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On-TRACC Pilot Study: A Novel Intervention for Persistent Post-Concussive Cognitive Symptoms
Kathleen F Pagulayan1,2, Holly K Rau1,2, David P Sheppard1,2
1Author Affiliations: VA Puget Sound Health Care System, Seattle, Washington (Drs Pagulayan, Rau, and Sheppard, and Ms Onstad-Hawes, and Dr Williams); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington (Drs Pagulayan and Sheppard); and Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington (Ms Shulein, and Drs Hoffman and Williams).
Objective:
To present the results of a pilot study of On-TRACC (Tools for Recovery and Clinical Care), a novel intervention for individuals experiencing persistent cognitive difficulties after mild traumatic brain injury (mTBI). On-TRACC is a 5-session, 1:1 manualized treatment that integrates psychoeducation, cognitive rehabilitation strategies, and self-management skills to target symptoms and increase understanding of the interaction between cognitive difficulties, injury history, and comorbid medical and psychological conditions. The primary study goals were to evaluate the feasibility, acceptability, and preliminary effectiveness of On-TRACC.
Setting:
Veterans Affairs medical center and an academic medical center.
Participants:
Veterans and civilian adults (n = 28) >3 months post-mTBI with current self-reported cognitive difficulties.
Design:
In this single-group, open-label pilot study, all participants received On-TRACC (5 sessions) via video-based telehealth.
Main Measures:
Primary measures were feasibility (eg, session attendance and homework completion rate, dropout rate, and treatment fidelity) and acceptability (treatment satisfaction/helpfulness ratings). Preliminary effectiveness was explored by measuring pre- to post-intervention change in cognitive symptom level and attribution, perceived self-efficacy, use of compensatory strategies, daily functioning, quality of life, and planned future engagement in health care.
Results:
The On-TRACC completion rate for all enrolled participants was 79% (with 88% treatment completion rate for participants who started On-TRACC); homework was fully or partially completed for 98% of attended sessions. Treatment satisfaction ratings were high, with 95% satisfied with the information and skills learned. There were no adverse events. Positive pre- to posttreatment changes were seen in cognitive self-efficacy, symptom attribution, functional status, quality of life, and planned engagement in care for comorbid conditions.
Conclusion:
On-TRACC was a feasible and acceptable intervention for individuals with chronic cognitive difficulties following mTBI. Additional research, including a randomized clinical trial, is needed to evaluate the efficacy of this intervention and its long-term impact on outcomes in this clinical population.
