Long-term Benefits of an Early Online Problem-Solving Intervention for Executive Dysfunction After Traumatic Brain Injury in Children A Randomized Clinical Trial
Long-term Benefits of an Early Online Problem-Solving Intervention for Executive Dysfunction After Traumatic Brain Injury in Children A Randomized Clinical Trial
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DOI：
10.1001/jamapediatrics.2013.5070
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发表时间：
2014-06-01
期刊：
影响因子：
26.1
通讯作者：
Taylor, H. Gerry
中科院分区：
文献类型：
--
作者：
Kurowski, Brad G.;Wade, Shari L.;Taylor, H. Gerry
重要性儿童创伤性脑损伤（TBI）后的执行功能障碍很常见，并导致在多种情况下的功能出现严重的短期和长期问题。我们假设短期执行功能的改善将维持到损伤后24个月，并且在顾问辅助问题解决（CAPS）intervention.ObjectiveTo评估在复杂的轻度至重度TBI的7个月内进行的CAPS干预与互联网资源条件相比在改善长期执行功能障碍方面的有效性。和参与者在3家三级儿科医院和2家三级综合医学中心进行的多中心、评估者盲法、随机临床试验。参与者包括132名12至17岁的青少年，他们在研究入组前1至7个月患有中度至重度TBI。干预基于网络的CAPS干预。主要结果和测量主要结果是父母报告的执行功能行为评定量表的全球执行复合物（GEC）。次要结果包括GEC.Results的行为调节指数（BRI）和元认知指数（MI）在年龄较大（> 14至17岁）的青少年，CAPS干预与较低的GEC评级在12（β =-0.46; P = 0.03）和18（β =-0.52; P = 0.02）个月后登记。年龄较大的青少年在6个月时GEC评分也有下降的趋势（beta =-0.40; P =.05），12岁时BRI评分较低（β =-0.40; P =.06）和18（β =-0.47; P = 0.04）个月，6（β =-0.41; P = 0.05）、12（β =-0.46; P = 0.03）和18（β =-0.50; P = 0.03）个月时MI评分较低。在年轻（12 - 14岁）的青少年，没有组间差异被发现的GEC，BRI，或MI ratings.CONCLUSIONS和RELEVANCE交付的CAPS干预后早期TBI在老年青少年改善长期的执行功能。据我们所知，该试验是在儿童TBI中进行的为数不多的大型随机临床治疗试验之一，以证明干预措施对管理执行功能障碍的有效性和损伤后立即进行干预的长期益处。应考虑在临床上使用CAPS干预;然而，进一步的研究应探索优化交付的方法。
IMPORTANCE Executive dysfunction after traumatic brain injury (TBI) in children is common and leads to significant short-and long-term problems in functioning across multiple settings. We hypothesized that improvements in short-term executive function would be maintained to 24 months after injury and that improvements would increase over time in a counselor-assisted problem-solving (CAPS) intervention.OBJECTIVE To evaluate the efficacy of a CAPS intervention administered within 7 months of complicated mild to severe TBI compared with an Internet resource condition in improving long-term executive dysfunction.DESIGN, SETTING, AND PARTICIPANTS Multisite, assessor-blinded, randomized clinical trial at 3 tertiary pediatric hospitals and 2 tertiary general medical centers. Participants included 132 adolescents aged 12 to 17 years who sustained a moderate to severe TBI 1 to 7 months before study enrollment.INTERVENTION Web-based CAPS intervention.MAIN OUTCOMES AND MEASURES The primary outcome was the parent-reported Global Executive Composite (GEC) of the Behavior Rating Inventory of Executive Function. Secondary outcomes included the Behavioral Regulation Index (BRI) and Metacognition Index (MI) of the GEC.RESULTS In older (> 14 to 17 years) adolescents, the CAPS intervention was associated with lower GEC ratings at 12 (beta = -0.46; P =.03) and 18 (beta = -0.52; P =.02) months after enrollment. Trends were also observed for older adolescents toward lower GEC ratings at 6 months (beta = -0.40; P =.05), lower BRI ratings at 12 (beta = -0.40; P =.06) and 18 (beta = -0.47; P =.04) months, and lower MI ratings at 6 (beta = -0.41; P =.05), 12 (beta = -0.46; P =.03), and 18 (beta = -0.50; P =.03) months. In younger (12-14 years) adolescents, no group differences were found on the GEC, BRI, or MI ratings.CONCLUSIONS AND RELEVANCE Delivery of the CAPS intervention early after TBI in older adolescents improves long-term executive function. This trial is, to our knowledge, one of the few large, randomized clinical treatment trials performed in pediatric TBI to demonstrate the efficacy of an intervention for management of executive dysfunction and long-term benefits of an intervention delivered soon after injury. Use of the CAPS intervention clinically should be considered; however, further research should explore ways to optimize delivery.