Advertisement

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

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Thurman D.J.
        • Alverson C.
        • Dunn K.A.
        • Guerrero J.
        • Sniezak J.E.
        Traumatic brain injury in the United States.
        J Head Trauma Rehabil. 1999; 14: 602-615
        • Thurman D.
        • Guerrero J.
        Trends in hospitalization associated with traumatic brain injury.
        JAMA. 1999; 282: 954-957
        • Dikmen S.S.
        • Temkin N.R.
        • Machamer J.E.
        • Holubkov A.L.
        • Fraser R.T.
        • Winn H.R.
        Employment following traumatic head injuries.
        Arch Neurol. 1994; 51: 177-186
        • Engli M.
        • Kirsivali-Farmer K.
        Needs of family members of critically ill patients with and without acute brain injury.
        J Neurosci Nurs. 1993; 25: 78-85
        • Serio C.D.
        • Kreutzer J.S.
        • Gervasio A.J.
        Predicting family needs after brain injury.
        J Head Trauma Rehabil. 1995; 10: 32-45
        • Campbell C.H.
        Needs of relatives and helpfulness of support groups in severe head injury.
        Rehabil Nurs. 1988; 13: 320-325
        • Harrison-Felix C.
        • Newton C.N.
        • Hall K.M.
        • Kreutzer J.S.
        Descriptive findings from the Traumatic Brain Injury Model Systems National Data Base.
        J Head Trauma Rehabil. 1996; 11: 1-14
        • Burke D.C.
        Models of brain injury rehabilitation.
        Brain Inj. 1995; 9: 735-743
        • Malec J.F.
        • Basford J.S.
        Postacute brain injury rehabilitation.
        Arch Phys Med Rehabil. 1996; 77: 198-207
        • Balas E.A.
        • Jaffrey F.
        • Kuperman G.J.
        • et al.
        Electronic communication with patients. Evaluation of distance medicine technology.
        JAMA. 1997; 278: 152-159
        • Weinberger M.
        • Tierney W.M.
        • Cowper P.A.
        • Katz B.P.
        • Booher P.A.
        Cost-effectiveness of increased telephone contact for patients with osteoarthritis. A randomized, controlled trial.
        Arthritis Rheum. 1993; 36: 243-246
        • Austin J.S.
        • Maisiak R.S.
        • Macrina D.M.
        • Heck L.W.
        Health outcome improvements in patients with systemic lupus erythematosus using two telephone counseling interventions.
        Arthritis Care Res. 1996; 9: 391-399
        • van Elderen-van Kemenade T.
        • Maes S.
        • van den Broek Y.
        Effects of a health education programme with telephone follow-up during cardiac rehabilitation.
        Br J Clin Psychol. 1994; 33: 367-378
        • Dornelas E.
        • Sampson R.A.
        • Gray J.F.
        • Wasers D.
        • Thompson P.D.
        A randomized controlled trial of smoking cessation counseling after myocardial infarction.
        Prev Med. 2000; 30: 261-268
        • Clark M.
        • Hampson S.E.
        Implementing a psychological intervention to improve lifestyle self-management in patients with type 2 diabetes.
        Patient Educ Couns. 2001; 42: 247-256
        • Katon W.
        • Rutter C.
        • Ludman E.J.
        • et al.
        A randomized trial of relapse prevention of depression in primary care.
        Arch Gen Psychiatry. 2001; 58: 241-247
        • Simon G.
        • Von Korff M.
        • Rutter C.
        • Wagner E.
        Randomised trial of monitoring, feedback and management of care by telephone to improve treatment of depression in primary care.
        BMJ. 2000; 320: 550-554
        • Simon G.E.
        • Ludman E.J.
        • Tutty S.
        • Operskalski B.
        • Von Korff M.
        Telephone psychotherapy and telephone care management for primary care patients starting antidepressant treatment.
        JAMA. 2004; 292: 935-942
        • Bostrom J.
        • Caldwell J.
        • McGuire K.
        • Everson D.
        Telephone follow-up after discharge from the hospital.
        Appl Nurs Res. 1996; 9: 47-52
        • Salazar A.M.
        • Warden D.L.
        • Schwab K.
        • et al.
        Cognitive rehabilitation for traumatic brain injury: a randomized trial. Defense and Veterans Head Injury Program (DVHIP) Study Group.
        JAMA. 2000; 283: 3075-3081
        • Martin E.M.
        • Coyle M.K.
        • Warden D.L.
        • Salazar A.
        Telephonic nursing in traumatic brain injury.
        Am J Nurs. 2003; 103: 75-81
        • Bell K.R.
        • Hoffman J.M.
        • Doctor J.N.
        • et al.
        Development of a telephone follow-up program for individuals following traumatic brain injury.
        J Head Trauma Rehabil. 2004; 19: 502-512
        • Dunn C.
        • Deroo L.
        • Rivara F.P.
        The use of brief interventions adapted from motivational interviewing across behavioral domains.
        Addiction. 2001; 96: 1725-1742
        • Miller W.R.
        • Rollnick S.
        Motivational interviewing.
        Guilford Pr, New York1991
        • Keith R.A.
        • Granger C.V.
        • Hamilton B.B.
        • Sherwin F.S.
        The functional independence measure.
        Adv Clin Rehabil. 1987; 1: 6-18
        • Rappaport M.
        • Hall K.M.
        • Hopkins K.
