title: Feasibility and Potential Benefits of a Web-Based Intervention Delivered Acutely After Mild Traumatic Brain Injury in Adolescents: A Pilot Study.
abstract: There is a paucity of evidence-based interventions for mild traumatic brain injury (mTBI).
  
  
  
  To evaluate the feasibility and potential benefits of an interactive, Web-based intervention for mTBI.
  
  
  
  Emergency department and outpatient settings.
  
  
  
  Of the 21 adolescents aged 11 to 18 years with mTBI recruited from November 2013 to June 2014 within 96 hours of injury, 13 completed the program.
  
  
  
  Prospective, open pilot.
  
  
  
  The Web-based Self-Management Activity-restriction and Relaxation Training (SMART) program incorporates anticipatory guidance and psychoeducation, self-management and pacing of cognitive and physical activities, and cognitive-behavioral principles for early management of mTBI in adolescents.
  
  
  
  Primary: Daily Post-Concussion Symptom Scale (PCSS). Secondary: Daily self-reported ratings of activities and satisfaction survey.
  
  
  
  Average time from injury to baseline testing was 14.0 (standard deviation = 16.7) hours. Baseline PCSS was 23.6 (range: 0-46), and daily activity was 1.8 (range: 0-5.75) hours. Repeated-measures, generalized linear mixed-effects model analysis demonstrated a significant decrease of PCSS at a rate of 2.0 points per day that stabilized after about 2 weeks. Daily activities, screen time, and physical activity increased by 0.06 (standard error [SE] = 0.04, P = .09), 0.04 (SE = 0.02, P = .15), and 0.03 (SE = 0.02, P = .05) hours per day, respectively, over the 4-week follow-up. Satisfaction was rated highly by parents and youth.
  
  
  
  Self-Management Activity-restriction and Relaxation Training is feasible and reported to be helpful and enjoyable by participants. Future research will need to determine the comparative benefits of SMART and ideal target population.
authors.affiliation: Division of Physical Medicine and Rehabilitation (Drs Kurowski and Wade), Division of Emergency Medicine (Drs Dexheimer and Babcock, and Ms Dyas), Division of Biomedical Informatics (Dr Dexheimer), and Division of Biostatistics and Epidemiology (Dr Zhang), Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Brad G
authors.initials: BG
authors.lastname: Kurowski
authors.forename: Shari L
authors.initials: SL
authors.lastname: Wade
authors.forename: Judith W
authors.initials: JW
authors.lastname: Dexheimer
authors.forename: Jenna
authors.initials: J
authors.lastname: Dyas
authors.forename: Nanhua
authors.initials: N
authors.lastname: Zhang
authors.forename: Lynn
authors.initials: L
authors.lastname: Babcock
mesh_terms: D000293:Adolescent; D001924:Brain Concussion / Q000534:rehabilitation*; D002648:Child; D015928:Cognitive Behavioral Therapy; D015444:Exercise; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D017060:Patient Satisfaction; D010865:Pilot Projects; D038223:Post-Concussion Syndrome / Q000175:diagnosis; D011446:Prospective Studies; D012064:Relaxation Therapy; D000073278:Self-Management