Graded exposure therapy for adults with persistent symptoms after mTBI: A historical comparison study.

IF 1.7 3区 心理学 Q4 NEUROSCIENCES
Mathilde Rioux, Penelope M A Brasher, Gabriel McKeown, Keith Owen Yeates, Ana-Maria Vranceanu, Deborah L Snell, Molly Cairncross, William J Panenka, Grant L Iverson, Chantel T Debert, Mark T Bayley, Cindy Hunt, Matthew J Burke, Noah D Silverberg
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Abstract

Fear avoidance behaviour is associated with slow recovery from mild traumatic brain injury (mTBI). This study is a preliminary evaluation of graded exposure therapy (GET), which directly targets fear avoidance behaviour, for reducing post-concussion symptoms (PCS) and disability following mTBI. In a historical comparison design, we compared two groups from independent randomized trials. The GET + UC group (N = 34) received GET (delivered over 16 videoconference sessions) in addition to usual care (UC). The historical comparison group (N = 71) received UC only. PCS severity (Rivermead Post Concussion Symptoms Questionnaire; RPQ) and disability (World Health Organization Disability Assessment Schedule; WHODAS 2.0 12-item) were measured at clinic intake (M = 2.7, SD = 1.1 months after injury) and again at M = 4.9 (SD = 1.1) months after injury. Between-group differences were estimated using linear mixed effects regression, with a sensitivity analysis controlling for injury-to-assessment intervals. The estimated average change on the RPQ was -14.3 in the GET + UC group and -5.3 in the UC group. The estimated average change on the WHODAS was -5.3 in the GET + UC group and -3.2 in the UC group. Between-group differences post-treatment were -5.3 on the RPQ and -1.5 on the WHODAS. Treatment effects were larger in sensitivity analyses. Findings suggest that a randomized controlled trial is warranted.

针对创伤后脑损伤持续症状成人的分级暴露疗法:历史比较研究。
恐惧回避行为与轻度脑外伤(mTBI)的缓慢恢复有关。本研究对直接针对恐惧回避行为的分级暴露疗法(GET)进行了初步评估,以减轻轻度脑损伤后的脑震荡症状(PCS)和残疾程度。在历史比较设计中,我们对独立随机试验中的两组进行了比较。GET + UC 组(N = 34)在常规护理(UC)的基础上接受 GET(通过 16 次视频会议进行)。历史对比组(N = 71)仅接受 UC。PCS 严重程度(Rivermead 脑震荡后症状调查表;RPQ)和残疾程度(世界卫生组织残疾评估表;WHODAS 2.0 12 项)分别在诊所接诊时(M = 2.7,SD = 1.1 个月后)和 M = 4.9(SD = 1.1)个月后进行测量。采用线性混合效应回归法估算组间差异,并进行敏感性分析,控制从受伤到评估的时间间隔。GET + UC 组的 RPQ 平均变化估计为 -14.3,UC 组为 -5.3。据估计,GET + UC 组的 WHODAS 平均变化为-5.3,UC 组为-3.2。治疗后,RPQ 的组间差异为-5.3,WHODAS 为-1.5。在敏感性分析中,治疗效果更大。研究结果表明,有必要进行随机对照试验。
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来源期刊
Neuropsychological Rehabilitation
Neuropsychological Rehabilitation 医学-神经科学
CiteScore
6.30
自引率
7.40%
发文量
78
审稿时长
>12 weeks
期刊介绍: Neuropsychological Rehabilitation publishes human experimental and clinical research related to rehabilitation, recovery of function, and brain plasticity. The journal is aimed at clinicians who wish to inform their practice in the light of the latest scientific research; at researchers in neurorehabilitation; and finally at researchers in cognitive neuroscience and related fields interested in the mechanisms of recovery and rehabilitation. Papers on neuropsychological assessment will be considered, and special topic reviews (2500-5000 words) addressing specific key questions in rehabilitation, recovery and brain plasticity will also be welcomed. The latter will enter a fast-track refereeing process.
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