Goal management training for improving fatigue in children and adolescents with acquired brain injuries: A 2-year follow-up of a randomised controlled trial

Figures & data

Table 1. T4-ample descriptives.

	pGMT	pBHW	Total (n = 38)
Characteristics
Sex, boys/girls. (n)	8/13	8/9	16/22
Education level (mother)
< Primary school	1	0	1
High school	5	5	10
University level	11	9	20
≥ University, master’s degree	3	3	6
Age, M (SD)	15.33 (2.22)	15.64 (2.39)	15.47 (2.48)
Age at intervention, M (SD)	13.33 (2.22)	13.65 (2.4)	13.47 (2.27)
Injury aetiology
Age at injury M (SD) years	7.90 (4.32)	7.47 (3.64)	7.71 (3.96)
Time since injury M (SD) years	4.95 (3.14)	5.76 (2.13)	5.32 (2.73)
Primary injury (n)
Traumatic brain injury	5	3	8
Brain tumour	5	5	10
Cerebrovascular accidents	8	5	13
Infection/inflammation	1	3	4
Hypoxia/anoxia	2	1	3
Intellectual abilities M (SD)
VCI	97.10 (12.85)	99.69 (14.55)	98.25 (13.49)
WMI	98.8 (10.3)	92.81 (14.48)	96.14 (12.51)
PSI	90.4 (15.35)	95.44 (16.03)	92.64 (15.64)
FSIQ	94.15 (13.06)	95.14 (14.41)	94.94 (13.51)
Fatigue at baseline M (SD)
General tired (parent-report)	63.49 (20.87)	64.21 (18.57)	63.81 (19.61)
Sleep/rest (parent-report)	68.84 (16.80)	61.76 (26.44)	65.67 (21.62)
Cognitive tired (parent-report)	49.60 (21.96)	49.01 (22.27)	49.34 (21.80)
Total (parent-report)	60.64 (15.49)	58.33 (19.17)	59.61 (17.03)
General tired (self-report)	74.42 (19.77)	60.29 (28.03)	66.44 (24.13)
Sleep/rest (self-report)	65.87 (20.60)	52.45 (26.76)	59.87 (24.69)
Cognitive tired (self-report)	63.29 (28.49)	57.60 (23.58)	60.75 (26.22)
Total (self-report)	66.86 (20.57)	56.78 (23.67)	62.35 (22.30)

Intellectual abilities measured with WISC-V. Scores obtained for n = 37. VCI: Verbal Comprehension Index, WMI: Working Memory Index, PSI: Processing Speed Index, and FSIQ: Full-scale IQ. Fatigue measured with the Paediatric Quality of Life Inventory Multidimensional Fatigue Scale, PedsQL-MFS Total score (pGMT, n = 20; pBHW, n = 16).

Figure 1. Calculation of the reliable clinical change index.

Note: Standard error (SE) is calculated by using SD and coefficient alpha from the normative sample.

Calculation of the Reliable Clinical Change Index equation with pre- and post-test values.

Table 2. Comparison of non-responders and the T4 sample.

Variable	T4 sample (n = 38)	Non-responders (n = 38)	p
Baseline
Age	13.47 (2.27)	13.29 (2.38)	.73
Time since injury	5.32 (2.73)	4.34 (2.65)	.10
FSIQ	94.94 (13.51)	90.03 (12.8)	.13
PedsQL total	70.5 (15.64)	64.25 (18.16)	.14
PedsQL-MFS total	57.60 (19.14)	53.34 (19.59)	.50
PedsQL-MFS general	59.49 (22.2)	56.53 (23.25)	.70
PedsQL-MFS sleep/rest	60.18 (23.15)	58.22 (24.4)	.77
PedsQL-MFS cognitive	53.12 (20.88)	45.27 (21.94)	.12
Change scores
PedsQL-MFS total	4.82 (15.36)	6.17 (14.77)	.52
PedsQL-MFS general	2.45 (16.38)	4.05 (18.38)	.71
PedsQL-MFS sleep/rest	5.88 (17.77)	5.79 (15.28)	.90
PedsQL-MFS cognitive	6.12 (18.84)	8.68 (18.04)	.34

*p < 0.05. Change scores are calculated by subtracting 6-month follow-up scores from the baseline scores. All scores are raw scores, except for the FSIQ – Full-scale IQ from the Wechsler Intelligence Scale Child, 5th edition. Fatigue assessed with the PedsQL-MFS: Total score, general, sleep/rest, and cognitive subscales.

