A novel bio-psycho-social approach for rehabilitation of traumatized victims of torture and war in the post-conflict context: a pilot randomized controlled trial in Kosovo

Abstract

BackgroundSome evidence showed that multidisciplinary rehabilitation in Western countries is effective for treating war-related trauma, but it remains unclear whether this approach is applicable to civilians living in resource-poor countries affected by war. In 2012–14, Danish Institute against Torture (DIGNITY) conducted a randomized controlled trial (RCT), in partnership with Kosova Rehabilitation Centre for Torture Victims (KRCT), to examine the effects of multidisciplinary intervention among victims of torture and war in Kosovo.MethodsA single-center, randomized, parallel-arm, single-masked, waiting-list controlled trial was implemented in northern Kosovo. Thirty-four participants meeting the recruiting criteria were randomized to either intervention group, which received integrated treatments plus a once-daily multivitamin, or the waiting list group, which received multivitamin alone. The integrated treatments consisted of 10 weekly individual 60-min sessions of cognitive behavioral therapy (CBT), based on an adapted prolonged exposure therapy manual, an individual 20-min breathing exercise with an emWave biofeedback device, and 90-min group physiotherapy. The waiting list group also received the same treatment after the intervention group had completed their sessions. Outcome assessments were conducted at 3, 6 and 9 months after baseline assessment. Outcomes measures consisted of 4 subtypes: mental, emotional, physical health, functioning and social outcomes, i.e. PTSD, depression, anxiety, chronic pain, anger and hatred expression, body mass index, handgrip strength, standing balance, income, employment rate and disability score.ResultsOver 1/3 of PTSD cases were successfully treated. Inconsistent patterns with mental health and chronic pain outcomes were observed while there was a definite impact of intervention on functioning and social outcomes, i.e. the employment rate, which increased nearly 15 %, and the monthly wage, which rose 45–137 %. There was also a noticeable improvement in handgrip strength and disability score; the feelings of anger and hatred diminished. However, most of these changes did not reach statistical significance.ConclusionsThe impact of bio-psycho-social intervention is likely sensitive to the context of post-war economy in Kosovo and the treatment goals. The potential for improving the emotional well-being and employment outcome in victims was demonstrated. A larger scale RCT in a similar setting is needed, with close monitoring of treatment integrity and data reliability.Trial registrationClinicaltrials.gov (NCT01696578).

Psychological and pharmacological interventions for posttraumatic stress disorder and comorbid mental health problems following complex traumatic events: Systematic review and component network meta-analysis

“…We included 116 studies (115 papers) in the systematic review. Of these, 50 were conducted in hospital settings , 24 were delivered in a community setting , seven were delivered in military clinics for veterans or active military personnel [103][104][105][106][107][108][109], five were conducted in refugee camps [110][111][112][113][114], four used remote delivery via web-based or telephone platforms [115][116][117][118], four were conducted in specialist trauma clinics [119][120][121][122], two were delivered in home settings [123,124], and two were delivered in primary care clinics [125,126]; clinical setting was not reported in 17 studies [127][128][129][130][131][132][133][134][135][136][137][138][139][140][141][142][143].…”

Economic evaluation of a bio-psycho-social intervention for comorbid disorders in a traumatized population in post-war Kosovo

“…At baseline, only 6 participants were in paid part-time employment. Nevertheless, by the end of the trial employment rate increased by approximately 15% for both groups and mean income of those who were in employment (most of them were employed part-time, but 2 had full-time jobs) also increased significantly (8).…”

“…A post-hoc economic analysis was performed using data from the RCT in Kosovo conducted by DIGNITY and the KRCT in 2012-13. The characteristics of the study participants and details of methods and results have been published previously (8).…”

“…In 2012-2013, the Danish Institute Against Torture (DIGNITY), in collaboration with the Kosovar Rehabilitation Centre for Torture Victims (KRCT), conducted a 10-week multidisciplinary rehabilitation programme in Kosovo, with physiotherapy, biofeedback-supported psychotherapy and social support. The intervention was designed as a randomized controlled trial (RCT) (8).…”

Trauma, Traumatization and Adverse Environments in War and Armed- Conflict

“…Preventative and interventional treatment programs for individuals, i.e., civilians, soldiers, POWs and survivors, at risk of developing psychological and psychiatric problems following exposure/association to war trauma have blossomed during the course of the previous decades [42][43][44][45], and yet the suffering involved by these victims remains at catastrophic levels. Nevertheless, there are several positive aspects to the attempts at prevention and intervention.…”