Improving Outcomes After Traumatic Injury: A Goal Management Approach (GMT)

This study is currently recruiting participants. (see Contacts and Locations)
Verified July 2014 by Vanderbilt University
Sponsor:
Collaborator:
U.S. Department of Education
Information provided by (Responsible Party):
Kristin Archer, Vanderbilt University
ClinicalTrials.gov Identifier:
NCT01714531
First received: October 22, 2012
Last updated: July 2, 2014
Last verified: July 2014
  Purpose

The majority of trauma survivors experience prolonged and profound physical and psychosocial disability, with up to 50% unable to return to productive employment. The Centers for Disease Control (CDC) estimates that more than 1 million of these individuals experience a mild traumatic brain injury (TBI) and cost the United States nearly $17 billion each year. Symptoms related to mild TBI result in cognitive, functional, and emotional impairments that can lead to vocational and social disability. Long-term cognitive deficits include problems with memory and attention, and most importantly executive functioning. Depressive and post-traumatic stress disorder (PTSD) symptoms are extremely common in individuals with cognitive impairment, occurring in up to 50% and 33% of individuals, respectively. The investigators have found that 55% of trauma patients with mild TBI have profound cognitive impairments in executive functioning at one-year survival. Executive functioning is defined as "a cognitive domain that controls the execution of complex activities of daily living essential for purposeful, goal directed behaviors." Deficits in executive functioning are the most disabling of all cognitive impairments and affect a person's ability to manage effectively in one's personal and professional life. Current literature shows that deficits in executive functioning contribute to reduced quality of life, difficulty in returning to work, and persistent psychological distress in various medical and surgical populations. Cognitive rehabilitation has proven effective for decreasing persistent cognitive impairment and functional disability in patients with TBI. The overall goal of cognitive rehabilitation is not only to improve a person's ability to process and interpret information but to increase self-confidence and self-efficacy for coping with emotional distress. Despite evidence supporting the use of cognitive rehabilitation, few studies have systematically addressed cognitive treatment for individuals with mild TBI. Therefore, the investigators propose to conduct a three-group randomized controlled trial to determine the efficacy of Goal Management Training (GMT), a structured manual-based intervention targeting executive functions that impact a person's ability to carry out daily tasks. The investigators hypothesize that telephone-based GMT will improve cognitive functioning, functional status, and psychological health in trauma survivors with mild TBI. Emerging research suggests that telephone rehabilitation is a feasible and effective alternative (with much broader applicability) to clinic-based interventions. Trauma survivors with mild TBI have limited access to rehabilitation services due to financial constraints and mobility and geographic restrictions that render clinic-based rehabilitation impractical. This clinical trial will recruit 90 trauma survivors with mild TBI and cognitive deficits in executive functioning. Eligible participants will be randomized to either 10-week (1) telephone-based GMT; (2) telephone-based attention-control; or (3) usual care. Primary outcomes will include observed and self-reported executive functioning and self-reported functional status as measured by a battery of standardized and previously validated cognitive tests and instruments, including the Delis-Kaplan Executive Function System Tower Test, the Dysexecutive Questionnaire, and the Functional Activities Questionnaire. Secondary outcomes will consist of depressive and PTSD symptoms, as measured by the Patient Health Questionnaire-9 and PTSD Checklist - Civilian Version, respectively. Outcome data will be collected at baseline (6 weeks after hospitalization) and at 4 month (treatment completion) and 7 month follow-up from hospital discharge. Our cognitive rehabilitation intervention will serve to broadly disseminate evidenced-based cognitive strategies to a trauma population that has difficulty returning to productive life both inside and outside the home due to profound functional and psychological disability. Findings from this study will support future research to improve the cognitive, functional and psychological health of patients following major trauma through innovative rehabilitation interventions and delivery methods.


Condition Intervention
Traumatic Brain Injury
Behavioral: Telephone-Based Goal Management Training
Behavioral: Telephone-Based Attention-Control

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Outcomes Assessor)
Primary Purpose: Treatment

Resource links provided by NLM:


Further study details as provided by Vanderbilt University:

Primary Outcome Measures:
  • D-KEFs Tower Test [ Time Frame: 7 months after hospital discharge ] [ Designated as safety issue: No ]
    cognitive test for executive functioning

  • Trail Making Test B [ Time Frame: 7 months after hospital discharge ] [ Designated as safety issue: No ]
    Cognitive test for set shifting and cognitive flexibility

