BETTER (Brain Injury Education, Training, and Therapy to Enhance Recovery)

Patients with TBI (age 18 and older) with mild-to-severe traumatic brain injury (TBI) face high incidence and hospitalization rates, and poor cognitive, physical, behavioral, and emotional impairments \<12 months post-discharge. These impairments affect patients' abilities to independently manage their health, wellness, and activities of daily living, resulting in dependence on family. The complexity of needs combined with the fragmentation of healthcare services creates the perfect storm for low patient quality of life (QOL), mismanaged symptoms, rehospitalizations, and increased caregiver strain. Lack of insurance or access to care aggravate these ongoing issues. Despite complex health needs, there are no U.S. standards for transitional care for patients with TBI. Transitional care is defined as actions in the clinical encounter designed to ensure the coordination and continuity of healthcare for patients transferring between different locations or levels of care (e.g., acute hospital care to home). In other patient groups with acute events (e.g., stroke, myocardial infarction), transitional care interventions have led to improved patient QOL and health outcomes. Yet, few TBI transitional care interventions exist. The paucity of theory-driven, evidence-based TBI transitional care interventions led our team to develop an intervention named BETTER (Brain Injury, Education, Training, and Therapy to Enhance Recovery). Based on the Individual and Family Self-Management Theory (IFSMT), BETTER is a patient- and family-centered, behavioral intervention for adults with TBI discharged home from acute hospital care and families. The goal is to improve patients' QOL (change in SF-36 total score, primary outcome) by 16-weeks post-discharge, as this timeframe includes high rates of unmet patient/family needs and preventable clinical events. Skilled clinical interventionists follow a manualized intervention protocol to address patient/family needs; establish goals; coordinate post-hospital care, services, and resources; and provide patient/family education and training on self- and family-management and coping skills \<16 weeks post-discharge. Findings from our NIH R03 pilot study showed BETTER significantly improved patients' physical QOL by 31.36 points (p = 0.006) and that the intervention was feasible and acceptable with adults with TBI and families. Thus, the purpose of this study is to examine the efficacy of BETTER (vs. usual care) among adults with TBI who are discharged home from acute hospital care and families. Findings will guide our team in designing a future, multi-site trial to disseminate and implement BETTER into clinical practice to ultimately drive advancements to enhance the standard of care for adults with TBI and families.

• Change in patient cognitive function (Neuro-QOL, Cognitive functioning) [Срок оценки: baseline (24-72 hours pre-discharge); 8-, 16-, and 24-weeks post-discharge]
• Change in patient physical functioning (Neuro-QOL, Upper & Lower extremity functioning) [Срок оценки: baseline (24-72 hours pre-discharge); 8-, 16-, and 24-weeks post-discharge]
• Change in patient sleep disturbance (NeuroQOL Sleep Disturbance, short-form) [Срок оценки: baseline (24-72 hours pre-discharge); 8-, 16-, and 24-weeks post-discharge]
• Change in patient TBI-related symptoms (Rivermead Post-concussion questionnaire) [Срок оценки: baseline (24-72 hours pre-discharge); 8-, 16-, and 24-weeks post-discharge]
• Change in patient participation [Participation Assessment with Recombined Tools-Objective (PART-O)] [Срок оценки: 8-, 16-, and 24-weeks post-discharge]
• Change in patient process of care transition [Care Transitions Measure-3 (CTM-3)] [Срок оценки: 8-, 16-, and 24-weeks post-discharge]
• Change in patient and caregiver difficulty accessing services [Service Obstacles Scale (SOS)] [Срок оценки: 8-, 16-, and 24-weeks post-discharge]
• Change in patient and caregiver quality of life / health status (Euro Qol, 5 Item [EQ-5D-5L]) + VAS (visual analog scale) + Cognitive domain (C) [Срок оценки: baseline (24-72 hours pre-discharge); 8-, 16-, and 24-weeks post-discharge]
• Change in patient and caregiver multi-dimensional interpersonal processes of care in the clinical encounter [Interpersonal Processes of Care (IPC) short-form] [Срок оценки: baseline (24-72 hours pre-discharge); 8-, 16-, and 24-weeks post-discharge]
• Change in patient and caregiver depressive symptoms [PHQ-9 (Patient Health Questionnaire-9)] [Срок оценки: baseline (24-72 hours pre-discharge); 8-, 16-, and 24-weeks post-discharge]
• Change in patient and caregiver Self-Efficacy for Management of Chronic Conditions Scale [Срок оценки: baseline (24-72 hours pre-discharge); 8-, 16-, and 24-weeks post-discharge]
• Change in patient and caregiver alcohol and substance abuse (CAGE-AID Substance Abuse Screening Tool) [Срок оценки: baseline (24-72 hours pre-discharge); 8-, 16-, and 24-weeks post-discharge]