0. Feasibility of two fatigue management interventions for people with TBI
Bhattacharjee R1, Theadom A1, Barker-Collo S2, McPherson, K3, Kayes N3, Mudge S3, Kersten P3, Feigin, V1
1National Institute of Stroke and Applied Neuroscience, AUT University 2University of Auckland 3Person Centred Research Centre, AUT University
Participant feedback
Background
CBT:
Aimed to improve fatigue through increasing understanding of fatigue, identifying personal triggers, and developing strategies such as self-monitoring, pacing, relaxation techniques, and modifying thoughts.
Activity Coaching:
Aimed to improve fatigue through increasing physical activity using an activity coaching approach which drew from key principles from Health Coaching Australia2. Participants identified a physical activity goal and worked with the therapists to develop a plan to increase their physical activity.
Fatigue is a common problem affecting up to 70% of people after Traumatic Brain Injury (TBI),1 yet current treatment of fatigue is highly variable.
This study trialled two types of fatigue management interventions with the potential to improve fatigue post-TBI.
Both interventions were well received by participants. When interviewed, all participants reported improved outcomes as a result of their participation. Some of the responses included:
“…it helped me to realise that I was capable of doing more than I thought I could.” - participant a.
“…it got me back on track with how to improve…I’ve learnt how to manage situations that could cause fatigue.” – participant c.
“ It enabled me to get back to something that’s been an important part of my life.” – participant d (about being able to return to sport)
Findings/Outcomes
Aims
Recruitment:
Recruitment was challenging:
- Only 34% (47/136) of eligible participants identified by service providers were contactable. Of these 46 declined for various reasons (see Figure 1).
- Additional participants were either self-referred or had taken part in previous research within our team.
Determine the feasibility of recruitment procedures
Explore the feasibility of programme delivery for people post mild-TBI
Evaluate the acceptability of the intervention components and materials
Discussion
The positive feedback suggests that the content of the trialled interventions were acceptable and useful for those with mild-TBI
The significant difficulties with recruitment indicate that group based initiatives might not be feasible for this population due to external factors such as work and family commitments
Availability of individual interventions increased uptake, although increased the cost of implementation
Other modes of delivery, such as web-delivery, deserve consideration for this population
Methods
Recruitment:
Participants were recruited through service providers, media advertisements, and from a pool of previous research participants who had consented to be contacted for other projects in the Auckland region
Assessments:
Participants were assessed at baseline and post- intervention (6 weeks)
Participants were informally interviewed about their experience of the interventions
Interventions:
Participants received either cognitive behavioural therapy (CBT) or an activity coaching intervention (delivered in an individual or group format) for 6 weeks
Outcomes:
Nine participants participated in the study, two participants withdrew before the start of their intervention (one gained employment and one had a death in the family). Follow up data was collected for 7 participants (78%). The changes in outcomes for the participants are shown below (lower scores indicate better outcomes):
Table 1: Fatigue Severity Scale
Participant
Baseline
6 wk
Change a
6.44
5.67
-0.77 b 7
5.89
-1.11 c
6.89
4.78
-2.11 d
5.33 4
-1.33 e
5.56
-0.11 f
4.56
4.89
0.33 g 5
-0.56
Table 2: CIS-Q* total
Participant
Baseline
6 wk
Change a
101 81
-20 b
116 86
-30 c
-15 d
106 59
-47 e 98 82
-16 f 60 46
-14 g 88 94 6
References
1.Olver, J., Ponsford, J., & Curan, C. (1996). Outcome following traumatic brain injury: a comparison between 2 and 5 years after injury. Brain Injury, 10,
2. Gale, J. (2012). A Practical Guide to Health Behaviour Change Using the HCA Approach. Retrieved Sep 05, 2012, from
* - Checklist of Individual Strength Questionnaire
Group-Physical Activity
Individual- Education
Individual- Physical Activity