  • Sustained Attention to Response Test [ Time Frame: 7 months after hospital discharge ] [ Designated as safety issue: No ]
    Cognitive test for failures of sustained attention

  • FAS Verbal Fluency Test [ Time Frame: 7 months after hospital discharge ] [ Designated as safety issue: No ]
    Cognitive test for verbal fluency


Secondary Outcome Measures:
  • Dysexecutive Questionnaire [ Time Frame: 7 months after hospital discharge ] [ Designated as safety issue: No ]
    Self-reported executive functioning

  • Functional Activities Questionnaire [ Time Frame: 7 months after hospital discharge ] [ Designated as safety issue: No ]
    Self-reported functional status


Other Outcome Measures:
  • Patient Health Questionnaire-9 [ Time Frame: 7 months after hospital discharge ] [ Designated as safety issue: No ]
    Self-reported measure of depressive symptoms

  • PTSD Checklist-Civilian Version (PCL-C) [ Time Frame: 7 months after hospital discharge ] [ Designated as safety issue: No ]
    Self-reported measure of PTSD symptoms


Estimated Enrollment: 90
Study Start Date: January 2013
Estimated Study Completion Date: June 2015
Estimated Primary Completion Date: June 2015 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Telephone-Based Goal Management Training
The GMT intervention targets cognitive deficits in executive functioning that impact a person's ability to carry out daily tasks. Participants learn how to recognize and stop absentmindedness and automatic pilot and how to reduce daily errors and 'slips' through goal setting. The telephone-based GMT condition includes 7 sessions delivered over the phone for 10 weeks.
Behavioral: Telephone-Based Goal Management Training
Other Name: GMT
Active Comparator: Telephone-Based Attention-Control
The attention group receives an educational intervention that is matched to the GMT intervention in terms of session length and contact with the study therapist. The telephone-based attention condition includes 7 sessions delivered over 10 weeks. Sessions address education on brain function and cognitive principles of memory, attention, language, perception, and motor skills. Education on stress reduction, sleep hygiene, energy management, exercise, communication, and nutrition are also provided
Behavioral: Telephone-Based Attention-Control
No Intervention: Usual Care Control
Participants in the control group will receive usual care as determined by the treating surgeon. Usual care may include referral to a physical therapist, occupational therapist, psychiatrist, and/or psychologist and utilization of health services will be recorded during follow-up assessments.

  Eligibility

Ages Eligible for Study:   21 Years to 80 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Determination of mild TBI using American Congress of Rehabilitation Medicine guidelines;
  2. No history of schizophrenia, or other psychotic disorder or suicidal intent;
  3. English speaking due to feasibility of employing study personnel to deliver and assess the study intervention;
  4. Age 21 years or older;
  5. Able to provide a telephone number and a stable address; and
  6. Presence of cognitive deficits in executive functioning (defined as 1 SD below the norm referenced mean on any 2 of the following neuropsychological tests, the D-KEF Tower Test, Trails B, and FAS)

Exclusion Criteria:

  1. Having a CT scan showing an intracranial hemorrhage;
  2. Current alcohol or substance abuse dependence (within the last 6 months);
  3. Persons with neurological history other than TBI (e.g., premorbid epilepsy, multiple sclerosis, Alzheimer's disease);
  4. Pre-existing cognitive impairment as determined by a validated surrogate or patient questionnaire (defined as a score greater than 3.3 on the IQCODE instrument;
  5. History of pre-morbid learning disability;and
  6. Involvement in current litigation
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01714531

Contacts
Contact: Lori Haislip, MA, CCRP 615-936-3312 lori.haislip@vanderbilt.edu

Locations
United States, Tennessee
Vanderbilt University Medical Center Recruiting
Nashville, Tennessee, United States, 37232
Principal Investigator: Kristin R Archer, PhD, DPT         
Sponsors and Collaborators
Vanderbilt University
U.S. Department of Education
Investigators
Principal Investigator: Kristin Archer, PhD Vanderbilt School of Medicine
  More Information

No publications provided

Responsible Party: Kristin Archer, Assistant Professor, Vanderbilt University
ClinicalTrials.gov Identifier: NCT01714531     History of Changes
Other Study ID Numbers: 111484, H133G120052
Study First Received: October 22, 2012
Last Updated: July 2, 2014
Health Authority: United States: Institutional Review Board

Keywords provided by Vanderbilt University:
Mild TBI

Additional relevant MeSH terms:
Brain Injuries
Wounds and Injuries
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Craniocerebral Trauma
Trauma, Nervous System

ClinicalTrials.gov processed this record on July 29, 2014