Clinical trial NCT04723745: Translational Research Center for TBI and Stress Disorders: Virtual Assessment of Deployment Trauma and Rehabilitation
Official title: Translational Research Center for TBI and Stress Disorders: Virtual Assessment of Deployment Trauma and Rehabilitation
Study type: OBSERVATIONAL
Overall status: UNKNOWN
Conditions: TBI (Traumatic Brain Injury)
PTSD
Keywords: TBI
PTSD/Stress Disorders
Iraq
Afghanistan
Lead sponsor: VA Boston Healthcare System
Sponsor class: FED
First posted: 2021-01-26
Enrollment: 100
Sex: ALL
Minimum age (years): 18
Maximum age (years): 70
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: PROBABILITY_SAMPLE
Study population: Participants will be post-9/11 Veterans. Critically, formal diagnosis of TBI or PTSD (or any other cognitive/psychiatric condition) is not required. While inclusion criteria do not require any specific diagnosis, we note that TRACTS and STEP-Home Veterans in our previous studies had high rates of both PTSD and mTBI .

Brief summary: For this clinical demonstration study, Veterans will be assessed with a battery of questionnaires/surveys and a 1:1 clinical interview with a V-TRACTS psychologist to target domains of head injury, psychological trauma, depression, suicidality, anxiety, chronic pain and sleep, substance use and activity level. V-TRACTS will convene a weekly consensus meeting to evaluate all the data, and develop a recommendation plan. After the consensus meeting, a V-TRACTS psychologist will provide comprehensive feedback encompassing the entire assessment battery. Additionally, if warranted, the investigators will offer an optional cognitive assessment, as well as rehabilitation options that the consensus committee targets the individual Veteran's needs and also via VA telehealth or other approved online service. It will be the Veteran's choice whether he/she wants to participate in any one or more of these options.

Detailed description: V-TRACTS plans to assess up to 110 post-9/11 Veterans. This clinical demonstration project may be conducted primarily (1) using a VA telehealth or online delivery system to meet the needs of remote Veterans or those who are unable to attend sessions on campus, as well as to maximize access to care during COVID-19 and thereafter or (2) in person at VA, when possible and preferable to the Veteran. The investigators will use a multidimensional but condensed version of the comprehensive TRACTS Core B (VABHS IRB #2354) evaluation. This condensed and efficient assessment will be used to develop a standard quantitative analytic to characterize each Veteran's risk for poor functional outcome and to determine his/her rehabilitation needs. For the intervention, the investigators propose to offer various telehealth assessment and treatment options to each Veteran assessed or to refer on to VA clinical service, as appropriate. There are three research-based treatments and an additional brief cognitive assessment included in this protocol that may be offered at the feedback appointment. First, is a Brief Assessment of Thinking, which is a neuropsychological/cognitive assessment that will be conducted to gather information about functioning in the areas of memory, attention, and thinking, if appropriate. Second, is STEP-Home-Brief, which is an innovative, integrated, transdiagnostic rehabilitation workshop that targets each individual Veteran's area(s) of weakness identified by the assessment, if appropriate. STEP-Home-Brief provides a patient-centered, transdiagnostic treatment approach and can be delivered via telehealth or in-person. STEP-Home-Brief also provides an introduction to a destigmatized "mental health" intervention that has been demonstrated to act as a gateway to further VA treatment engagement. Third, is an At-Home Exercise program, if appropriate, which will provide Veterans with an at-home, 5-week program targeting cardiovascular health and endurance. Fourth, the investigators may offer referrals to the experimental 12-week STEP-Home workshop (VABHS IRB #3210). Fifth, the investigators may offer referrals to clinical programs, as appropriate. These referrals include but are not limited to Polytrauma, Center for Returning Veterans, Whole Health, PTSD, Mental Health, Vocational Rehabilitation, and Neurology. The decision as to which type of treatment would best meet the needs of individual Veterans will be informed by a consensus of the V-TRACTS clinical team. It will be the Veteran's choice whether he/she wants to participate in any one or more of the cognitive assessment or rehabilitation options. These options are available sequentially or concurrently.

Eligibility criteria: Inclusion Criteria:

* Participants will be post-9/11 Veterans. Critically, formal diagnosis of TBI or PTSD (or any other cognitive/psychiatric condition) is not required. While inclusion criteria do not require any specific diagnosis, we note that TRACTS and STEP-Home Veterans in our previous studies had high rates of both PTSD and mTBI.
