Cognitive-Behavioral Prevention of Postconcussion Syndrome in At-Risk Patients: A Pilot Randomized Controlled Trial
Cognitive-Behavioral Prevention of Postconcussion Syndrome in At-Risk Patients: A Pilot Randomized Controlled Trial
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DOI：
10.1097/htr.0b013e3182915cb5
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发表时间：
2013-07-01
影响因子：
2.4
通讯作者：
Whittal, Maureen L.
中科院分区：
文献类型：
--
作者：
Silverberg, Noah D.;Hallam, Bradley J.;Whittal, Maureen L.
目的：研究轻度创伤性脑损伤后立即给予认知行为治疗（CBT）对慢性脑震荡后综合征（PCS）风险患者的耐受性并评估其治疗效果。单位：三级康复中心。参会人员：28例无并发症的轻度创伤性脑损伤患者，根据已发表的算法确定有慢性PCS风险，该算法包括亚急性脑震荡后症状和适应不良疾病信念（恢复预期和感知后果）。他们在伤后6周内入组。设计：开放标签、平行组、随机对照试验，入组后3个月进行盲法结局评估。干预措施包括：（1）职业治疗师的常规治疗（教育，安抚和症状管理策略），或（2）心理学家提供的常规治疗加CBT。主要测量指标：Rivermead脑震荡后症状问卷。结果：4名参与者（2：2）退出。CBT组的治疗可信度和满意度都很高。脑震荡后症状的治疗效应量为中等（Cohen d = 0.74），大多数次要结局指标的治疗效应量为中等-大（Cohen d = 0.62 - 1.61）。接受CBT的参与者在随访时诊断为PCS的比例更低（54% vs 91%，P <0.05）。结论：我们的初步数据表明，轻度创伤性脑损伤后不久进行的CBT耐受性良好，可能有助于有慢性PCS风险的患者的恢复。一个明确的临床试验是必要的。
Objective: To examine the tolerability and estimate the treatment effect of cognitive-behavioral therapy (CBT) delivered soon after mild traumatic brain injury to patients at risk for chronic postconcussion syndrome (PCS). Setting: Tertiary rehabilitation center. Participants: Twenty-eight patients with uncomplicated mild traumatic brain injury, determined to be at risk for chronic PCS based on a published algorithm that incorporates subacute postconcussion symptoms and maladaptive illness beliefs (recovery expectations and perceived consequences). They were enrolled within 6 weeks postinjury. Design: Open-label, parallel-group, randomized controlled trial, with masked outcome assessment 3 months after enrolment. Interventions were (1) treatment as usual (education, reassurance, and symptom management strategies) from an occupational therapist, or (2) treatment as usual plus CBT delivered by a psychologist. Main Measures: Rivermead Postconcussion Symptoms Questionnaire. Results: Four participants (2:2) withdrew. Treatment credibility and satisfaction ratings were high in the CBT group. Treatment effect sizes were moderate for postconcussion symptoms (Cohen d = 0.74) and moderate-large for most secondary outcome measures (Cohen d = 0.62-1.61). Fewer participants receiving CBT had a diagnosis of PCS at follow-up (54% vs 91%, P < .05). Conclusion: Our preliminary data suggest that CBT delivered soon after mild traumatic brain injury is well tolerated and may facilitate recovery in patients who are at risk for chronic PCS. A definitive clinical trial is warranted.