Background: There have been few trials of interventions to facilitate recovery following mild traumatic brain injury (mTBI) in adolescence. To address this gap, we developed and piloted a novel Web-based intervention, entitled Self-Management Activity Restriction and Relaxation Training (SMART), and examined its impact on symptom burden, functional disability, and executive functioning during the month following mTBI in adolescents. Materials and Methods: Open-label, single arm study. Adolescents with recent mTBI and a parent were recruited from the emergency department and provided access upon discharge to SMART-a Web-based program designed to facilitate recovery via self-management and education about symptoms and sequelae associated with mTBI. Symptom burden, functional disability, and executive functioning were rated by both the adolescent and the parent initially and at assessments at 1-, 2-and 4-weeks postinjury. Mixed models analyses were used to examine trajectories on these outcomes. Results: Of the 21 adolescent/parent dyads enrolled, 13 engaged in the program and reported significant improvement in symptoms over the 4-week program (adolescent, p = 0.0005; parent, p = 0.004). Adolescents spent a median of 35.5 min (range 1.1-107.6) using the program. Parent ratings of the adolescent's functional disability and executive functioning significantly improved over the 4-week period from baseline (p = 0.009 and p = 0.03, respectively), whereas adolescents themselves did not report significant changes in either outcome. All participants improved and there were no adverse outcomes. Conclusion: The SMART program, a novel Web-based intervention, may serve as a self-management tool for adolescents and their parents to assist with the recovery following a recent mTBI.
When compared with video review for retrospective study of RSI in a pediatric ED, chart review significantly underestimated adverse effects, inconsistently contained data on important RSI process elements, rarely provided time data, and often conflicted with observations made on video review. Interpretation of and design of future studies of RSI should take into consideration the quality of the data source.
Background
There is a paucity of evidence-based interventions for mild traumatic brain injury (mTBI).
Objective
To evaluate the feasibility and potential benefits of an interactive, web-based intervention for mTBI.
Setting
Emergency department (ED) and outpatient settings.
Participants
Of the 21 adolescents ages 11–18 years with mTBI recruited from November 2013 to June 2014 within 96 hours of injury, 13 completed the program.
Design
Prospective, open pilot.
Intervention
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.
Main Measures
Primary: Daily post-concussion symptom score (PCSS). Secondary: Daily self-reported ratings of activities and satisfaction survey
Results
Average time from injury to baseline testing was 14.0 (SD:16.7) hours. Baseline PCSS was 23.6 (range:0–46), and daily activity was 1.8 hours (range:0–5.75). Repeated-measures, generalized linear mixed-effects model analysis demonstrated a significant decrease of PCSS at a rate of 2.0 points/day that stabilized after about two weeks. Daily activities, screen time and physical activity increased by 0.06 (SE=0.04, p=0.09), 0.04 (SE=0.02, p=0.15) and 0.03 (SE=0.02, p=0.05) hours/day, respectively, over the 4-week follow-up. Satisfaction was rated highly by parents and youth.
Conclusions
SMART 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.
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