Randomised controlled clinical trial of a structured cognitive rehabilitation in patients with attention deficit following mild traumatic brain injury: study protocol

BMJ Open. 2019 Sep 18;9(9):e028711. doi: 10.1136/bmjopen-2018-028711.

Abstract

Objectives: To measure the clinical, structural and functional changes of an individualised structured cognitive rehabilitation in mild traumatic brain injury (mTBI) population.

Setting: A single centre study, Malaysia.

Participants: Adults aged between 18 and 60 years with mTBI as a result of road traffic accident, with no previous history of head trauma, minimum of 9 years education and abnormal cognition at 3 months will be included. The exclusion criteria include pre-existing chronic illness or neurological/psychiatric condition, long-term medication that affects cognitive/psychological status, clinical evidence of substance intoxication at the time of injury and major polytrauma. Based on multiple estimated calculations, the minimum intended sample size is 50 participants (Cohen's d effect size=0.35; alpha level of 0.05; 85% power to detect statistical significance; 40% attrition rate).

Interventions: Intervention group will receive individualised structured cognitive rehabilitation. Control group will receive the best patient-centred care for attention disorders. Therapy frequency for both groups will be 1 hour per week for 12 weeks.

Outcome measures: Primary: Neuropsychological Assessment Battery-Screening Module (S-NAB) scores. Secondary: Diffusion Tensor Imaging (DTI) parameters and Goal Attainment Scaling score (GAS).

Results: Results will include descriptive statistics of population demographics, CogniPlus cognitive program and metacognitive strategies. The effect of intervention will be the effect size of S-NAB scores and mean GAS T scores. DTI parameters will be compared between groups via repeated measure analysis. Correlation analysis of outcome measures will be calculated using Pearson's correlation coefficient.

Conclusion: This is a complex clinical intervention with multiple outcome measures to provide a comprehensive evidence-based treatment model.

Ethics and dissemination: The study protocol was approved by the Medical Research Ethics Committee UMMC (MREC ID NO: 2016928-4293). The findings of the trial will be disseminated through peer-reviewed journals and scientific conferences.

Trial registration number: NCT03237676.

Keywords: Diffusion Tensor Imaging; cognitive rehabilitation; mild traumatic brain injury; neuropsychology; randomised controlled trial.

Publication types

  • Clinical Trial Protocol
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Accidental Injuries / complications*
  • Attention Deficit Disorder with Hyperactivity / diagnosis
  • Attention Deficit Disorder with Hyperactivity / rehabilitation*
  • Brain Concussion / diagnosis
  • Brain Concussion / rehabilitation*
  • Cognition
  • Cognitive Behavioral Therapy / instrumentation*
  • Diffusion Tensor Imaging
  • Humans
  • Malaysia
  • Neuropsychological Tests
  • Randomized Controlled Trials as Topic
  • Recovery of Function
  • Surveys and Questionnaires

Associated data

  • ClinicalTrials.gov/NCT03237676