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Social Competence Treatment After Traumatic Brain Injury: A Multicenter,Randomized Controlled Trial of Interactive Group Treatment Versus Noninteractive Treatment
Authors:Cynthia Harrison-Felix  Jody K Newman  Lenore Hawley  Clare Morey  Jessica M Ketchum  William C Walker  Kathleen R Bell  Scott R Millis  Cynthia Braden  James Malec  Flora M Hammond  CB Eagye  Laura Howe
Institution:1. Craig Hospital, Englewood, CO;2. Traumatic Brain Injury Model Systems National Data and Statistical Center, Englewood, CO;3. Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA;4. Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA;5. Department of Rehabilitation Medicine, University of Washington, Seattle, WA;6. Rehabilitation Institute of Michigan, Detroit, MI;7. Wayne State University School of Medicine, Detroit, MI;8. Rehabilitation Hospital of Indiana, Indianapolis, IN;9. Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN;10. Polytrauma Rehabilitation Center, VA Palo Alto Health Care System, Livermore, CA
Abstract:

Objective

To evaluate the effectiveness of a replicable group treatment program for improving social competence after traumatic brain injury (TBI).

Design

Multicenter randomized controlled trial comparing 2 methods of conducting a social competency skills program, an interactive group format versus a classroom lecture.

Setting

Community and veteran rehabilitation centers.

Participants

Civilian, military, and veteran adults with TBI and social competence difficulties (N=179), at least 6 months postinjury.

Interventions

The experimental intervention consisted of 13 weekly group interactive sessions (1.5h) with structured and facilitated group interactions to improve social competence, and the control consisted of 13 traditional classroom sessions using the same curriculum with brief supplemental individual sessions but without structured group interaction.

Main Outcome Measures

Profile of Pragmatic Impairment in Communication (PPIC), an objective behavioral rating of social communication impairments after TBI. LaTrobe Communication Questionnaire (LCQ), Goal Attainment Scale (GAS), Satisfaction with Life Scale, Posttraumatic Stress Disorder Checklist-C (PCL) civilian version, Brief Symptom Inventory 18 (BSI-18), Scale of Perceived Social Self-Efficacy (PSSE).

Results

Social competence goals (GAS) were achieved and maintained for most participants regardless of treatment method. Significant improvements in the primary outcome (PPIC) and 2 of the secondary outcomes (LCQ and BSI) were seen immediately posttreatment and at 3 months posttreatment in the alternative treatment arm only; however, these improvements were not significantly different between the group interactive structured treatment and alternative treatment arms. Similar trends were observed for PSSE and PCL-C.

Conclusions

Social competence skills improved for persons with TBI in both treatment conditions. The group interactive format was not found to be a superior method of treatment delivery in this study.
Keywords:Brain injuries  Rehabilitation  Social skills  Treatment  AT  Alternative Treatment  BSI  Brief Symptom Inventory  GAS  Goal Attainment Scale  GIST  group interactive structured treatment  LCQ  LaTrobe Communication Questionnaire  MTBI  mild traumatic brain injury  OSU-TBI-ID  Ohio State University Traumatic Brain Injury Identification  PCL-C  Posttraumatic Stress Disorder Checklist-Civilian Version  PPIC  Profile of Pragmatic Impairment in Communication  PSSE  Scale of Perceived Social Self-Efficacy  PTSD  posttraumatic stress disorder  RAVLT  Rey Auditory Verbal Learning Test  SWLS  Satisfaction with Life Scale  TBI  traumatic brain injury  TMT  Trail Making Test  VA  Department of Veterans Affairs
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