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Online Family Problem-Solving Therapy (F-PST) for Executive and Behavioral Dysfunction After Traumatic Brain Injury
Brad G Kurowski1, H Gerry Taylor, Kelly A McNally
1Division of Pediatric Rehabilitation Medicine, Departments of Pediatrics and Neurology and Rehabilitation Medicine (Dr Kurowski), Division of Epidemiology and Biostatistics, Department of Pediatrics (Dr Cassedy), Division of Neurology, Department of Pediatrics (Dr Horn), and Division of Pediatric Rehabilitation Medicine, Department of Pediatrics (Dr Wade), Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Ohio; Biobehavioral Health Center, Abigail Wexner Research Institute at Nationwide Children's Hospital and The Ohio State University, Columbus, and Case Western Reserve University and Rainbow Babies & Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Dr Taylor); Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio (Dr McNally); Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado (Dr Kirkwood); and MetroHealth Medical Center and Case Western Reserve University, Cleveland, Ohio (Dr Stancin).
Objective:
To examine the comparative effectiveness of 3 modes of family problem-solving therapy (F-PST): therapist-guided online, self-guided online, and face-to-face.
Setting:
Four children's hospitals and a general hospital with pediatric commitment.
Participants:
A total of 150 adolescents aged 14 to 18 years, previously hospitalized with traumatic brain injury (TBI), and evidence of behavior problems at enrollment.
Design:
Multicenter, randomized clinical trial.
Main Measures:
Behavior Rating Inventory of Executive Function (BRIEF) Global Executive Composite (GEC), Behavior Regulation Index, and Metacognition Index, and Strengths and Difficulties Questionnaire (SDQ) Total at baseline and 6 and 9 months later.
Results:
Mixed-model intention-to-treat analyses of comparative effectiveness failed to reveal statistically significant differences among treatment groups. At 6 months, parent BRIEF-GEC improved for the therapist-guided and self-guided, online groups. Effects remained significant and increased in magnitude at 9 months for the self-guided online group. Scores for the Self-guided online group significantly improved from baseline to 9 months on the SDQ Total.
Conclusions:
This comparative effectiveness study supports the utility of both self- and therapist-guided online F-PST in improving executive function behaviors in adolescents following TBI. Further work regarding clinical implementation and how best to integrate telehealth with ongoing rehabilitation care is warranted.
