Acceptance and Commitment Therapy Integrated Vestibular Rehabilitation (ACTIVE) RCT

Nearly 378,000 mTBIs have occurred among U.S. military service members (SM) since 2000. These injuries result in myriad symptoms (e.g., dizziness, headache, fogginess) and impairments (e.g., cognitive, ocular, vestibular) that typically resolve within a month. However, many SMs experience symptoms and impairment lasting months or longer, resulting in limited operational readiness and duty restrictions. As such, one of the challenges related to mTBI and psychological health issues in military SMs is identifying and implementing timely and effective treatments that address these symptoms in an integrated manner and mitigate downstream problems.

Interventions are needed to target comorbid mTBI and psychological health symptoms. Previous research suggests that targeted rehabilitation combined with behavioral management (physical activity, sleep, nutrition, hydration) is effective in improving symptoms and associated functional impairment and reducing recovery time following mTBI. Acceptance and Commitment Therapy (ACT) is a trans-diagnostic cognitive-behavioral therapy based on incorporation of mindfulness and acceptance-based work into traditional behavior therapy. ACT is designed to improve psychological health, functioning, and well-being by improving psychological flexibility or the ability to remain present in the moment despite emotional distress.

There is separate evidence for the effectiveness of targeted rehabilitation combined with behavioral management interventions, and ACT in regard to enhancing recovery from mTBI and PH, respectively. However, researchers have yet to synergize these approaches to evaluate their effectiveness in military SMs following mTBI involving symptom domains in psychological health. Our overarching hypothesis is that a combined, brief (\<4 weeks) intervention involving both ACT and integrated usual care rehabilitation will reduce symptoms, impairment, and functional limitations, and accelerate return to activity among military SMs and civilians following mTBI compared to usual care rehabilitation (CONTROL). The investigators believe that the potential synergy of these combined interventions could provide a more efficient and effective treatment strategy that could mitigate downstream psychological health morbidity in the estimated 60-65% of SMs with impairment following mTBI.

• Ohio State University TBI Identification short form (OSU TBI-ID) [Срок оценки: Baseline]
• Dizziness Handicap Inventory (DHI) [Срок оценки: Baseline, 4-week, 3-month, 6-month study visits]
• Concussion Clinical Profiles Screening (CP-Screen) [Срок оценки: Baseline]
• Vestibular/Ocular Motor Screening (VOMS) - Change from Baseline in Symptom Reporting at 4-weeks [Срок оценки: Baseline, 4-week]
• Vestibular/Ocular Motor Screening (VOMS) - Change from Baseline in Convergence Measurement at 4-Weeks [Срок оценки: Baseline, 4-week]
• Modified Balance Error Scoring System (mBESS) - Change from Baseline in Total Errors at 4-weeks [Срок оценки: Baseline, 4-week]
• Patient Health Questionnaire 9 (PHQ-9) [Срок оценки: Baseline, 4-week, 3-month, 6-month study visits]
• DSM-Cross Cutting Symptom Measure - Adult (DSM-CCSM-A) [Срок оценки: Baseline, 4-week, 3-month, 6-month study visits]
• PTSD Checklist (PCL-5) [Срок оценки: Baseline, 4-week, 3-month, 6-month study visits]
• World Health Organization Disability Assessment Schedule 2 (WHODAS 2.0) [Срок оценки: Baseline, 4-week, 3-month, 6-month study visits]
• Acceptance and Action Questionnaire - Version 2 (AAQ-II) [Срок оценки: Baseline, 4-week, 3-month, 6-month study visits]
• Work and Social Adjustment Scale (WSAS) [Срок оценки: Baseline, 4-week, 3-month, 6-month study visits]