The Effect of a Scheduled Telephone Intervention on Outcome After Moderate to Severe Traumatic Brain Injury: A Randomized Trial

Abstract 

Bell KR, Temkin NR, Esselman PC, Doctor JN, Bombardier CH, Fraser RT, Hoffman JM, Powell JM, Dikmen S. The effect of a scheduled telephone intervention on outcome after moderate to severe traumatic brain injury: a randomized trial.

Objective

To measure the effectiveness of a scheduled telephone intervention offering counseling and education to people with traumatic brain injury (TBI) on behavioral outcomes compared with standard follow-up at 1 year postinjury.

Design

Two-group randomized, prospective clinical trial throughout the first year after injury.

Setting

Subjects’ homes via telephone in an urban-rural catchment area from a level I trauma center.

Participants

Subjects (N=171; age range, 18–70y) with a primary diagnosis of TBI who were discharged from an acute rehabilitation unit. They were randomly assigned to the telephone intervention (n=85) or to standard follow-up (n=86) groups at discharge. Of these, 79 participated in the intervention and completed the outcome assessment (3 withdrew; 3 were lost to follow-up), and 78 participated in usual care and completed the outcome assessment (8 were lost to follow-up).

Interventions

Subjects were randomly assigned to receive telephone calls at 2 and 4 weeks and 2, 3, 5, 7, and 9 months after discharge. The calls consisted of brief motivational interviewing, counseling, and education, plus facilitating usual care or usual care alone through follow-up appointments and therapy prescriptions.

Main outcome measures

A composite outcome was used as the primary endpoint on an intent-to-treat basis. Secondary analyses were conducted with individual measures, including the FIM instrument, Disability Rating Scale, Community Integration Questionnaire, Neurobehavioral Functioning Inventory, Functional Status Examination, Glasgow Outcome Scale–Extended, Medical Outcomes Study 36-Item Short-Form Health Survey, Brief Symptom Inventory, EuroQol, and Modified Perceived Quality of Life scale. The primary analysis was a blocked Mann-Whitney U test.

Results

At 1-year follow-up, those who had received scheduled telephone intervention fared significantly better on the primary composite outcome index (P=.002). In addition, this group fared better on specific composites such as functional status (P=.003) and quality of well-being (P=.006). There were no significant differences on vocational status (P=.08) or community integration status (P=.13).

Conclusions

Scheduled telephone counseling and education resulted in improved overall outcome, particularly for functional status and quality of well-being, when compared with usual outpatient care. Telephone counseling shows promise as a low-cost, widely available rehabilitation intervention for TBI.

Key words:  Brain injuries , Rehabilitation , Telephone , Treatment outcome