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J Neurotrauma. 2018 Nov 17. doi: 10.1089/neu.2018.5885. [Epub ahead of print]

Examination of Injury, Host, and Social-Environmental Moderators of Online Family Problem Solving Treatment Efficacy for Pediatric Traumatic Brain Injury Using an Individual Participant Data Meta-Analytic Approach.

Author information

1
1 Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine , Cincinnati, Ohio.
2
2 Department of Statistics, Nationwide Children's Hospital Research Institute, Department of Pediatrics, The Ohio State University , Columbus, Ohio.
3
3 Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine , Cincinnati, Ohio.
4
4 Department of Psychology, Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute, University of Calgary , Calgary, Alberta, Canada .
5
5 Center for Biobehavioral Health, Nationwide Children's Hospital Research Institute, Department of Pediatrics, The Ohio State University , Columbus, Ohio.

Abstract

A series of five randomized controlled clinical trials (RCTs) conducted between 2002 and 2015 support the potential efficacy of online family problem-solving treatment (OFPST) in improving both child and parent/family outcomes after pediatric traumatic brain injury (TBI). However, small sample sizes and heterogeneity across individual studies have precluded examination of potentially important moderators. We jointly analyzed individual participant data (IPD) from these five RCTs, involving 359 children and adolescents between the ages of 5 and 18 years, to confirm the role of previously identified moderators (child's age and pre-treatment symptom levels, parental education) and to examine other potential moderators (race, sex, IQ), using IPD meta-analysis. This reanalysis revealed statistically strong evidence that parental education, child age at baseline, IQ, sex, and parental depression level pre-treatment moderated the effect of OFPST on various outcomes. In particular, children of parents with a less than high school education exhibited fewer internalizing problems and better social competence. Children injured at an older age exhibited fewer externalizing behaviors and less executive dysfunction following OFPST. Child IQ moderated the effect of OFPST on social competence, with significantly better competence for children with lower IQ who received OFPST. Lower levels of parental depression followed OFPST among subgroups with lower IQ, boys, and higher parental depression scores at baseline. Our findings indicate that the optimal application of OFPST is likely to involve older children, those with lower IQ scores, or those from families with lower socioeconomic status (SES).

KEYWORDS:

brain injury; heterogeneous treatment effects meta-analysis; precision medicine

PMID:
30328749
DOI:
10.1089/neu.2018.5885

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