* 18-70 years old
* English-speaking (sessions will be conducted in English)
* Agreeing to participate either remotely or in person (i.e., completion of ICF/HIPAA)

Exclusion Criteria:

* Schizophreniform disorder/active psychosis
* Active suicidality
* Neurological diagnosis (excluding TBI)

Primary outcomes:
measure: Feasibility of a virtual deployment trauma assessment and feedback in post-9/11 Veterans: Willingness to Enroll
timeFrame: Through study completion, 4-6 weeks from initial meeting
measure: Feasibility of a virtual deployment trauma assessment and feedback in post-9/11 Veterans: Actual Enrollment
timeFrame: Through study completion, 4-6 weeks from initial meeting
measure: Feasibility of a virtual deployment trauma assessment and feedback in post-9/11 Veterans: Interest in Workshop Goals
timeFrame: Through study completion, 4-6 weeks from initial meeting
measure: Acceptability of a virtual deployment trauma assessment and feedback in post-9/11 Veterans
timeFrame: Through study completion, 4-6 weeks from initial meeting
Secondary outcomes:
measure: Quality of Life Scale (QOLS)
timeFrame: Through study completion, 4-6 weeks from initial meeting
measure: WHODAS-Brief
timeFrame: Through study completion, 4-6 weeks from initial meeting
Other outcomes:
Locations:
city: Boston
country: United States
facility: VA Boston Healthcare System
state: Massachusetts
Study officials:
affiliation: VA Boston Healthcare System
name: Regina McGlinchey, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Hoge CW, McGurk D, Thomas JL, Cox AL, Engel CC, Castro CA. Mild traumatic brain injury in U.S. Soldiers returning from Iraq. N Engl J Med. 2008 Jan 31;358(5):453-63. doi: 10.1056/NEJMoa072972. Epub 2008 Jan 30.
citation: McGlinchey RE, Milberg WP, Fonda JR, Fortier CB. A methodology for assessing deployment trauma and its consequences in OEF/OIF/OND veterans: The TRACTS longitudinal prospective cohort study. Int J Methods Psychiatr Res. 2017 Sep;26(3):e1556. doi: 10.1002/mpr.1556. Epub 2017 Feb 17.
citation: Evans DL, Charney DS, Lewis L, Golden RN, Gorman JM, Krishnan KR, Nemeroff CB, Bremner JD, Carney RM, Coyne JC, Delong MR, Frasure-Smith N, Glassman AH, Gold PW, Grant I, Gwyther L, Ironson G, Johnson RL, Kanner AM, Katon WJ, Kaufmann PG, Keefe FJ, Ketter T, Laughren TP, Leserman J, Lyketsos CG, McDonald WM, McEwen BS, Miller AH, Musselman D, O'Connor C, Petitto JM, Pollock BG, Robinson RG, Roose SP, Rowland J, Sheline Y, Sheps DS, Simon G, Spiegel D, Stunkard A, Sunderland T, Tibbits P Jr, Valvo WJ. Mood disorders in the medically ill: scientific review and recommendations. Biol Psychiatry. 2005 Aug 1;58(3):175-89. doi: 10.1016/j.biopsych.2005.05.001.
citation: Sayer NA, Orazem RJ, Noorbaloochi S, Gravely A, Frazier P, Carlson KF, Schnurr PP, Oleson H. Iraq and Afghanistan War Veterans with Reintegration Problems: Differences by Veterans Affairs Healthcare User Status. Adm Policy Ment Health. 2015 Jul;42(4):493-503. doi: 10.1007/s10488-014-0564-2.
citation: Hoge CW, Castro CA, Messer SC, McGurk D, Cotting DI, Koffman RL. Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. N Engl J Med. 2004 Jul 1;351(1):13-22. doi: 10.1056/NEJMoa040603.
citation: Fortier CB, Kenna A, Dams-O'Connor K, Fonda J, Levin LK, Hursh C, Franz H, Milberg WP, McGlinchey RE. Feasibility of a Skills-Based Group Reintegration Workshop for OEF/OIF Veterans: STEP-Home. J Head Trauma Rehabil. 2018 Jul/Aug;33(4):E17-E23. doi: 10.1097/HTR.0000000000000362.