Figure 2. PedsQL-MFS (parent-report) Total scale and subscales throughout T1–T4 for the T4 sample.

Graphical illustrations of the PedsQL-MFS parent-report for pGMT and pBHW separately. Lines represent mean scores for Total fatigue, General fatigue, Sleep/rest, and Cognitive fatigue throughout T1–T4.

Table 3. Two-year outcome for T4 sample on the PedsQL-MFS parent-report.

Measure PedsQL Mean [95%CI]		Baseline T1	8-week T2	6-month T3	24-month T4	Group p	Time p	Group *time p	df
Total fatigue	GMT BHW Total	57.38 [49.30–65.46] 57.65 [48.62–66.68] 57.51 [51.46–63.57]	58.99 [50.30–67.68] 58.31 [48.60–68.01] 58.65 [52.14–65.16]	62.95 [52.83–73.07] 61.55 [50.22–72.88] 62.25 [55.27–70.01]	62.84 [51.89–73.79] 56.12 [43.96–68.29] 59.48 [54.65–69.84]	.69	.62	.86	52.22
General fatigue	GMT BHW Total	58.67 [49.02–68.32] 60.46 [49.68–71.25] 59.57 [52.33–66.80]	60.44 [50.89–69.69] 58.73 [48.06–69.40] 59.58 [52.43–66.74]	64.23 [54.33–74.13] 59.85 [48.76–70.94] 62.04 [54.60–69.47]	65.59 [54.98–76.20] 56.86 [45.07–68.66] 61.23 [53.29–69.16]	.55	.91	.76	61.25
Sleep/rest fatigue	GMT BHW Total	61.61 [52.03–71.19] 58.26 [47.55–68.97] 59.94 [52.75–67.12]	61.92 [51.98–71.85] 59.87 [48.77–70.97] 60.89 [53.45–68.34]	67.47 [55.23–79.71] 63.92 [50.24–77.61] 65.69 [56.52–74.87]	68.25 [56.09–80.42] 59.56 [46.04–73.08] 63.91 [54.81–73.00]	.49	.58	.89	54.07
Cognitive fatigue	GMT BHW Total	51.97 [43.16–60.78] 54.24 [44.39–64.09] 53.10 [46.50–59.71]	54.78 [45.75–63.81] 56.41 [46.32–66.50] 55.60 [48.83–62.36]	57.24 [45.67–68.80] 61.04 [48.09–73.99] 59.14 [50.46–67.82]	54.56 [39.67–69.46] 54.17 [37.61–70.72] 54.36 [43.23–65.50]	.76	.53	.97	45.98

Fixed effects estimates, and estimated means with 95% CI for pGMT, pBHW, and total T4 sample, with df for Group*Time. Scores are reversed with higher scores representing reduced fatigue.

Table 4. RCIs for the PedsQL-MFS total score.

Characteristics	RCI
	No clinical change		Negative clinical change		Positive clinical change
	Parent	Self	Parent	Self	Parent	Self
Primary injury
Traumatic brain injury	6	2	0	4	2	2
Brain tumour	2	5	2	2	6	3
Hypoxia/anoxia	2	2	1	1	0	0
Cerebrovascular accidents	1	4	7	6	3	3
Infection/inflammation	1	1	1	0	2	2
Sex (boys/girls)	4/8	6/8	5/6	7/6	6/7	3/7
Age at injury, Mean (SD)	9.25 (4.41)	8.79 (4.1)	7.64 (3.14)	6.38 (3.53)	6.69 (4.31)	7.9 (4.48)
Time since injury, Mean (SD)	4.33 (2.39)	4.93 (2.53)	5.82 (2.82)	5.62 (3.23)	5.54 (3.04)	5.4 (2.68)
FSIQ, Median (IQR)*	101.5 (22)	100 (20)	89 (11)	87 (16)	102 (25)	106.5 (18)
Intervention group (pGMT/pBHW)	4/8	9/5	7/4	8/5	9/4	4/6
Clinical cut-off total fatigue at baseline (<70 / > 70)	9/3	7/7	6/5	6/7	12/1	8/2

Descriptives for the three RCI groups on the PedsQL-MFS, parent-, and self-report (total score) independently of intervention groups. Numbers represent n if not specified otherwise. Parent-report: n = 36. Self-report: n = 37. Cases excluded because of incomplete response; total score not possible to calculate.

Data availability statement

The data presented in this study are not publicly available due to protection of privacy.