Evaluation of the Short-Term Executive Plus Intervention for Executive Dysfunction After Traumatic Brain Injury: A Randomized Controlled Trial With Minimization
Evaluation of the Short-Term Executive Plus Intervention for Executive Dysfunction After Traumatic Brain Injury: A Randomized Controlled Trial With Minimization
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DOI：
10.1016/j.apmr.2013.08.005
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发表时间：
2014-01-01
影响因子：
4.3
通讯作者：
Oswald, Jennifer
中科院分区：
文献类型：
--
作者：
Cantor, Joshua;Ashman, Teresa;Oswald, Jennifer
目的：确定短期执行强化（STEP）认知康复计划是否改善创伤性脑损伤（TBI）后的执行功能障碍。设计：随机、等待名单对照试验，最小化和盲法结局评估。设置：社区。参与者：TBI和执行功能障碍的参与者（N=98; TBI严重程度50%中度/重度;自损伤以来的平均时间+/- SD，12 +/-14岁;平均年龄+/- SD，45 +/-14岁; 62%女性; 76%白色）。12周（9小时/周）的问题解决和情绪调节的团体训练和个人注意力和补偿策略训练。主要结局指标：因素分析被用来创建一个复合执行功能的措施，使用解决问题的库存，额叶系统行为量表，行为评估的执行障碍综合征，和自我意识的缺陷访谈。采用情绪调节困难量表（Difficulties in Emotion Regulation Scale）评定情绪调节能力。主要的注意力测量是注意力评级和监测量表。次要指标包括执行功能、注意力和记忆力的神经心理学指标，以及情感困扰、自我效能、社会参与和生活质量的指标。意向治疗混合效应分析显示，复合执行功能测量（P = 0.008）和额叶系统行为量表（P= 0.049）和问题解决量表（P = 0.016）的治疗效果显著。我们没有发现组间差异的神经心理学措施或措施的注意力，情绪调节，自我意识，情感困扰，自我效能，参与，或quality of life.Conclusions：STEP程序是有效的改善自我报告后TBI的执行功能和解决问题。需要进一步的研究来确定不同干预成分的作用及其对不同TBI人群的有效性。Archives of Physical Medicine and Rehabilitation 2014;95：1-9（c）2014美国康复医学大会
Objective: To determine whether the Short-Term Executive Plus (STEP) cognitive rehabilitation program improves executive dysfunction after traumatic brain injury (TBI).Design: Randomized, waitlist controlled trial with minimization and blinded outcome assessment.Setting: Community.Participants: Participants with TBI and executive dysfunction (N=98; TBI severity 50% moderate/severe; mean time since injury +/- SD, 12 +/- 14y; mean age +/- SD, 45 +/- 14y; 62% women; 76% white).Intervention: STEP program: 12 weeks (9h/wk) of group training in problem solving and emotional regulation and individual sessions of attention and compensatory strategies training. Main Outcome Measures: Factor analysis was used to create a composite executive function measure using the Problem Solving Inventory, Frontal Systems Behavior Scale, Behavioral Assessment of the Dysexecutive Syndrome, and Self-Awareness of Deficits Interview. Emotional regulation was assessed with the Difficulties in Emotion Regulation Scale. The primary attention measure was the Attention Rating and Monitoring Scale. Secondary measures included neuropsychological measures of executive function, attention, and memory and measures of affective distress, self-efficacy, social participation, and quality of life.Results: Intention-to-treat mixed-effects analyses revealed significant treatment effects for the composite executive function measure (P =.008) and the Frontal Systems Behavior Scale (P=.049) and Problem Solving Inventory (P =.016). We found no between-group differences on the neuropsychological measures or on measures of attention, emotional regulation, self-awareness, affective distress, self-efficacy, participation, or quality of life.Conclusions: The STEP program is efficacious in improving self-reported post-TBI executive function and problem solving. Further research is needed to identify the roles of the different components of the intervention and its effectiveness with different TBI populations. Archives of Physical Medicine and Rehabilitation 2014;95:1-9 (c) 2014 by the American Congress of Rehabilitation Medicine