Cognitive Rehabilitation of OIF/OEF Veterans with Cognitive Disorder

描述(由申请人提供)： 项目摘要-由于目前在阿富汗(持久自由行动；OEF)和伊拉克(伊拉克自由行动；OIF)的军事行动，退伍军人事务部(VA)正在为越来越多经历过轻微创伤性脑损伤(MTBI)或脑震荡的退伍军人提供医疗保健，其中许多人抱怨认知障碍。MTBI是最常见的与战斗有关的损伤，可发生或不直接撞击、明显的外部损伤或意识丧失。目前，MTBI的认知康复通常包括代偿策略的培训，帮助患者发展内部策略(例如，视觉意象)，并利用外部辅助工具(例如，记忆笔记本、日历/组织者、计时器)来补偿认知缺陷。来自我们无资金支持的认知康复试点研究的初步数据令人鼓舞，表明治疗后在多个结果指标上有所改善。然而，到目前为止，还没有发表的研究对经历过与战斗相关的MTBI的OEF/OIF退伍军人进行特定认知康复干预的效果进行评估。因此，这项研究的主要目的是评估为期10周的手动补偿策略训练(CST)对因战斗相关的轻度创伤性脑损伤后遗症而导致认知障碍的OEF/OIF退伍军人的疗效。具体目标是：1)确定认知康复团体治疗的疗效；2)确定与改善功能结果相关的治疗因素和患者特征。总体目标是开发一种循证的、机械化的、易于在VHA治疗环境中实施的集体治疗。研究设计利用了俄勒冈州波特兰、华盛顿州普吉特湾、加利福尼亚州圣地亚哥和爱达荷州博伊西的四个参与VAS可用的资源。这项研究将招募280名退伍军人参加这些志愿服务机构的医疗服务。纳入标准将是：1)在参与退伍军人管理局登记的OEF/OIF退伍军人能够提供知情同意；以及2)作为标准退伍军人管理局临床护理的一部分，已筛查MTBI阳性并抱怨认知障碍。排除标准将是：1)当前戒断少于30天的物质使用障碍；2)原发精神障碍病史；以及3)听觉或视觉障碍，将阻碍参加认知康复小组的能力或受益于补偿策略。在随机对照试验中，我们将比较两组：符合条件的参与者将被随机分配到认知策略培训(CST)组或日常护理(UC)组。CST组的参与者将在他们参与研究期间接受CST干预，研究将包括按照CST治疗手册的指导，为期10周的每周120分钟的小组会议。UC参与者在参与期间将继续接受常规护理(即，他们的常规医疗、精神和心理治疗护理；不进行CST干预)，但将在研究结束后提供CST。两组都将在基线、5周(CST中途)、10周(CST结束后立即)和15周(CST完成后5周)进行评估。这些评估将包括一个简短的认知评估单元和一系列问卷和纸笔测试，旨在评估当前心理和认知症状的严重性、补偿策略的效用、自我效能、适应功能、可靠地管理个人事务的能力、物质使用、生活质量和治疗满意度。在他们参与研究期间，所有参与者将继续接受他们的常规医疗、精神和心理治疗护理。 公共卫生相关性： 项目摘要-叙述相关性在退伍军人保健系统内寻求护理和康复服务的OEF/OIF退伍军人人数正在迅速增加。MTBI的认知影响在临床上具有重要意义，可能会对退伍军人重新融入平民生活、重返岗位、在竞争性就业中取得成功或独立工作的能力产生不利影响。这项拟议研究的主要成果将是对患有认知障碍的OIF/OIF退伍军人进行经验证的、手册化的认知康复干预。集体治疗方式具有效率高的优点，而手工治疗方法将允许在整个VHA系统中广泛应用。因此，拟议的研究可能会对为患有与战斗有关的MTBI和认知障碍的退伍军人提供的康复服务的质量和有效性产生重大影响。

DESCRIPTION (provided by applicant): PROJECT SUMMARY - ABSTRACT As a result of the current military operations in Afghanistan (Operation Enduring Freedom; OEF) and Iraq (Operation Iraqi Freedom; OIF), the Department of Veterans Affairs (VA) is providing health care for increasing numbers of veterans who have experienced mild traumatic brain injury (MTBI) or concussion, many of whom complain of cognitive impairment. MTBI is the most common combat- related injury and can occur with or without direct impact, obvious external injuries, or loss of consciousness. Currently, cognitive rehabilitation for MTBI typically includes training in compensatory strategies that help patients develop internal strategies (e.g., visual imagery) and utilize external aides (e.g., memory notebooks, calendars/organizers, timers) to compensate for cognitive deficits. Initial data from our unfunded cognitive rehabilitation pilot study are encouraging and indicate post-treatment improvement on multiple outcome measures. However, to date, no published studies have evaluated the efficacy of specific cognitive rehabilitation interventions with OEF/OIF veterans who have experienced combat-related MTBI. The primary objective of this study, therefore, is to evaluate the efficacy of a manualized, 10-week, Compensatory Strategy Training (CST) intervention for OEF/OIF veterans with cognitive disorder resulting from the aftereffects of combat-related mild traumatic brain injury. The specific goals are: 1) to determine the efficacy of cognitive rehabilitation group treatment; and 2) to determine the treatment factors and patient characteristics that are associated with improved functional outcomes. The overall goal is to develop an