Concussion coach for postconcussive symptoms: A randomized, controlled trial of a smartphone application with Afghanistan and Iraq war Veterans

Abstract

Objective: Investigate the effectiveness of Concussion Coach, an interactive smartphone application, as a treatment for residual neurobehavioral symptoms and distress in Veterans with a history of mild traumatic brain injury (mild TBI). Methods: Veterans with mild TBI were randomized to Concussion Coach (n = 238) or Treatment-as-Usual (TAU) (n = 241) in a 3-month randomized controlled trial. Primary outcome measures included postconcussive symptom (PCS) severity as measured by the Neurobehavioral Symptom Inventory (NSI), and psychological distress as measured by the Brief Symptom Inventory-18 (BSI-18). Measures of self-efficacy, social support, and comfort with technology were administered as potential moderators and mediators. An intention-to-treat (ITT) analysis was performed (N = 461: Concussion Coach = 231 and TAU = 230) using Bayesian Network (BN)modeling. Results: The probability of decreased PCS severity was significantly greater for those assigned to Concussion Coach, .35 [.32,.37], than for TAU, .29 (.27, .32), with an odds ratio (OR) of 1.29. Also, Concussion Coach showed a significantly greater probability of increased self-efficacy (.36 [.32, .39]) than did TAU (.28 [.25, .30], OR = 1.42). In turn, self-efficacy (increased vs. decreased) showed a significantly greater probability of decreased PCS severity (.51 [.47, .54] vs. .27 [.24, .30], OR = 2.71) and decreased psychological distress (.53 [.49, .56] vs. .32 [.29, .35], OR = 2.35), suggesting that self-efficacy may have mediated Concussion Coach effects. Conclusions: Concussion Coach is effective at reducing PCS severity and psychological distress. Increased self-efficacy/perception of self-management of symptoms may be key to successful treatment of residual symptoms in those with history of concussion.

Keywords:

• TBI
• Veterans Health Administration
• postconcussive
• mobile application
• smart phone
• rehabilitation
• Bayesian network

Clinical Trial Registration:

• clinicaltrials.gov (NCT02501642)

Acknowledgements

The authors would like to thank Dr. Tracy Kretzmer, Dr. Julia Hoffman, Dr. Zoe Proctor-Weber, Dr. Tanya Harris, Padmaja Ramaiah, Angel Klanchar, Barbara McKenzie, Susan Horrigan, Amanda Shelley and the Veterans who participated in this study.

Additional information

Funding

The research reported here was funded by VA HSRD grant IIR 13-196-1, and further supported by the Department of Defense (DoD), and Department of Veterans Affairs, Veterans Health Administration (VHA). Further support was provided by 9Line LLC and St Michael’s Inc. The views expressed herein are those of the authors and do not necessarily reflect the views of the DoD, VHA, or DVBIC. The first author was an employee of the VHA when this study was conducted.