Metacognitive Training to Enhance Strategy Use In Blast Related TBI

元认知训练可增强爆炸相关 TBI 中策略的使用

• 批准号: 8926243
• 负责人: Julia Kay Waid-Ebbs
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-10-01 至 2018-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8926243
• 关键词: Activities of Daily Living; Address; Adult; Affect; Award; Beck depression inventory; Behavior; Blast Cell; Brain Concussion; Brain Injuries; Case Series; Cellular Phone; Clinical Trials; Cognition; Cognitive; Color; Communities; Community Participation; Comorbidity; Control Groups; Data; Decision Making; Diagnosis; Educational workshop; Effectiveness; Emotional; Environment; Equipment and supply inventories; Executive Dysfunction; Florida; Freedom; Frequencies; Future; Goals; Health; Home environment; Impairment; Individual; Informal Social Control; Injury; Intention; Intervention; Investigation; K-Series Research Career Programs; Laboratories; Lead; Learning; Life; Linear Regressions; London; Measures; Mental Depression; Mentors; Methods; Monitor; Outcome; Participant; Patients; Performance; Pilot Projects; Pittsburgh Sleep Quality Index; Post-Traumatic Stress Disorders; Probability; Problem Solving; Process; Randomized; Recovery; Recruitment Activity; Regression Analysis; Research; Research Personnel; Role; Sample Size; Sampling; Schedule; Scientist; Services; Severities; Signal Transduction; Site; Sleep; Sleep Disorders; Soldier; Speech; Sports; Symptoms; Technology; Testing; Time; Training; Training Programs; Translating; Translations; Traumatic Brain Injury; Veterans; War; Woman; Work; base; brain health; cognitive ability; cognitive capacity; cognitive process; cognitive skill; combat; community reintegration; computerized; design; disability; effective therapy; executive function; group intervention; improved; innovation; innovative technologies; interest; learning strategy; member; men; mild traumatic brain injury; neuromechanism; operation; preference; public health relevance; skills; skills training; social skills; success; treatment effect; treatment group; treatment response; wound

DESCRIPTION: Background: Traumatic brain injury has been referred to as the "signature" injury of the Operation Iraqi Freedom/Operation Enduring Freedom/Operation New Dawn (OIF/OEF/OND) wars. Over 25,000 soldiers were diagnosed with mild traumatic brain injury (mTBI) in 2012 alone. Not only do soldiers have blast-related mTBI, estimates of comorbid Post Traumatic Stress Disorder (PTSD), range from 11% to 50%. Since neural mechanisms affected by mTBI and PTSD often are overlapping, it is suggested that mTBI and PTSD may have an additive effect on symptoms. Indeed, an estimated 44-50% of soldiers with mTBI/PTSD remain symptomatic after one-year, compared to an estimated 10% in sports related concussion. Both mTBI and PTSD are associated with deficits in executive functioning. Additional factors that accompany mTBI in combat Veterans are depression and sleep deficits. Consequently, the combination of all these factors, impact executive functions and result in combat Veterans who are struggling to live productive lives. An effective treatment of executive function is needed for Veterans diagnosed with mTBI. Goal Management Training (GMT) is a metacognitive intervention that has been validated in TBI. However, limitations in GMT studies raise questions regarding effectiveness of GMT in mTBI. Based on preliminary data, GMT improved significantly on a problem solving measure in Veterans with blast-related mTBI, but lacked transfer to everyday activities. Therefore, we developed a Smartphone application to enhance the transfer of GMT skills to everyday tasks. The purpose: of this randomized study is to determine the effect of an innovative treatment for executive functions, enhanced with Smartphone technology, in Veterans with multiple blast related mTBI. In addition to determining the overall benefit of GMT, the study will investigate the influence of comorbid factors, such as post-traumatic stress disorder, depression, sleep disorders and cognitive capacity. Method: Veterans diagnosed with repeat blast-related mTBI and executive function deficit will be recruited from two sites (Tampa and North Florida/South Georgia) by Speech Services. Veterans will be randomized to GMT (38 participants) or to a control treatment called Brain Health Workshop (BHW) (16 participants).The Tower of London, a measure of planning and problem solving will be used to determine response to treatment. Primary analysis will use two sample t-test to compare group A (intervention) and group B (control) on improvements in time to completion on the TOL. In addition, as an exploratory analysis, we will perform a regression analysis that includes treatment group, PTSD severity and their interaction as independent variables, to adjust for PTSD severity measured by Clinician Administered PTSD Scale and to investigate whether there is interaction between treatment group and PTSD severity. Additional, exploratory tertiary analysis using paired t-tests will determine whether treatment effect generalizes to executive function performance in everyday activities (BRIEF-A) or engagement in community participation (CRIS). To test the second specific aim, a general linear regression will be used to determine whether factors such as PTSD, sleep, depression or cognitive capacity is associated with response to treatment. Results: If the results support the hypothesis that GMT will improve executive functions than this cognitive intervention can be adapted to a tele-health method of delivery and tested in a larger clinical trial. Moreover, the influence of the four factors on response to treatment, can guide future studies to determine which patients are likely to benefit from GMT.

