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Telephone Problem-Solving Treatment Improves Sleep Quality in Service Members With Combat-Related Mild Traumatic Brain Injury: Results From a Randomized Clinical Trial

Vuletic, S. MD; Bell, K. R. MD; Jain, S. PhD; Bush, N. PhD; Temkin, N. PhD; Fann, J. R. MD, MPH; Stanfill, K. E. PhD; Dikmen, S. PhD; Brockway, J. A. PhD; He, F. MS; Ernstrom, K. MS; Raman, R. PhD; Grant, G. MD, FACS; Stein, M. B. MD, MPH; Gahm, G. A. PhD

Section Editor(s): Nakase-Richardson, Risa PhD

for the CONTACT Investigators

The Journal of Head Trauma Rehabilitation: March/April 2016 - Volume 31 - Issue 2 - p 147–157
doi: 10.1097/HTR.0000000000000221
Original Articles

Objective: Evaluate sleep quality, its correlates, and the effect of telephone-based problem-solving treatment (PST) in active duty postdeployment service members with mild traumatic brain injury (mTBI)

Setting: Randomized clinical trial.

Participants: Active duty service members with combat-related mTBI.

Study design: Education-only (EO) and PST groups (N = 178 each) received printed study materials and 12 educational brochures. The PST group additionally received up to 12 PST telephone calls addressing participant-selected issues. Outcomes were evaluated postintervention (6 months) and at 12 months.

Main Measure: Pittsburgh Sleep Quality Index.

Results: Sleep quality was manifestly poor in both groups at baseline (Pittsburgh Sleep Quality Index = 12.5 ± 4). Overall sleep quality was significantly different between the PST and EO groups at 6 months (P = .003) but not at 12 months. Longitudinally, PST significantly improved sleep quality at 6 months (P = .001) but not over the follow-up. Low sleep quality was associated with concussion symptoms, pain, depression, and posttraumatic stress disorder at all time points (P < .0001).

Conclusions: Sleep disorders, common in postdeployment service members with mTBI, are strongly associated with the presence of pain, posttraumatic stress disorder, and depression. Telephone-based PST may be an effective therapeutic approach for reducing sleep disorders in this population. Research should focus on maintenance of treatment gains.

National Center for Telehealth and Technology (T2), Tacoma, Washington (Drs Vuletic, Bush, Stanfill, and Gahm); Departments of Rehabilitation Medicine (Drs Bell, Temkin, Dikmen, and Brockway), Neurological Surgery (Drs Temkin and Dikmen), Biostatistics (Drs Temkin and Fann), and Psychiatry and Behavioral Sciences (Dr Fann), University of Washington, Seattle; Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas (Dr Bell); Departments of Family Medicine and Public Health (Drs Jain, Raman, and Stein and Messrs He and Ernstrom) and Psychiatry (Dr Stein), University of California San Diego, La Jolla; Department of Neurosurgery, Stanford University School of Medicine, Stanford, California (Dr Grant); and Defense Centers of Excellence (DCoE), Olympia, Washington (Dr Gahm).

Corresponding Author: G. A. Gahm, PhD, Defense Centers of Excellence (DCoE), 4124 41st LP SE, Olympia, WA 98501 (

This research was supported by grant W81XWH-08-2-0159 from the US Army Medical Research and Materiel Command (USAMRMC). The authors are thankful to all study participants and their families; the CONTACT study team members: Wesley R. Cole, PhD (Womack Army Medical Center, Fort Bragg, North Carolina), Tessa Hart, PhD (Moss Rehabilitation Research Institute, Pennsylvania), Ariel J Lang, PhD, MPH (UCSD, La Jolla, California), Jef St. De Lore, MPH (University of Washington, Seattle, Washington), Jason Barber, MS (University of Washington, Seattle, Washington), Sara E. Fey-Hinckley, MA, LMFT, CBIS (University of Washington, Seattle, Washington), Jocelyn L. Savage, LICSW (University of Washington, Seattle, Washington), Michael Warren, MA (University of Washington, Seattle, Washington), Elissa Thomas (National Center for Telehealth and Technology, T2, Tacoma, Washington), Karina Boykin (National Center for Telehealth and Technology, T2, Tacoma, Washington); as well as Derek Smolensky, PhD, MPH (National Center for Telehealth and Technology, T2, Tacoma, Washington); and the Geneva Foundation (Tacoma, Washington), in particular Kasey Zink.

The views, opinions, and/or findings contained in this article are those of the authors and should not be construed as an official Department of Defense position, policy, or decision unless so designated by other official documentation.

The authors declare no conflicts of interest.

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