Effect of Collaborative Care on Persistent Postconcussive Symptoms in Adolescents: A Randomized Clinical Trial.
Effect of Collaborative Care on Persistent Postconcussive Symptoms in Adolescents: A Randomized Clinical Trial.
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DOI：
10.1001/jamanetworkopen.2021.0207
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发表时间：
2021-02-01
影响因子：
13.8
通讯作者：
Rivara FP
中科院分区：
文献类型：
--
作者：
McCarty CA;Zatzick DF;Marcynyszyn LA;Wang J;Hilt R;Jinguji T;Quitiquit C;Chrisman SPD;Rivara FP
协同护理与认知行为疗法联合治疗青少年持续性脑震荡后症状的效果如何？在这项200名青少年的随机临床试验中，与接受常规护理的对照组相比，接受合作护理的青少年在3个月和12个月时脑震荡后症状较少，12个月时健康相关生活质量较高。这些发现表明，协作护理与认知行为疗法是一种很有希望的治疗方法，可以缓解症状，改善青少年持续脑震荡后症状。本随机临床试验探讨了与常规治疗相比，对持续脑震荡后症状的青少年进行协作治疗是否与1年内脑震荡后、生活质量、焦虑和抑郁症状的改善有关。尽管有持续脑震荡后症状的青少年的损伤程度很高，但很少有研究测试这些问题是否可以补救。研究与常规治疗相比，协作治疗是否与1年内脑震荡后、生活质量、焦虑和抑郁症状的改善有关。协同护理模式治疗青少年脑震荡后持续症状II试验是一项随机临床试验，于2017年3月至2020年5月进行，并在3、6和12个月进行随访评估。参与者从华盛顿西部的儿科初级保健、运动医学、神经病学和康复诊所招募。11至18岁的青少年，在过去9个月内被诊断为与运动或娱乐有关的脑震荡，并且在受伤后至少持续1个月的3种症状符合条件。数据分析时间为2020年6月至9月。协作护理干预包括认知行为治疗和护理管理，主要通过远程医疗提供，在整个6个月的治疗期间，必要时加强药物咨询。比较组在专科诊所接受常规治疗。主要结局是青少年脑震荡后、生活质量、焦虑和抑郁症状的报告。次要结局是父母报告的症状。在390名符合条件的青少年中，201名（51.5%）同意参与，200名（平均[SD]年龄14.7[1.7]岁；124名女孩[62.0%]）入组，96%至98%的人在3至12个月的保留率。99名参与者随机分为常规治疗组，101名随机分为协作治疗组。与常规护理相比，接受合作护理的青少年在3个月（减少3.4点；95% CI，减少- 6.6至- 0.1点）和12个月（减少4.1点；95% CI，减少- 7.7至- 0.4点）时报告了健康行为量表得分的显着改善。此外，与对照组相比，干预组在12个月时报告的儿童生活质量量表得分平均提高4.7分（95% CI， 0.05至9.3分）。在青少年抑郁或焦虑症状或父母报告的结果方面，各组之间没有差异。虽然两组随着时间的推移都有所改善，但接受协作护理干预的青少年在1年内症状更少，生活质量更好。通过远程保健提供干预措施扩大了这种治疗的范围。ClinicalTrials.gov标识符：NCT03034720
What is the effectiveness of collaborative care with cognitive behavioral therapy for treating adolescents with persistent postconcussive symptoms? In this randomized clinical trial of 200 adolescents, those who received collaborative care reported fewer postconcussive symptoms at 3 and 12 months and higher health-related quality of life at 12 months compared with a control group receiving usual care. These findings suggest that collaborative care with cognitive behavioral therapy is a promising treatment to alleviate symptoms and improve functioning for adolescents with persistent postconcussive symptoms. This randomized clinical trial examines whether collaborative care treatment for adolescents with persistent postconcussive symptoms is associated with improvements in postconcussive, quality of life, anxiety, and depressive symptoms over 1 year, compared with usual care. Despite the high level of impairment for adolescents with persistent postconcussive symptoms, few studies have tested whether such problems can be remediated. To examine whether collaborative care treatment is associated with improvements in postconcussive, quality of life, anxiety, and depressive symptoms over 1 year, compared with usual care. The Collaborative Care Model for Treatment of Persistent Symptoms After Concussion Among Youth II Trial was a randomized clinical trial conducted from March 2017 to May 2020 with follow-up assessments at 3, 6, and 12 months. Participants were recruited from pediatric primary care, sports medicine, neurology, and rehabilitation clinics in western Washington. Adolescents aged 11 to 18 years with a diagnosed sports-related or recreational-related concussion within the past 9 months and with at least 3 symptoms persisting at least 1 month after injury were eligible. Data analysis was performed from June to September 2020. The collaborative care intervention included cognitive behavioral therapy and care management, delivered mostly through telehealth, throughout the 6-month treatment period, with enhanced medication consultation when warranted. The comparator group was usual care provided in specialty clinics. Primary outcomes were adolescents’ reports of postconcussive, quality of life, anxiety, and depressive symptoms. Secondary outcomes were parent-reported symptoms. Of the 390 eligible adolescents, 201 (51.5%) agreed to participate, and 200 were enrolled (mean [SD] age, 14.7 [1.7] years; 124 girls [62.0%]), with 96% to 98% 3- to 12-month retention. Ninety-nine participants were randomized to usual care, and 101 were randomized to collaborative care. Adolescents who received collaborative care reported significant improvements in Health Behavior Inventory scores compared with usual care at 3 months (3.4 point decrease; 95% CI, −6.6 to −0.1 point decrease) and 12 months (4.1 point decrease; 95% CI, −7.7 to −0.4 point decrease). In addition, youth-reported Pediatric Quality of Life Inventory scores at 12 months improved by a mean of 4.7 points (95% CI, 0.05 to 9.3 points) in the intervention group compared with the control group. No differences emerged by group over time for adolescent depressive or anxiety symptoms or for parent-reported outcomes. Although both groups improved over time, youth receiving the collaborative care intervention had fewer symptoms and better quality of life over 1 year. Intervention delivery through telehealth broadens the reach of this treatment. ClinicalTrials.gov Identifier: NCT03034720
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影响因子：
1.9
作者：
Conder, Robert;Conder, Alanna Adler
通讯作者：
Conder, Alanna Adler
影响因子：
2.4
作者：
Silverberg, Noah D.;Hallam, Bradley J.;Whittal, Maureen L.
通讯作者：
Whittal, Maureen L.
DOI：
10.1017/s1355617708090188
发表时间：
2009-01
期刊：
Journal of the International Neuropsychological Society : JINS
影响因子：
--
作者：
Ayr LK;Yeates KO;Taylor HG;Browne M
通讯作者：
Browne M
影响因子：
2.5
作者：
McCarty, Carolyn A.;Zatzick, Douglas;Rivara, Frederick P.
通讯作者：
Rivara, Frederick P.
影响因子：
8
作者：
Barlow, Karen Maria;Crawford, Susan;Dewey, Deborah
通讯作者：
Dewey, Deborah