Predicting treatment response to cognitive rehabilitation in military service members with mild traumatic brain injury.

OBJECTIVE

Determine factors that affect responsiveness to cognitive rehabilitation (CR) interventions in service members (SMs) who sustained mild traumatic brain injury (mTBI).

METHOD: 126 SMs with a history of mTBI 3 to 24 months postinjury participated in a randomized clinical trial of one of four, 6-week treatment arms: (a) psychoeducation, (b) computer-based CR, (c) therapist-directed manualized CR, and (d) therapist-directed CR integrated with cognitive-behavioral psychotherapy. Practice-adjusted reliable change scores (RCS) were calculated for the three primary outcome measures: Paced Auditory Serial Addition Test (PASAT), Symptom Checklist-90 Revised (SCL-90-R) Global Severity Index (GSI), and Key Behaviors Change Inventory (KBCI). Hierarchical logistic regression was used to predict RCS. Variables considered were: (a) demographic, (b) injury characteristics, (c) comorbid mental health conditions, (d) nonspecific treatment variables (i.e., team vs. no-team milieu), and (e) specific treatment elements.

RESULTS

No predictor variables were associated with RCS improvements on the PASAT or the SCL-90-R. Comorbid depression (p < .02) and team-treatment milieu (p < .02) were associated with RCS improvement on the KBCI. Specific CR (ps > .65) and psychotherapy treatments (p > .26) were not associated with improvements on any outcome. There was evidence that self-administered computer CR was not only not beneficial, but negatively associated with cognitive and neurobehavioral improvement.

CONCLUSIONS

Although reliable improvements were found on the PASAT and KBCI, no specific treatment intervention effects were found. Rather, comorbid depression and team-milieu treatment environment were associated with improvement, but only on the KBCI. Comorbid depression was associated with higher rates of improvement. (PsycINFO Database Record