Online problem-solving therapy after traumatic brain injury: a randomized controlled trial

Abstract

Background: Pediatric traumatic brain injury (TBI) contributes to impairments in functioning in everyday settings. Evidence suggests that online family problem-solving therapy (FPST) may be effective in reducing adolescent behavioral morbidity. This article examines the efficacy of Counselor-Assisted Problem Solving (CAPS), a form of online FPST in improving long-term functional outcomes of adolescents with TBI relative to Internet resources only.

Methods: Children, aged 12 to 17 years, who were hospitalized in the previous 7 months for TBI were enrolled in a multisite, assessor-blinded randomized controlled trial. Consented participants were randomly assigned to CAPS or an Internet resource comparison (IRC) condition. Outcomes were assessed at baseline and at follow-ups 6, 12, and 18 months postbaseline. The Child and Functional Assessment Scale and the Iowa Family Interaction Rating Scale (IFIRS) served as primary outcomes of child and family functioning respectively.

Results: For the Child and Functional Assessment Scale total, we found a significant group × time interaction, with less impaired functioning for the CAPS group than for the IRC group at the final follow-up. Parent education moderated the efficacy of CAPS on overall rates of impairment and school/work functioning, with the advantage of CAPS over IRC evident at the final follow-up only for participants with less-educated parents. Neither group differences nor group × time interactions were found for the IFIRS.

Conclusions: Relatively brief, online treatment shortly after injury may result in long-term improvements in child functioning, particularly among families of lower socioeconomic status. Clinical implementation of CAPS during the initial months postinjury should be considered.

Trial registration: ClinicalTrials.gov NCT00409448.

Keywords: RCT; adolescent; brain injury; child; online; therapy.

Copyright © 2015 by the American Academy of Pediatrics.

Figures

FIGURE 1

CONSORT (Consolidated Standards of Reporting Trials) flowchart.

FIGURE 2

Average total CAFAS scores over time by group. There was a significant group × visit interaction: F(3, 301) = 4.18, P = .006. Total score for the CAPS group was significantly less than the IRC group at visit 4, P < .05.

FIGURE 3

Ratings of functioning at school or work over time by group and primary caregiver education. There was a significant group × time × caregiver education interaction, F(3, 315) = 3.26, P = .02. Post hoc contrasts indicate a significant group difference between the low-education CAPS and IRC groups at visit 4: t(351) = −2.20, P = .03.