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J Consult Clin Psychol. 2019 Nov;87(11):1043-1055. doi: 10.1037/ccp0000440. Epub 2019 Sep 26.

Adolescent quality of life following family problem-solving treatment for brain injury.

Author information

1
Division of Rehabilitation Medicine.
2
Division of Epidemiology and Biostatistics, Cincinnati Children's Hospital Medical Center.
3
Abigail Wexner Research Institute, Nationwide Children's Hospital.
4
Psychiatry and Behavioral Health, Nationwide Children's Hospital, and Department.
5
Children's Hospital Colorado.
6
Department of Psychiatry, Case Western Reserve University.
7
Division of Neurology, Cincinnati Children's Hospital Medical Center.
8
Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center.

Abstract

OBJECTIVE:

To examine changes in quality of life (QoL) in adolescents receiving family problem-solving therapy (F-PST) following traumatic brain injury (TBI).

METHOD:

Adolescents hospitalized for moderate-to-severe TBI were randomized to 1 of 3 ten-session, 6-month long treatments: face-to-face F-PST (n = 34), therapist-guided online F-PST (n = 56), and self-guided online F-PST (n = 60). Participants included 96 boys and 54 girls, of whom 124 were White and 6 were Hispanic. Outcomes were assessed pretreatment and 6 and 9 months later. Adolescents and parents rated adolescent QoL and TBI-related symptoms on the PedsQL and Health and Behavior Inventory (HBI), respectively. We used mixed modeling to examine changes over time and moderators of treatment efficacy.

RESULTS:

Therapist- and self-guided online groups demonstrated improvements in parent-proxy QoL from baseline to 9 months, Cohen's d = 0.75; p = .004 and Cohen's d = 1.30; p < .001, respectively. The face-to-face group had poorer parent-proxy QoL at 6 months (M = 62, SE = 3.4) than either the therapist- (M = 70.9, SE = 2.8) or self-guided online group (M = 71.1, SE = 2.6). There were no changes or group differences in self-reported QoL over time. Similar findings were observed on the HBI. Differential treatment effects on parent-proxy outcomes were found in boys versus girls and in those from single versus 2-parent households. Improvements in parent-proxy HBI ratings mediated QoL improvements.

CONCLUSIONS:

Both online treatments, but not face-to-face F-PST, were associated with clinical improvements, raising questions about our current delivery paradigm. Individual and family moderators of treatment efficacy underscore the potential of personalized treatment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

TRIAL REGISTRATION:

ClinicalTrials.gov NCT02368366.

PMID:
31556652
DOI:
10.1037/ccp0000440

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