描述： 背景：创伤性脑损伤被称为伊拉克自由行动/持久自由行动/新黎明行动（OIF/OEF/OND）战争的“标志性”伤害。仅 2012 年就有超过 25,000 名士兵被诊断患有轻度创伤性脑损伤 (mTBI)。士兵不仅患有与爆炸相关的 mTBI，估计患有创伤后应激障碍 (PTSD) 的人也有 11% 到 50% 不等。由于受 mTBI 和 PTSD 影响的神经机制通常是重叠的，因此有人认为 mTBI 和 PTSD 可能对症状产生累加效应。事实上，据估计，患有 mTBI/PTSD 的士兵在一年后仍有 44-50% 的症状，而运动相关脑震荡的士兵中估计只有 10% 的人有症状。 mTBI 和 PTSD 都与执行功能缺陷有关。退伍军人中伴随 mTBI 的其他因素包括抑郁和睡眠不足。因此，所有这些因素的结合，影响了执行功能，并导致退伍军人正在努力过上富有成效的生活。需要对执行功能进行有效的治疗 退伍军人被诊断患有 mTBI。目标管理培训 (GMT) 是一种元认知干预措施，已在 TBI 中得到验证。然而，GMT 研究的局限性引发了关于 GMT 在 mTBI 中的有效性的问题。根据初步数据，GMT 显着改善了患有爆炸相关 mTBI 的退伍军人的问题解决措施，但缺乏转移到日常活动中。因此，我们开发了一款智能手机应用程序，以增强将 GMT 技能转移到日常任务中的能力。这项随机研究的目的是确定通过智能手机技术增强执行功能的创新疗法对患有多发性爆炸相关 mTBI 的退伍军人的效果。除了确定 GMT 的总体益处外，该研究还将调查合并症因素的影响，例如创伤后应激障碍、抑郁症、睡眠障碍和认知能力。方法：语音服务中心将从两个地点（坦帕和北佛罗里达/南乔治亚）招募被诊断患有重复爆炸相关 mTBI 和执行功能缺陷的退伍军人。退伍军人将被随机分配接受 GMT（38 名参与者）或称为脑健康研讨会 (BHW)（16 名参与者）的对照治疗。伦敦塔将使用计划和问题解决的衡量标准来确定对治疗的反应。主要分析将使用两个样本 t 检验来比较 A 组（干预组）和 B 组（对照组）在完成 TOL 的时间方面的改进。此外，作为探索性分析，我们将进行回归分析，其中包括治疗组、PTSD 严重程度及其相互作用作为自变量，以调整临床医生管理的 PTSD 量表测量的 PTSD 严重程度，并研究治疗组和治疗组之间是否存在相互作用。创伤后应激障碍的严重程度。此外，使用配对 t 检验的探索性三级分析将确定治疗效果是否推广到日常活动中的执行功能表现 (BRIEF-A) 或社区参与度 (CRIS)。为了测试第二个具体目标，将使用一般线性回归来确定创伤后应激障碍、睡眠、抑郁或认知能力等因素是否与治疗反应相关。结果：如果结果支持 GMT 将改善执行功能的假设，那么这种认知干预就可以适应远程医疗交付方法，并在更大规模的临床试验中进行测试。此外，这四个因素对治疗反应的影响可以指导未来的研究，以确定哪些患者可能从 GMT 中受益。