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The Effect of Telephone Counseling on Reducing Post-Traumatic Symptoms after Mild Traumatic Brain Injury: A Randomized Trial
  1. Kathleen R. Bell, M.D. (krbell{at}u.washington.edu)
  1. University of Washington, United States
    1. Jeanne M. Hoffman, Ph.D. (jeanneh{at}u.washington.edu)
    1. University of Washington, United States
      1. Nancy R. Temkin, Ph.D. (temkin{at}u.washington.edu)
      1. University of Washington, United States
        1. Janet M. Powell, Ph.D. (jmpowell{at}u.washington.edu)
        1. University of Washington, United States
          1. Robert T. Fraser, Ph.D. (rfraser{at}u.washington.edu)
          1. University of Washington, United States
            1. Peter C. Esselman, M.D. (esselman{at}u.washington.edu)
            1. University of Washington, United States
              1. Jason K. Barber, M.S. (barber{at}u.washington.edu)
              1. University of Washington, United States
                1. Sureyya Dikmen, Ph.D. (dikmen{at}u.washington.edu)
                1. University of Washington, United States

                  Abstract

                  Background: Mild traumatic brain injury (MTBI) is a significant public health problem affecting approximately one million people annually in the United States. Ten to fifteen percent are estimated to have persistent post-traumatic symptoms. We wished to determine whether focused, scheduled telephone counseling during the first 3 months after MTBI decreases symptoms and improves functioning at 6 months.

                  Methods: This was a two-group, parallel, randomized clinical trial with outcome assessed by blinded examiner at 6 months after injury. 366 of 389 eligible subjects age 16 or older with MTBI were enrolled in the emergency department with an 85% follow-up completion rate. Five telephone calls were completed, individualized for patient concerns and scripted to address education, reassurance, and reactivation. Two composites were analyzed, one relating to post-traumatic symptoms that developed or worsened after injury and their impact on functioning; the other related to general health status.

                  Results: The telephone counseling group had a significantly better outcome for symptoms (6.6 difference in adjusted mean symptom score, 95% confidence interval (CI) 1.2 to 12.0), but no difference in general health outcome (1.5 difference in adjusted mean functional score, 95% CI -2.2 to 5.2). A smaller proportion of the treatment group had each individual symptom (except anxiety) at assessment. Similarly, fewer of the treatment group had daily functioning negatively impacted by symptoms with the largest differences in work, leisure activities, memory and concentration, and financial independence.

                  Conclusions: Telephone counseling, focusing on symptom management, was successful in reducing chronic symptoms after MTBI. ClinicalTrials.gov, #NCT00483444

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