title: Telephone Problem Solving for Service Members with Mild Traumatic Brain Injury: A Randomized, Clinical Trial.
abstract: Mild traumatic brain injury (mTBI) is a common injury for service members in recent military conflicts. There is insufficient evidence of how best to treat the consequences of mTBI. In a randomized, clinical trial, we evaluated the efficacy of telephone-delivered problem-solving treatment (PST) on psychological and physical symptoms in 356 post-deployment active duty service members from Joint Base Lewis McChord, Washington, and Fort Bragg, North Carolina. Members with medically confirmed mTBI sustained during deployment to Iraq and Afghanistan within the previous 24 months received PST or education-only (EO) interventions. The PST group received up to 12 biweekly telephone calls from a counselor for subject-selected problems. Both groups received 12 educational brochures describing common mTBI and post-deployment problems, with follow-up for all at 6 months (end of PST), and at 12 months. At 6 months, the PST group significantly improved on a measure of psychological distress (Brief Symptom Inventory; BSI-18) compared to the EO group (p = 0.005), but not on post-concussion symptoms (Rivermead Post-Concussion Symptoms Questionnaire [RPQ]; p = 0.19), the two primary endpoints. However, these effects did not persist at 12-month follow-up (BSI, p = 0.54; RPQ, p = 0.45). The PST group also had significant short-term improvement on secondary endpoints, including sleep (p = 0.01), depression (p = 0.03), post-traumatic stress disorder (p = 0.04), and physical functioning (p = 0.03). Participants preferred PST over EO (p < 0.001). Telephone-delivered PST appears to be a well-accepted treatment that offers promise for reducing psychological distress after combat-related mTBI and could be a useful adjunct treatment post-mTBI. Further studies are required to determine how to sustain its effects. (Trial registration: ClinicalTrials.gov Identifier: NCT01387490 https://clinicaltrials.gov ).
authors: 1 Department of Rehabilitation Medicine, University of Washington , Seattle, Washington.
authors: Kathleen R
authors: KR
authors: Bell
authors: 1 Department of Rehabilitation Medicine, University of Washington , Seattle, Washington.|2 Department of Psychiatry and Behavioral Sciences, University of Washington , Seattle, Washington.
authors: Jesse R
authors: JR
authors: Fann
authors: 1 Department of Rehabilitation Medicine, University of Washington , Seattle, Washington.
authors: Jo Ann
authors: JA
authors: Brockway
authors: 3 Defense and Veterans Brain Injury Center, Intrepid Spirit, Womack Army Medical Center , Fort Bragg, North Carolina.
authors: Wesley R
authors: WR
authors: Cole
authors: 4 National Center for Telehealth and Technology , Joint Base Lewis McChord, Tacoma, Washington.
authors: Nigel E
authors: NE
authors: Bush
authors: 1 Department of Rehabilitation Medicine, University of Washington , Seattle, Washington.|5 Department of Neurological Surgery, University of Washington , Seattle, Washington.
authors: Sureyya
authors: S
authors: Dikmen
authors: 6 Moss Rehabilitation Research Institute , Elkins Park, Pennsylvania.
authors: Tessa
authors: T
authors: Hart
authors: 7 Department of Psychiatry, University California San Diego and VA San Diego Healthcare System Center of Excellence for Stress and Mental Health , La Jolla, California.
authors: Ariel J
authors: AJ
authors: Lang
authors: 8 Department of Surgery, Duke University , Durham, North Carolina.
authors: Gerald
authors: G
authors: Grant
authors: 4 National Center for Telehealth and Technology , Joint Base Lewis McChord, Tacoma, Washington.
authors: Gregory
authors: G
authors: Gahm
authors: 4 National Center for Telehealth and Technology , Joint Base Lewis McChord, Tacoma, Washington.
authors: Mark A
authors: MA
authors: Reger
authors: 5 Department of Neurological Surgery, University of Washington , Seattle, Washington.
authors: Jef
authors: J
authors: St De Lore
authors: 1 Department of Rehabilitation Medicine, University of Washington , Seattle, Washington.
authors: Joan
authors: J
authors: Machamer
authors: 9 Department of Family Medicine and Public Health, University of California San Diego , La Jolla, California.
authors: Karin
authors: K
authors: Ernstrom
authors: 9 Department of Family Medicine and Public Health, University of California San Diego , La Jolla, California.
authors: Rema
authors: R
authors: Raman
authors: 9 Department of Family Medicine and Public Health, University of California San Diego , La Jolla, California.
authors: Sonia
authors: S
authors: Jain
authors: 7 Department of Psychiatry, University California San Diego and VA San Diego Healthcare System Center of Excellence for Stress and Mental Health , La Jolla, California.|9 Department of Family Medicine and Public Health, University of California San Diego , La Jolla, California.
authors: Murray B
authors: MB
authors: Stein
authors: 1 Department of Rehabilitation Medicine, University of Washington , Seattle, Washington.|5 Department of Neurological Surgery, University of Washington , Seattle, Washington.|10 Department of Biostatistics, University of Washington , Seattle, Washington.
authors: Nancy
authors: N
authors: Temkin
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D001924:Brain Concussion / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008889:Military Personnel / Q000523:psychology*; D009657:North Carolina / Q000453:epidemiology; D010353:Patient Education as Topic / Q000379:methods*; D038223:Post-Concussion Syndrome / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D011340:Problem Solving; D013689:Telephone; D014861:Washington / Q000453:epidemiology; D055815:Young Adult
keywords: mild traumatic brain injury; problem-solving treatment (or training or therapy); service members (or military); telehealth