evidence-based, manualized, group treatment that can be readily implemented in VHA treatment settings. The study design makes use of the convergent availability of resources available at the four participating VAs in Portland Oregon, Puget Sound Washington, San Diego California, and Boise Idaho. The study will recruit a total of 280 OEF/OIF veterans enrolled for medical services at these VAs. Inclusion criteria will be: 1) OEF/OIF veterans enrolled at a participating VA who are able to provide informed consent; and 2) As part of standard VA clinical care, have screened positive for MTBI and complain of cognitive impairment. Exclusion criteria will be: 1) Current substance use disorder with less than 30 days abstinence; 2) History of a primary psychotic disorder; and 3) Auditory or visual impairments that would prevent ability to participate in the cognitive rehabilitation group or benefit from compensatory strategies. In a randomized controlled trial, we will compare two groups: eligible participants will be randomly assigned to either the Cognitive Strategy Training (CST) group or Usual Care (UC) group. Participants in the CST group will receive the CST intervention during their participation in the study, which will consist of weekly 120-minute group sessions for 10 weeks as guided by the CST Treatment Manual. UC participants will continue to receive usual care (i.e., their regular medical, psychiatric, and psychotherapeutic care; no CST intervention) during their participation, but will be offered CST after the end of the study. Both groups will undergo assessments at baseline, 5 weeks (midway through CST), 10 weeks (immediately following the end of CST), and 15 weeks (5 weeks after CST is completed). These assessments will include a brief cognitive assessment battery and a battery of questionnaires and paper-pencil tests designed to assess current psychological and cognitive symptom severity, utility of compensatory strategies, self-efficacy, adaptive functioning, ability to reliably manage personal affairs, substance use, quality of life, and treatment satisfaction ratings. During their study participation, all participants will continue to receive their regular medical, psychiatric, and psychotherapeutic care. PUBLIC HEALTH RELEVANCE: PROJECT SUMMARY - NARRATIVE RELEVANCE The number of OEF/OIF veterans seeking care and rehabilitation services within the VA Health Care System is increasing rapidly. The cognitive effects of MTBI are clinically significant and can adversely affect a veteran's ability to reintegrate into civilian life, return to duty, succeed in competitive employment, or function independently. The primary product of the proposed study would be an empirically validated, manualized, cognitive rehabilitation intervention for OIF/OIF veterans with cognitive disorders. The group treatment modality has the virtue of efficiency and a manualized treatment approach would allow wide-ranging application throughout the VHA system. As such, the proposed study is likely to have a significant effect on the quality and effectiveness of rehabilitative services being offered to our returning soldiers with combat-related MTBI and cognitive impairment.