Self-efficacy predicts response to cognitive rehabilitation in military service members with post-concussive symptoms

ABSTRACT

This study examined whether self-efficacy differentiated treatment responders from non-responders in a trial of cognitive rehabilitation (CR) for postconcussive symptoms. 126 service members with mild TBI seen on average 9.5 months since injury completed one of four cognitive rehabilitation treatments for 6 weeks. The four treatment arms were: (1) Psychoeducation control, (2) Self-administered computerized CR, (3) Interdisciplinary CR, and (4) Interdisciplinary CR integrated with CBT. Outcome was assessed across time (baseline, and 6, 12, and 18 weeks post-treatment) for three domains: psychological (Symptom Checklist–90-Revised; SCL-90-R), cognitive (Paced Auditory Serial Addition Test; PASAT), and functional/behavioural (Key Behaviors Change Inventory; KBCI). Mixed model ANOVAs tested for self-efficacy differences across time in treatment responders versus non-responders, as defined by reliable change indices. A significant interaction was found on the SCL-90 such that responders had increasing self-efficacy with respect to psychological symptoms across four time points, whereas non-responders’ self-efficacy did not change. Perceived self-efficacy at the beginning of treatment was associated with treatment engagement within the psychological domain for responders only, suggesting a mediating role in treatment outcome. Overall, results suggest that increasing patients’ level of self-efficacy may be important for successful treatment of psychological distress in those with remote concussion.

KEYWORDS:

• Concussion
• Rehabilitation
• Self-efficacy
• Traumatic brain injury

Acknowledgements

The research reported here was supported by the Department of Veterans Affairs, Veterans Health Administration (VHA), the Department of Defense (DoD), and 9 Line LLC. Further support was provided by the Defense and Veterans Brain Injury Center, Grant number MDA 905-03-2-0003, and the James A. Haley Veterans’ Hospital. The views expressed herein are those of the authors and do not necessarily reflect the views of the VHA, Department of the Army, Department of Health Affairs or the DoD.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by Defense and Veterans Brain Injury Center [grant number MDA 905-03-2-0003].