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Feasibility and Potential Benefits of a Web-Based Intervention Delivered Acutely After Mild Traumatic Brain Injury in Adolescents: A Pilot Study

Kurowski, Brad G. MD, MS; Wade, Shari L. PhD; Dexheimer, Judith W. PhD; Dyas, Jenna BS; Zhang, Nanhua PhD; Babcock, Lynn MD, MS

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

Journal of Head Trauma Rehabilitation: November/December 2016 - Volume 31 - Issue 6 - p 369–378
doi: 10.1097/HTR.0000000000000180
Original Articles

Background: There is a paucity of evidence-based interventions for mild traumatic brain injury (mTBI).

Objective: To evaluate the feasibility and potential benefits of an interactive, Web-based intervention for mTBI.

Setting: Emergency department and outpatient settings.

Participants: Of the 21 adolescents aged 11 to 18 years with mTBI recruited from November 2013 to June 2014 within 96 hours of injury, 13 completed the program.

Design: Prospective, open pilot.

InterventionThe Web-based Self-Management Activity-restriction and Relaxation Training (SMART) program incorporates anticipatory guidance and psychoeducation, self-management and pacing of cognitive and physical activities, and cognitive-behavioral principles for early management of mTBI in adolescents.

Main Measures: Primary: Daily Post-Concussion Symptom Scale (PCSS). Secondary: Daily self-reported ratings of activities and satisfaction survey.

Results: Average time from injury to baseline testing was 14.0 (standard deviation = 16.7) hours. Baseline PCSS was 23.6 (range: 0-46), and daily activity was 1.8 (range: 0-5.75) hours. Repeated-measures, generalized linear mixed-effects model analysis demonstrated a significant decrease of PCSS at a rate of 2.0 points per day that stabilized after about 2 weeks. Daily activities, screen time, and physical activity increased by 0.06 (standard error [SE] = 0.04, P = .09), 0.04 (SE = 0.02, P = .15), and 0.03 (SE = 0.02, P = .05) hours per day, respectively, over the 4-week follow-up. Satisfaction was rated highly by parents and youth.

Conclusions: Self-Management Activity-restriction and Relaxation Training is feasible and reported to be helpful and enjoyable by participants. Future research will need to determine the comparative benefits of SMART and ideal target population.

Division of Physical Medicine and Rehabilitation (Drs Kurowski and Wade), Division of Emergency Medicine (Drs Dexheimer and Babcock, and Ms Dyas), Division of Biomedical Informatics (Dr Dexheimer), and Division of Biostatistics and Epidemiology (Dr Zhang), Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio.

Corresponding Author: Brad G. Kurowski, MD, MS, Division of Physical Medicine and Rehabilitation, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH 45229 (

Funding for this study was supported in part by the Ohio Department of Public Safety, Cincinnati Children's Research Foundation Place Outcomes Grant, National Institute for Child Health and Human Development K23HD074683–01A1, and Grant 8 UL1 TR000077 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or other supporting agencies.

The authors declare no conflicts of interest.

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