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SHP 08-189 – HSR&D Study

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SHP 08-189
Prototype of Web-Based Treatment of mild TBI Symptoms in OEF/OIF
Audrey L. Nelson RN PhD FAAN
James A. Haley Veterans' Hospital, Tampa, FL
Tampa, FL
Funding Period: May 2008 - September 2008

BACKGROUND/RATIONALE:
Traumatic brain injury (TBI) is a leading cause of death and disability. More than 80% of TBIs are classified as mild, involving only a brief loss or alteration of consciousness. Even for patients not admitted to the hospital, the economic burden of mild TBI is considerable with many patients not returning to work until 1 to 3 months post-injury and having reduced self-rated productivity for several months thereafter. Concussion or mild TBI is one of the most common forms of combat-related injury.

Most cases of mild TBI recover completely within the first 3 months in terms of both cognitive function and structural integrity viewed via neuroimaging. However, a significant minority continue to complain of cognitive difficulty and other distressing symptoms for months or years post injury. Frequently these complaints involve a constellation of physical, emotional, and cognitive symptoms collectively known as postconcussion syndrome (PCS).

Fortunately, there is effective treatment available for patients having sustained a mild TBI and experiencing PCS symptoms or the full PCS syndrome. Brief psychological treatment significantly reduces the severity and duration of PCS symptoms following mild TBI. Several standardized, empirically supported treatment manuals are available. We would like to test these using internet-based administration.

Because the research to date has evaluated the effectiveness of brief psychoeducation only in patients seen during acute admission to the hospital, it is our ultimate goal to test the effectiveness of a web-based treatment approach in subacute and chronic patients. We think the internet might be an efficient delivery mode for this psychoeducation and are developing a prototype to be used in future studies.

OBJECTIVE(S):
The primary purpose of this project was to a) develop a website prototype designed to educate individuals who sustained a mild TBI in order to reduce the frequency and severity of postconcussion symptoms (PCS) and b) partner with patient consumers with mild TBI to refine the content, appearance, and protocol of the prototype for use in development of the actual web site.

METHODS:
The proposed study involved partnering with experts in information technology to develop and beta test a web site prototype with our patients. This program, will form the basis for an intervention to be tested in the future with a larger patient cohort.

A total of 12 OEF/OIF veteran participants with mild TBI were recruited to provide us with feedback about the web site prototype.

FINDINGS/RESULTS:
We found, by piloting the prototype with 12 patients with mild TBI that there was good retention of the key points presented in the prototype and that the overall satisfaction with the prototype was good. Patients generally rated the usefulness, quality, interactive nature and general format as good to high. Over half (54%) said that they would definitely use the website if it were available.

IMPACT:
Based on our respondents' feedback, the website we develop with future funding will incorporate more combat-related information (e.g. PTSD, blast) and will make the program interactive, colorful, and dynamic.

PUBLICATIONS:
None at this time.


DRA: Military and Environmental Exposures, Acute and Combat-Related Injury
DRE: none
Keywords: Operation Enduring Freedom, Operation Iraqi Freedom, Traumatic Brain Injury
MeSH Terms: none

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