Randomized controlled trial of an online problem-solving intervention following adolescent traumatic brain injury: Family outcomes

Publication date: Available online 6 February 2019

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Megan E. Narad, Stacey Raj, Keith O. Yeates, H.Gerry Taylor, Michael W. Kirkwood, Terry Stancin, Shari L. Wade

Abstract

Objective

To examine parent/family outcomes of a randomized controlled trial (RCT) comparing Teen Online Problem-Solving with Family (TOPS-F), Teen Online Problem-Solving- Teen Only (TOPS-TO), or access to internet resources alone (IRC).

Design

Three-arm randomized controlled trial.

Setting

Four children's hospitals and one general medical center in Ohio and Colorado.

Participants

152 children/adolescents, 11-18 years old, hospitalized for complicated mild to severe traumatic brain injury (TBI) in the previous 18-months.

Interventions: Intervention groups: TOPS-F, TOPS-TO, and IRC.

Main Outcome Measure

Parental depression (CES-D), parental psychological distress (SCL-90-GSI), family functioning (FAD-GF), cohesiveness (PARQ) and conflict (IBQ) were assessed pre- and post-treatment. Treatment effects and the moderating effect of the number of parents in the home (single vs. two-parent families).

Results

Number of parents moderated treatment effects with effects ranging from trending to statistically significant for depression, family functioning, cohesion, and conflict. Among single parents, TOPS-TO reported better family functioning than TOPS-F, and greater cohesion and less conflict than IRC. Among two-parent families, TOPS-F reported less depression than IRC, and less depression and greater cohesion than TOPS-TO. The effect of family composition was also noted within TOPS-TO and TOPS-F. In TOPS-F, two-parent families reported less depression than single-parent families. In TOPS-TO single parents reported greater cohesion and better family functioning than two-parent families.

Conclusions

Findings support the TOPS intervention to improve family outcomes, with differential effects noted for single vs. two-parent households. The TOPS-TO format appeared more beneficial for single-parent households, while TOPS-F was more beneficial for two-parent households, highlighting the importance of considering family composition when determining the best treatment modality.

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