WASHINGTON, DC—A University of Washington and Madigan Army Medical Center study will examine the use of telephone technology to support servicemembers who have suffered a mild traumatic brain injury (mTBI).

Jo Ann Brockway, PhD, Clinical Associate Professor from the Department of Rehabilitative Medicine at the University of Washington, presented a study during a Defense Centers of Excellence (DCoE) for Psychological Health and Traumatic Brain Injury webinar that will evaluate the efficacy of an individualized scheduled telephone support (ISTS) for patients who have sustained a mTBI.

The CONcussion Treatment After Combat Trauma study will utilize a telephone intervention that provides injury-related education, training in problem solving, and behavioral strategies for problems that commonly co-occur with mTBI. Such problems include headaches, anxiety, and depression.

The primary aims of the study, which is funded by the DoD US Army Medical Research and Materiel Command, will be to compare the effects of ISTS with usual care on post-concussion symptom severity as well as on the symptoms of emotional stress.

Telephone Intervention

There has been an increased incidence of brain injuries in servicemembers in theater and blasts have been a leading cause of these injuries in the war zone. Some symptoms associated with mTBI are memory impairment, headaches, balance problems, dizziness, fatigue, blurred vision, and sleep problems. These symptoms often resolve by three months after the injury, but for some patients symptoms may persist for six months or more.

Brockway said that the reason a telephone intervention is being studied is that it can reach patients who live in geographical areas where there are no specialized TBI services or where transportation to these services is a problem. ’The use of the telephone can be economical and it can be a convenient way to assist people who may not have other access to services.”

In a prior study conducted by the University of Washington, researchers compared the use of a telephone intervention versus usual care in civilians with mTBI. That study found that symptoms were decreased and there was functional improvement in the telephone intervention group. This group had fewer medical and psychological symptoms than the usual care group, but there was no difference in PTSD prevalence in the two groups.

ISTS Compared to Usual Care

The current study will recruit servicemembers returning to Fort Lewis from theater, based on their responses to a TBI screening questionnaire. Servicemembers with moderate or severe TBI, and those with a psychotic disorder or severe alcohol or drug abuse problems will be excluded.

Participants will be randomly assigned to either the treatment or control group. Those assigned to the control group will receive the usual care, which is defined as any medical or other follow up that servicemembers would normally get in post deployment clinics. These participants will also receive 12 educational brochures on mTBI symptoms and distress at two-week intervals.

The participants assigned to the ISTS group will receive usual care plus 12 scheduled follow-up scripted phone calls. These telephone calls will include self-management therapy. “This is not psychotherapy over the phone, but it is really focused on dealing with troublesome symptoms. We have specialized modules for many of the symptoms that are most likely to occur after mTBI, including headaches, dizziness, anxiety, depression, and relationship problems,” she said.

As part of the telephone intervention, an action plan will be developed to address the servicemember’s particular concerns. Brockway explained that they do not anticipate that the problems the servicemember may be experiencing will be resolved over the duration of one phone call. For example, researchers are using a four module session for depression.

The hypothesis for the primary objective of the study is that the interventions will be associated with lower levels of post-concussive symptoms compared to usual care at the six-month follow-up. In addition the study is testing the hypothesis that the individualized scheduled telephone intervention will be associated with lower levels of emotional stress compared to individuals who get usual care at the six-month follow up.

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