Dataset Information

Examination of Injury, Host, and Social-Environmental Moderators of Online Family Problem Solving Treatment Efficacy for Pediatric Traumatic Brain Injury Using an Individual Participant Data Meta-Analytic Approach.

ABSTRACT: A series of five randomized controlled clinical trials (RCTs) conducted between 2002 and 2015 support the potential efficacy of online family problem-solving treatment (OFPST) in improving both child and parent/family outcomes after pediatric traumatic brain injury (TBI). However, small sample sizes and heterogeneity across individual studies have precluded examination of potentially important moderators. We jointly analyzed individual participant data (IPD) from these five RCTs, involving 359 children and adolescents between the ages of 5 and 18 years, to confirm the role of previously identified moderators (child's age and pre-treatment symptom levels, parental education) and to examine other potential moderators (race, sex, IQ), using IPD meta-analysis. This reanalysis revealed statistically strong evidence that parental education, child age at baseline, IQ, sex, and parental depression level pre-treatment moderated the effect of OFPST on various outcomes. In particular, children of parents with a less than high school education exhibited fewer internalizing problems and better social competence. Children injured at an older age exhibited fewer externalizing behaviors and less executive dysfunction following OFPST. Child IQ moderated the effect of OFPST on social competence, with significantly better competence for children with lower IQ who received OFPST. Lower levels of parental depression followed OFPST among subgroups with lower IQ, boys, and higher parental depression scores at baseline. Our findings indicate that the optimal application of OFPST is likely to involve older children, those with lower IQ scores, or those from families with lower socioeconomic status (SES).

SUBMITTER: Zhang N

PROVIDER: S-EPMC6444887 | biostudies-literature | 2019 Apr

REPOSITORIES: biostudies-literature

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Examination of Injury, Host, and Social-Environmental Moderators of Online Family Problem Solving Treatment Efficacy for Pediatric Traumatic Brain Injury Using an Individual Participant Data Meta-Analytic Approach.

Zhang Nanhua N Kaizar Eloise E EE Narad Megan E ME Kurowski Brad G BG Yeates Keith Owen KO Taylor H Gerry HG Wade Shari L SL

Journal of neurotrauma 20181117 7

A series of five randomized controlled clinical trials (RCTs) conducted between 2002 and 2015 support the potential efficacy of online family problem-solving treatment (OFPST) in improving both child and parent/family outcomes after pediatric traumatic brain injury (TBI). However, small sample sizes and heterogeneity across individual studies have precluded examination of potentially important moderators. We jointly analyzed individual participant data (IPD) from these five RCTs, involving 359 c ...[more]

PMID: 30328749

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Project description:ImportanceExecutive dysfunction after traumatic brain injury (TBI) in children is common and leads to significant short- and long-term problems in functioning across multiple settings. We hypothesized that improvements in short-term executive function would be maintained to 24 months after injury and that improvements would increase over time in a counselor-assisted problem-solving (CAPS) intervention.ObjectiveTo evaluate the efficacy of a CAPS intervention administered within 7 months of complicated mild to severe TBI compared with an Internet resource condition in improving long-term executive dysfunction.Design, setting, and participantsMultisite, assessor-blinded, randomized clinical trial at 3 tertiary pediatric hospitals and 2 tertiary general medical centers. Participants included 132 adolescents aged 12 to 17 years who sustained a moderate to severe TBI 1 to 7 months before study enrollment.InterventionWeb-based CAPS intervention.Main outcomes and measuresThe primary outcome was the parent-reported Global Executive Composite (GEC) of the Behavior Rating Inventory of Executive Function. Secondary outcomes included the Behavioral Regulation Index (BRI) and Metacognition Index (MI) of the GEC.ResultsIn older (>14 to 17 years) adolescents, the CAPS intervention was associated with lower GEC ratings at 12 (β = -0.46; P = .03) and 18 (β = -0.52; P = .02) months after enrollment. Trends were also observed for older adolescents toward lower GEC ratings at 6 months (β = -0.40; P = .05), lower BRI ratings at 12 (β = -0.40; P = .06) and 18 (β = -0.47; P = .04) months, and lower MI ratings at 6 (β = -0.41; P = .05), 12 (β = -0.46; P = .03), and 18 (β = -0.50; P = .03) months. In younger (12-14 years) adolescents, no group differences were found on the GEC, BRI, or MI ratings.Conclusions and relevanceDelivery of the CAPS intervention early after TBI in older adolescents improves long-term executive function. This trial is, to our knowledge, one of the few large, randomized clinical treatment trials performed in pediatric TBI to demonstrate the efficacy of an intervention for management of executive dysfunction and long-term benefits of an intervention delivered soon after injury. Use of the CAPS intervention clinically should be considered; however, further research should explore ways to optimize delivery.Trial registrationclinicaltrials.gov Identifier: NCT00409448.

Dataset Information

Examination of Injury, Host, and Social-Environmental Moderators of Online Family Problem Solving Treatment Efficacy for Pediatric Traumatic Brain Injury Using an Individual Participant Data Meta-Analytic Approach.

Publications

Examination of Injury, Host, and Social-Environmental Moderators of Online Family Problem Solving Treatment Efficacy for Pediatric Traumatic Brain Injury Using an Individual Participant Data Meta-Analytic Approach.

Similar Datasets

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