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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).
The On-TRACC intervention shows promise for improving cognitive difficulties after mild traumatic brain injury (mTBI). This pilot study found the treatment feasible, acceptable, and effective in enhancing self-efficacy and quality of life.
Area of Science:
- Neuroscience
- Rehabilitation Medicine
- Psychology
Background:
- Persistent cognitive difficulties are common after mild traumatic brain injury (mTBI).
- Existing interventions may not adequately address the complex needs of individuals with chronic post-mTBI cognitive symptoms.
- A novel, integrated approach is needed to support recovery and clinical care.
Purpose of the Study:
- To evaluate the feasibility, acceptability, and preliminary effectiveness of On-TRACC (Tools for Recovery and Clinical Care).
- On-TRACC is a manualized, 5-session intervention integrating psychoeducation, cognitive rehabilitation, and self-management skills.
- The study aimed to assess the intervention's impact on cognitive symptoms and related factors in individuals with chronic post-mTBI cognitive difficulties.
Main Methods:
- A single-group, open-label pilot study was conducted with 28 veterans and civilian adults experiencing cognitive difficulties >3 months post-mTBI.
- Participants received the 5-session On-TRACC intervention via video-based telehealth.
- Feasibility (attendance, completion rates, fidelity) and acceptability (satisfaction) were primary measures, with preliminary effectiveness assessed through changes in cognitive self-efficacy, symptom attribution, functioning, and quality of life.
Main Results:
- High completion rates (79% overall, 88% for those starting) and homework completion (98%) indicate feasibility.
- Participants reported high satisfaction (95%) with the intervention, deeming it acceptable.
- Significant improvements were observed in cognitive self-efficacy, symptom attribution, functional status, quality of life, and planned healthcare engagement.
Conclusions:
- On-TRACC is a feasible and acceptable intervention for managing chronic cognitive difficulties post-mild traumatic brain injury (mTBI).
- The intervention demonstrated preliminary effectiveness in improving key patient-reported outcomes.
- Further research, including randomized clinical trials, is warranted to confirm efficacy and long-term impact.