citation: Goetter EM, Bui E, Ojserkis RA, Zakarian RJ, Brendel RW, Simon NM. A Systematic Review of Dropout From Psychotherapy for Posttraumatic Stress Disorder Among Iraq and Afghanistan Combat Veterans. J Trauma Stress. 2015 Oct;28(5):401-9. doi: 10.1002/jts.22038. Epub 2015 Sep 16.
citation: Fortier CB, Amick MM, Grande L, McGlynn S, Kenna A, Morra L, Clark A, Milberg WP, McGlinchey RE. The Boston Assessment of Traumatic Brain Injury-Lifetime (BAT-L) semistructured interview: evidence of research utility and validity. J Head Trauma Rehabil. 2014 Jan-Feb;29(1):89-98. doi: 10.1097/HTR.0b013e3182865859.
citation: Fortier CB, Amick MM, Kenna A, Milberg WP, McGlinchey RE. Correspondence of the Boston Assessment of Traumatic Brain Injury-Lifetime (BAT-L) clinical interview and the VA TBI screen. J Head Trauma Rehabil. 2015 Jan-Feb;30(1):E1-7. doi: 10.1097/HTR.0000000000000008.
citation: Soble JR, Silva MA, Vanderploeg RD, Curtiss G, Belanger HG, Donnell AJ, Scott SG. Normative Data for the Neurobehavioral Symptom Inventory (NSI) and post-concussion symptom profiles among TBI, PTSD, and nonclinical samples. Clin Neuropsychol. 2014;28(4):614-32. doi: 10.1080/13854046.2014.894576. Epub 2014 Mar 14.
citation: Yardley L, Masson E, Verschuur C, Haacke N, Luxon L. Symptoms, anxiety and handicap in dizzy patients: development of the vertigo symptom scale. J Psychosom Res. 1992 Dec;36(8):731-41. doi: 10.1016/0022-3999(92)90131-k.
citation: Newman CW, Jacobson GP, Spitzer JB. Development of the Tinnitus Handicap Inventory. Arch Otolaryngol Head Neck Surg. 1996 Feb;122(2):143-8. doi: 10.1001/archotol.1996.01890140029007.
citation: Weathers, F.W., Blake, D.D., Schnurr, P.P., Kaloupek, D.G., Marx, B.P., & Keane, T.M. (2013). The Life Events Checklist for DSM-5 (LEC-5). Instrument available from the National Center for PTSD at www.ptsd.va.gov
citation: Weathers FW, Bovin MJ, Lee DJ, Sloan DM, Schnurr PP, Kaloupek DG, Keane TM, Marx BP. The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5): Development and initial psychometric evaluation in military veterans. Psychol Assess. 2018 Mar;30(3):383-395. doi: 10.1037/pas0000486. Epub 2017 May 11.
citation: Beck, A.T., R.A. Steer, and G.T. Brown, Beck Depression Inventory-II. 1996.
citation: Beck, A.T., and R.A. Steer, Beck Anxiety Inventory Manual. 1993.
citation: Beck, A.T., and R.A. Steer, Beck Scale for Suicide Ideation (BSS). 1993.
citation: Melzack R. The short-form McGill Pain Questionnaire. Pain. 1987 Aug;30(2):191-197. doi: 10.1016/0304-3959(87)91074-8.
citation: Buysse DJ, Reynolds CF 3rd, Monk TH, Hoch CC, Yeager AL, Kupfer DJ. Quantification of subjective sleep quality in healthy elderly men and women using the Pittsburgh Sleep Quality Index (PSQI). Sleep. 1991 Aug;14(4):331-8.
citation: WHO ASSIST Working Group. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): development, reliability and feasibility. Addiction. 2002 Sep;97(9):1183-94. doi: 10.1046/j.1360-0443.2002.00185.x.
citation: Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption--II. Addiction. 1993 Jun;88(6):791-804. doi: 10.1111/j.1360-0443.1993.tb02093.x.
citation: Malloy P, Tremont G, Grace J, Frakey L. The Frontal Systems Behavior Scale discriminates frontotemporal dementia from Alzheimer's disease. Alzheimers Dement. 2007 Jul;3(3):200-3. doi: 10.1016/j.jalz.2007.04.374.
citation: Üstün T.B., et al., Measuring Health and Disability: Manual for WHO Disability Assessment Schedule (WHODAS 2.0) Malta: World Health Organization; 2010.
