Abstract

Objective: Investigate the effectiveness of Concussion Coach, an interactive smartphone application, as a treatment for residual neurobehavioral symptoms and distress in Veterans with a history of mild traumatic brain injury (mild TBI). Methods: Veterans with mild TBI were randomized to Concussion Coach (n = 238) or Treatment-as-Usual (TAU) (n = 241) in a 3-month randomized controlled trial. Primary outcome measures included postconcussive symptom (PCS) severity as measured by the Neurobehavioral Symptom Inventory (NSI), and psychological distress as measured by the Brief Symptom Inventory-18 (BSI-18). Measures of self-efficacy, social support, and comfort with technology were administered as potential moderators and mediators. An intention-to-treat (ITT) analysis was performed (N = 461: Concussion Coach = 231 and TAU = 230) using Bayesian Network (BN)modeling. Results: The probability of decreased PCS severity was significantly greater for those assigned to Concussion Coach, .35 [.32,.37], than for TAU, .29 (.27, .32), with an odds ratio (OR) of 1.29. Also, Concussion Coach showed a significantly greater probability of increased self-efficacy (.36 [.32, .39]) than did TAU (.28 [.25, .30], OR = 1.42). In turn, self-efficacy (increased vs. decreased) showed a significantly greater probability of decreased PCS severity (.51 [.47, .54] vs. .27 [.24, .30], OR = 2.71) and decreased psychological distress (.53 [.49, .56] vs. .32 [.29, .35], OR = 2.35), suggesting that self-efficacy may have mediated Concussion Coach effects. Conclusions: Concussion Coach is effective at reducing PCS severity and psychological distress. Increased self-efficacy/perception of self-management of symptoms may be key to successful treatment of residual symptoms in those with history of concussion.

摘要

目的：调查 Concussion Coach（一种交互式智能手机应用程序）的有效性，用于治疗有轻度创伤性脑损伤（轻度 TBI）病史的退伍军人的残余神经行为症状和痛苦。方法：在为期 3 个月的随机对照试验中，患有轻度 TBI 的退伍军人被随机分配到脑震荡教练 (n = 238) 或常规治疗 (TAU) (n = 241)。主要结果指标包括通过神经行为症状量表 (NSI) 测量的脑震荡后症状 (PCS) 严重程度，以及通过简要症状量表 18 (BSI-18) 测量的心理困扰。自我效能感、社会支持和技术舒适度的测量作为潜在的调节器和调解器进行管理。使用贝叶斯网络 (BN) 建模进行意向治疗 (ITT) 分析（N = 461：脑震荡教练 = 231 和 TAU = 230）。结果：分配给脑震荡教练的人降低 PCS 严重程度的概率为 0.35 [.32, .37]，而 TAU 为 0.29 (.27, .32)，优势比 (OR) 为 1.29。此外，与 TAU (.28 [.25, .30], OR = 1.42) 相比，脑震荡教练显示出更高的自我效能感 (.36 [.32, .39]) 概率。反过来，自我效能感（增加与减少）表明 PCS 严重程度降低的概率显着增加（0.51 [.47, .54] 对比 .27 [.24, .30]，OR = 2.71）和心理压力降低痛苦（.53 [.49, .56] 与 .32 [.29, .35]，OR = 2.35），表明自我效能感可能具有介导的脑震荡教练效应。结论：脑震荡教练可有效降低 PCS 严重程度和心理困扰。提高自我效能感/对症状自我管理的认识可能是成功治疗有脑震荡史患者残留症状的关键。