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Feasibility of a Cognitive Behavioral Intervention to Manage Fatigue in Individuals With Traumatic Brain Injury: A Pilot Study

Raina, Ketki D. PhD, OTR/L; Morse, Jennifer Q. PhD; Chisholm, Denise PhD, OTR/L; Leibold, Mary Lou PhD, OTR/L; Shen, Jennifer MD; Whyte, Ellen MD

Section Editor(s): Caplan, Bruce PhD, ABPP; Bogner, Jennifer PhD, ABPP; Brenner, Lisa PhD, ABPP; Arciniegas, David MD

Journal of Head Trauma Rehabilitation: September/October 2016 - Volume 31 - Issue 5 - p E41–E49
doi: 10.1097/HTR.0000000000000196
Focus on Clinical Research and Practice, Part 4

Objective: To evaluate the feasibility of conducting a randomized clinical trial of an Internet-based manualized intervention to teach individuals with traumatic brain injury to manage their fatigue.

Setting: Community dwelling.

Participants: Forty-one participants randomized to Maximizing Energy (MAX) intervention group (n = 20) and Health Education group (n = 21).

Intervention: The experimental group (MAX intervention) received an 8-week program that combined education and Problem-Solving Therapy to teach individuals to manage fatigue-related problems. The attention control group received health education.

Measures: Primary outcome measures pertained to the feasibility of conducting the trial. Secondary outcomes were fatigue impact and fatigue severity assessed at baseline and postintervention.

Results: Of the 65 participants referred, 41 were enrolled (63% recruitment rate), of which 3 withdrew (92% retention rate). Participants in the experimental and control groups completed their homework 75% and 85% of the time, respectively, and were equally engaged in the sessions. Participants in the experimental group were able to learn and implement the MAX intervention steps. Effect sizes for all measures ranged from small (−0.17) to medium (−0.58) in favor of the intervention group.

Conclusion: Findings from the study suggest that the MAX intervention is feasible to administer to individuals with post–traumatic brain injury fatigue.

Department of Occupational Therapy, School of Health and Rehabilitation Sciences (Drs Raina, Chisholm, and Leibold), Department of Physical Medicine and Rehabilitation, School of Medicine (Dr Shen), and Department of Psychiatry, School of Medicine (Dr Whyte), University of Pittsburgh, Pittsburgh, Pennsylvania; and Department of Counseling Psychology, School of Health Sciences, Chatham University, Pittsburgh, Pennsylvania (Dr Morse).

Corresponding Author: Ketki D. Raina, PhD, OTR/L, Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, 5012 Forbes Tower, Pittsburgh, PA 15260 (

The study was funded by the US Army Medical Research and Material Command (award no. W81XWH-10-1-0920).

The authors declare no conflicts of interest.

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