citation: Craig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, Oja P. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003 Aug;35(8):1381-95. doi: 10.1249/01.MSS.0000078924.61453.FB.
citation: Esterman M, Noonan SK, Rosenberg M, Degutis J. In the zone or zoning out? Tracking behavioral and neural fluctuations during sustained attention. Cereb Cortex. 2013 Nov;23(11):2712-23. doi: 10.1093/cercor/bhs261. Epub 2012 Aug 31.
citation: Esterman M, Poole V, Liu G, DeGutis J. Modulating Reward Induces Differential Neurocognitive Approaches to Sustained Attention. Cereb Cortex. 2017 Aug 1;27(8):4022-4032. doi: 10.1093/cercor/bhw214.
citation: D'Zurilla TJ, Goldfried MR. Problem solving and behavior modification. J Abnorm Psychol. 1971 Aug;78(1):107-26. doi: 10.1037/h0031360. No abstract available.
citation: von Cramon, D.Y., Matthes-von Cramon, G., & Mai, N., Problem solving deficits in brain-injured patients: a therapeutic approach. Neuropsychological Rehabilitation, 1991. 1: p. 45-64.
citation: D'Zurilla, T.J., Problem-solving therapies, in Handbook of Cognitive Behavioral Therapies, K. Dobson, Editor. 1988, The Guilford Press: New York, NY.
citation: D'Zurilla, T.J.N., A. M., Problem-solving therapies, in Handbook of Cognitive-Behavioral Therapies, K.S. Dobson, Editor. 2001, Guilford Press: New York, NY. p. 211-245.
citation: Rath, J.F., et al., Group treatment of problem-solving deficits in outpatients with traumatic brain injury: a randomised outcome study. Neuropsychological Rehabilitation, 2003. 13(4): p. 461-488.
citation: Gordon, W.A., Methodological considerations in cognitive remediation, in Neuropsychological Rehabilitation, M. Meier, Diller, L., Benton, A., Editor. 1987, Churchill Livingston: London. p. 111-131.
citation: Sohlberg, M.M., et al., APT-II: Attention Processing Training. A program to address attentional deficits for persons with mild cognitive dysfunction. 2001, Wake Forest, NC: Lash & Associates Publishing/Training Inc.
citation: Sohlberg MM, Mateer CA. Effectiveness of an attention-training program. J Clin Exp Neuropsychol. 1987 Apr;9(2):117-30. doi: 10.1080/01688638708405352.
citation: Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, Nieman DC, Swain DP; American College of Sports Medicine. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011 Jul;43(7):1334-59. doi: 10.1249/MSS.0b013e318213fefb.
citation: van Middelkoop M, Rubinstein SM, Verhagen AP, Ostelo RW, Koes BW, van Tulder MW. Exercise therapy for chronic nonspecific low-back pain. Best Pract Res Clin Rheumatol. 2010 Apr;24(2):193-204. doi: 10.1016/j.berh.2010.01.002.
citation: Gordon BR, McDowell CP, Hallgren M, Meyer JD, Lyons M, Herring MP. Association of Efficacy of Resistance Exercise Training With Depressive Symptoms: Meta-analysis and Meta-regression Analysis of Randomized Clinical Trials. JAMA Psychiatry. 2018 Jun 1;75(6):566-576. doi: 10.1001/jamapsychiatry.2018.0572.
citation: Gordon BR, McDowell CP, Lyons M, Herring MP. The Effects of Resistance Exercise Training on Anxiety: A Meta-Analysis and Meta-Regression Analysis of Randomized Controlled Trials. Sports Med. 2017 Dec;47(12):2521-2532. doi: 10.1007/s40279-017-0769-0.
citation: Whitworth JW, Nosrat S, SantaBarbara NJ, Ciccolo JT. Feasibility of Resistance Exercise for Posttraumatic Stress and Anxiety Symptoms: A Randomized Controlled Pilot Study. J Trauma Stress. 2019 Dec;32(6):977-984. doi: 10.1002/jts.22464. Epub 2019 Nov 19.
