Neuropsychological Tests; D010353:Patient Education as Topic; D020127:Recovery of Function; D012107:Research Design; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000295:instrumentation* / Q000379:methods; D013689:Telephone; D013714:Tennessee; D013997:Time Factors; D014193:Trauma Centers; D016896:Treatment Outcome