Effectiveness of a Behavioral Intervention to Help Individuals Manage Posttraumatic Brain Injury Fatigue

SIGNIFICANCE: The proposed project focuses on an important and pervasive problem: chronic pathological fatigue after traumatic brain injury (TBI). In this study, we address post-TBI fatigue by examining the efficacy of a new intervention designed to reduce the impact of post-TBI fatigue on everyday activities. Chronic pathological fatigue remains one of the most common and distressing symptoms following TBI. Post-TBI fatigue is associated with problems in emotional, social, physical, and cognitive functioning; reduced participation in everyday life; and work disability. Thus, post-TBI fatigue hinders individuals’ reintegration into the community.

INNOVATION: A significant proportion of individuals with TBI (50% to 80%) experience persistent and significant fatigue that affects their daily life. Despite the high prevalence of post-TBI fatigue and its detrimental effects on participation in everyday life, no treatments have been effective in the reduction of post-TBI fatigue. Little data exist on the efficacy of energy conservation education and work simplification strategy training (education) on the management of post-TBI fatigue. The Maximizing Energy (MAX) intervention optimizes and individualizes the occupational therapist delivered education by using the problem-solving-therapy framework to enhance the probability of successful implementation in everyday life situations. This study is among the first to test the preliminary efficacy of education augmented by manualized problem-solving therapy compared to education alone on individuals’ ability to manage post-TBI fatigue. Our objective was to test the efficacy of a novel intervention—MAX—compared to a health education attention control intervention for decreasing the impact of post-TBI fatigue.

METHOD: We used a pilot randomized-controlled, single-blind clinical trial, and the setting took place in the participants’ homes. Thirty-four participants were randomized to experimental (n = 20) and control (n = 14) groups. The mean age of the participants in the experimental and control groups was 47 yr (SD = 15.6) and 50 yr (SD = 13.9), respectively. Most participants in both groups were White males who were 58 mo postinjury. Both groups received two 1:1 sessions per week for 8 wk via web cameras. The modified Fatigue Impact Scale (mFIS) and Patient Reported Outcomes Measurement Information System (PROMIS) Fatigue scale were administered to assess fatigue impact in everyday life at baseline (Time 1 [T1]), intervention completion (Time 2 [T2]), and 4 wk (Time 3 [T3]) and 8 wk (Time 4 [T4]) after intervention completion. We used two 2 (group) × 4 (time) repeated measures analyses of variance (ANOVAs) to obtain mFIS and PROMIS Fatigue scale scores. We conducted post hoc analyses using paired-samples t tests. As is appropriate for pilot studies, the p value was set at <.1.

RESULTS: There were no significant differences between the groups for demographic variables and baseline outcome scores. The Group × Time interaction was significant for mFIS scores (F[2, 32] = 3.9, p < .01) and PROMIS Fatigue scale scores (F[2, 32] = 4.7, p < .01). Post hoc tests revealed a significant difference in mFIS and PROMIS Fatigue scale T2, T3, and T4 scores compared to T1 scores for the experimental group and no differences between the times for the control group.

CONCLUSION: The MAX intervention seems to be a promising self-management intervention to help individuals manage post-TBI fatigue and reduce its impact on everyday life. The MAX intervention also has a sustained effect on fatigue impact up to 12 wk after the intervention.