Online Family Problem-solving Treatment for Pediatric Traumatic Brain Injury

Abstract

Background and objectives: To determine whether online family problem-solving treatment (OFPST) is more effective in improving behavioral outcomes after pediatric traumatic brain injury with increasing time since injury.

Methods: This was an individual participant data meta-analysis of outcome data from 5 randomized controlled trials of OFPST conducted between 2003 and 2016. We included 359 children ages 5 to 18 years who were hospitalized for moderate-to-severe traumatic brain injury 1 to 24 months earlier. Outcomes, assessed pre- and posttreatment, included parent-reported measures of externalizing, internalizing, and executive function behaviors and social competence.

Results: Participants included 231 boys and 128 girls with an average age at injury of 13.6 years. Time since injury and age at injury moderated OFPST efficacy. For earlier ages and short time since injury, control participants demonstrated better externalizing problem scores than those receiving OFPST (Cohen's d = 0.44; P = .008; n = 295), whereas at older ages and longer time since injury, children receiving OFPST had better scores (Cohen's d = -0.60; P = .002). Children receiving OFPST were rated as having better executive functioning relative to control participants at a later age at injury, with greater effects seen at longer (Cohen's d = -0.66; P = .009; n = 298) than shorter (Cohen's d = -0. 28; P = .028) time since injury.

Conclusions: OFPST may be more beneficial for older children and when begun after the initial months postinjury. With these findings, we shed light on the optimal application of family problem-solving treatments within the first 2 years after injury.

Trial registration: ClinicalTrials.gov NCT00178022 NCT00409058 NCT00409448 NCT01042899.

FIGURE 1

Adjusted mean levels of CBCL externalizing problems on time since injury for early and late age at injury. In post hoc model-based analyses, we compared expected 6-month externalizing scores (arrowhead; shaded bars indicate 95% confidence intervals) for OFPST and control conditions within each of 4 groups defined by time since injury and age at injury, and the baseline score (dot) is set to the observed mean within the group defined by the median age at injury and time since injury (13.93 and 0.38 years, respectively); sex, parent education, and TBI severity are set at their sample-wide mean values. Age at injury and time since injury are set to the 10th and 90th percentiles (9.83 and 16.88 years, respectively; 0.13 and 1.11 years, respectively). Based on interpreting our model at pre-specified ages at injury and time since injury, we estimated statistically significant differences in average 6-month externalizing problem scores due to different treatment assignment for early age at injury and short time since injury (P = .03) and for late age at injury and long time since injury (P < .001).

FIGURE 2

Adjusted mean levels of the BRIEF GEC of the time since injury for early and late age at injury. In post hoc model-based analyses, we compared expected 6-month BRIEF GEC scores (arrowhead; shaded bars indicate 95% confidence intervals) for OFPST and control conditions within each of 4 groups defined by the time since injury and age at injury, and the baseline score (dot) is set to the observed mean within the group defined by the median age at injury and time since injury (13.93 and 0.38 years, respectively); sex, parent education, and TBI severity are set at their sample-wide mean values. Age at injury and the time since injury are set to the 10th and 90th percentiles (9.83 and 16.88 years, respectively; 0.13 and 1.11 years, respectively). Based on interpreting our model at pre-specified ages at injury and time since injury, we estimated statistically significant differences in average 6-month BRIEF GEC scores due to different treatment assignment for short time since injury and early or late age at injury (P = .03 for both) and for long time since injury and late age at injury (P < .001).