        • Belleza T.
        • Cope D.N.
        Disability rating scale for severe head trauma.
        Arch Phys Med Rehabil. 1982; 63: 118-123
        • Willer B.
        • Kreutzer J.S.
        • Gordon W.A.
        Assessment of community integration following rehabilitation for traumatic brain injury.
        J Head Trauma Rehabil. 1993; 8: 75-85
        • Kreutzer J.
        • Seel R.T.
        • Marwitz J.H.
        The Neurobehavioral Functioning Inventory.
        Psychological Corp, San Antonio1999
        • Dikmen S.
        • Machamer J.
        • Miller B.
        • Doctor J.
        • Temkin N.
        Functional status examination.
        J Neurotrauma. 2001; 18: 127-140
        • Wilson J.T.
        • Pettigrew L.E.
        • Teasdale G.M.
        Structured interviews for the Glasgow Outcome Scale and the extended Glasgow Outcome Scale.
        J Neurotrauma. 1998; 15: 573-585
        • Ware J.E.
        SF-36 Health Survey manual and interpretation guide.
        The Health Institute, New England Medical Center, Boston1993
        • Derogatis L.R.
        • Melisaratos N.
        The Brief Symptom Inventory.
        Psychol Med. 1983; 13: 595-605
      1. EuroQol–a new facility for the measurement of health-related quality of life. The EuroQol Group.
        Health Policy. 1990; 16: 199-208
        • Patrick D.L.
        • Danis M.
        • Southerland L.I.
        • Hong G.
        Quality of life following intensive care.
        J Gen Intern Med. 1988; 3: 218-223
        • O’Brien P.C.
        Procedures for comparing samples with multiple endpoints.
        Biometrics. 1984; 40: 1079-1087
        • Marascuilo L.A.
        • McSweeney M.
        Nonparametric and distribution free methods for the social sciences.
        Brooks/Cole, Monterey1977
        • Fuhrer M.J.
        • Keith R.A.
        Facilitating patient learning during medical rehabilitation.
        Am J Phys Med Rehabil. 1998; 77: 557-561
        • Prigatano G.P.
        Personality and psychosocial consequences of brain injury.
        in: Prigatano G.P. Neuropsychological rehabilitation after brain injury. Johns Hopkins Univ Pr, Baltimore1986: 29-50
        • Cope D.N.
        Physiatric assessment for rehabilitation.
        in: Rosenthal M. Griffith E. Bond M. Miller J.D. Rehabilitation of the adult and child with traumatic brain injury. 2nd ed. FA Davis, Philadelphia1990: 253-263
        • Holland D.
        • Shigaki C.L.
        Educating families and caretakers of traumatically brain injured patients in the new health care environment.
        Brain Inj. 1998; 12: 993-1009
        • Kreutzer J.
        • Sander A.M.
        • Fernandez C.C.
        Misperceptions, mishaps, and pitfalls in working with families after traumatic brain injury.
        J Head Trauma Rehabil. 1997; 12: 63-73
        • Malec J.F.
        • Machulda M.M.
        • Moessner A.M.
        Differing problem perceptions of staff, survivors, and significant other after brain injury.
        J Head Trauma Rehabil. 1997; 12: 1-13
        • Paterson B.
        • Kieloch B.
        • Gmiterek J.
        ‘They never told us anything’.
        Rehabil Nurs. 2001; 26: 48-53
        • Snyder R.E.
        • Cunningham W.
        • Nakazono T.T.
        • Hays R.D.
        Access to medical care reported by Asians and Pacific Islanders in a West Coast physician group association.
        Med Care Res Rev. 2000; 57: 196-215
        • Burnett D.M.
        • Kolakowsky-Hayner S.A.
        • Slater D.
        • et al.
        Ethnographic analysis of traumatic brain injury patients in the national Model Systems database.
        Arch Phys Med Rehabil. 2003; 84: 263-267
        • Bazarian J.J.
        • Pope C.
        • McClung J.
        • Cheng Y.T.
        • Flesher W.
        Ethnic and racial disparities in emergency department care for mild traumatic brain injury.
        Acad Emerg Med. 2003; 10: 1209-1217
        • Atkins B.J.
        • Wright G.N.
        • Humphreys R.R.
        • Provitt E.
        • Bolton B.
        • Cooper P.G.
        Three views: vocational rehabilitation of blacks. The statement, the response, the comment.
        J Rehabil. 1980; 46: 40-49
      2. Lift every voice. modernizing disability policies and programs to serve a diverse nation.
        National Council on Disability, Washington (DC)1999 (Available at: http://www.ncd.gov/newsroom/publications/1999/lift_report.htm. Accessed October 4, 2004.)
        • Sherer M.
        • Nick T.G.
        • Sander A.M.
        • et al.
        Race and productivity outcome after traumatic brain injury.
        J Head Trauma Rehabil. 2003; 18: 408-424
        • Yeates K.O.
        • Taylor H.G.
        • Woodrome S.E.
        • Wade S.L.
        • Stancin T.
        • Drotar D.
        Race as a moderator of parent and family outcomes following pediatric traumatic brain injury.
        J Pediatr Psychol. 2002; 27: 393-403
        • Anderson L.M.
        • Scrimshaw S.C.
        • Fullilove M.T.
        • Fielding J.E.
        • Normand J.
        Task force on community preventive services.
        Am J Prev Med. 2003; 24: 68-79