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. 2017 Feb 8:10:34.
doi: 10.1186/s13031-016-0100-y. eCollection 2016.

A novel bio-psycho-social approach for rehabilitation of traumatized victims of torture and war in the post-conflict context: a pilot randomized controlled trial in Kosovo

Shr-Jie Wang  1 , Ardiana Bytyçi  2 , Selvi Izeti  2 , Melita Kallaba  3 , Feride Rushiti  3 , Edith Montgomery  1 , Jens Modvig  1
Affiliations

A novel bio-psycho-social approach for rehabilitation of traumatized victims of torture and war in the post-conflict context: a pilot randomized controlled trial in Kosovo

Shr-Jie Wang et al. Confl Health. .

Abstract

Background: Some evidence showed that multidisciplinary rehabilitation in Western countries is effective for treating war-related trauma, but it remains unclear whether this approach is applicable to civilians living in resource-poor countries affected by war. In 2012-14, Danish Institute against Torture (DIGNITY) conducted a randomized controlled trial (RCT), in partnership with Kosova Rehabilitation Centre for Torture Victims (KRCT), to examine the effects of multidisciplinary intervention among victims of torture and war in Kosovo.

Methods: A single-center, randomized, parallel-arm, single-masked, waiting-list controlled trial was implemented in northern Kosovo. Thirty-four participants meeting the recruiting criteria were randomized to either intervention group, which received integrated treatments plus a once-daily multivitamin, or the waiting list group, which received multivitamin alone. The integrated treatments consisted of 10 weekly individual 60-min sessions of cognitive behavioral therapy (CBT), based on an adapted prolonged exposure therapy manual, an individual 20-min breathing exercise with an emWave biofeedback device, and 90-min group physiotherapy. The waiting list group also received the same treatment after the intervention group had completed their sessions. Outcome assessments were conducted at 3, 6 and 9 months after baseline assessment. Outcomes measures consisted of 4 subtypes: mental, emotional, physical health, functioning and social outcomes, i.e. PTSD, depression, anxiety, chronic pain, anger and hatred expression, body mass index, handgrip strength, standing balance, income, employment rate and disability score.

Results: Over 1/3 of PTSD cases were successfully treated. Inconsistent patterns with mental health and chronic pain outcomes were observed while there was a definite impact of intervention on functioning and social outcomes, i.e. the employment rate, which increased nearly 15 %, and the monthly wage, which rose 45-137 %. There was also a noticeable improvement in handgrip strength and disability score; the feelings of anger and hatred diminished. However, most of these changes did not reach statistical significance.

Conclusions: The impact of bio-psycho-social intervention is likely sensitive to the context of post-war economy in Kosovo and the treatment goals. The potential for improving the emotional well-being and employment outcome in victims was demonstrated. A larger scale RCT in a similar setting is needed, with close monitoring of treatment integrity and data reliability.

Trial registration: Clinicaltrials.gov (NCT01696578).

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Figures

Fig. 1
Fig. 1
CONSORT flow diagram for enrolment
Fig. 2
Fig. 2
a Mean of mental health outcomes over time: PTSD, depression and anxiety disorders. b Mean of pain outcomes over time: numbers of bodily pain sites and SF-MPQ. c Mean of physical health outcomes over time: handgrip strength, standing balance and BMI
Fig. 3
Fig. 3
a Proportion of binary outcome over time: PTSD, depression and anxiety disorders. b Proportion of binary outcome over time: pain intensity and frequency. c Proportion of binary outcome over time: emotional well-being
Fig. 4
Fig. 4
Functioning and social outcomes over time: employment rate, monthly income and disability score
See this image and copyright information in PMC

References

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