citation: Whitworth, J. W., Nosrat, S., SantaBarbara, N. J., & Ciccolo, J. T. (2019). High intensity resistance training improves sleep quality and anxiety in individuals who screen positive for posttraumatic stress disorder: A randomized controlled feasibility trial. Mental Health and Physical Activity, 16, 43-49. https://doi.org/10.1016/j.mhpa.2019.04.001
citation: Chwastiak LA, Rosenheck RA, Kazis LE. Association of psychiatric illness and obesity, physical inactivity, and smoking among a national sample of veterans. Psychosomatics. 2011 May-Jun;52(3):230-6. doi: 10.1016/j.psym.2010.12.009.
citation: Chen P, Mao L, Nassis GP, Harmer P, Ainsworth BE, Li F. Coronavirus disease (COVID-19): The need to maintain regular physical activity while taking precautions. J Sport Health Sci. 2020 Mar;9(2):103-104. doi: 10.1016/j.jshs.2020.02.001. Epub 2020 Feb 4. No abstract available.
citation: Vaara JP, Kyrolainen H, Niemi J, Ohrankammen O, Hakkinen A, Kocay S, Hakkinen K. Associations of maximal strength and muscular endurance test scores with cardiorespiratory fitness and body composition. J Strength Cond Res. 2012 Aug;26(8):2078-86. doi: 10.1519/JSC.0b013e31823b06ff.
citation: Wechsler, D., Wechsler test of adult reading. Psychological Corporation: San Antonio, TX, 2001.
citation: Strauss, E.; Sherman, E.; Spreen, O., A compendium of neuropsychological tests. 3rd ed.; Oxford: New York, 2006.
citation: Corporation, T.P. Wechsler test of adult reading. Assessment 2001.
citation: Wechsler, D., Manual for the wechsler adult intelligence scale-iii. Psychological Corporation: San Antonio, TX, 1997.
citation: Ricker JH, Axelrod BN. Analysis of an Oral Paradigm for the Trail Making Test. Assessment. 1994 Mar;1(1):47-52. doi: 10.1177/1073191194001001007.
citation: Abraham E., Axelrod B., Ricker J. (1996). Application of the oral trail making test to a mixed clinical sample. Archives of Clinical Neuropsychology, 11, 697-701.
citation: Mrazik M, Millis S, Drane DL. The oral trail making test: effects of age and concurrent validity. Arch Clin Neuropsychol. 2010 May;25(3):236-43. doi: 10.1093/arclin/acq006. Epub 2010 Mar 2.
citation: Bohnen N, Twijnstra A, Jolles J. Performance in the Stroop color word test in relationship to the persistence of symptoms following mild head injury. Acta Neurol Scand. 1992 Feb;85(2):116-21. doi: 10.1111/j.1600-0404.1992.tb04009.x.
citation: Delis, D.; Kaplan, E.; Kramer, G.L., D-kefs examiner's and technical manual. Pearson Education: San Antonio, Texas, 2001.
citation: Basso MR, Bornstein RA, Lang JM. Practice effects on commonly used measures of executive function across twelve months. Clin Neuropsychol. 1999 Aug;13(3):283-92. doi: 10.1076/clin.13.3.283.1743.
citation: Moore BA, Donders J. Predictors of invalid neuropsychological test performance after traumatic brain injury. Brain Inj. 2004 Oct;18(10):975-84. doi: 10.1080/02699050410001672350.
citation: Delis, D.C.; Kramer, J.; Kaplan, E.; Ober, B., California verbal learning test-second edition. The Psychological Corporation: San Antonio, TX, 2000.
citation: DeJong J, Donders J. A confirmatory factor analysis of the California Verbal Learning Test--Second Edition (CVLT-II) in a traumatic brain injury sample. Assessment. 2009 Dec;16(4):328-36. doi: 10.1177/1073191109336989. Epub 2009 Jun 22.
citation: Woods SP, Delis DC, Scott JC, Kramer JH, Holdnack JA. The California Verbal Learning Test--second edition: test-retest reliability, practice effects, and reliable change indices for the standard and alternate forms. Arch Clin Neuropsychol. 2006 Aug;21(5):413-20. doi: 10.1016/j.acn.2006.06.002. Epub 2006 Jul 14.
citation: Haff, G., & Triplett, N. T. (2016). Essentials of strength training and conditioning. Fourth edition. Champaign, IL: Human Kinetics.
citation: Burckhardt CS, Woods SL, Schultz AA, Ziebarth DM. Quality of life of adults with chronic illness: a psychometric study. Res Nurs Health. 1989 Dec;12(6):347-54. doi: 10.1002/nur.4770120604.
citation: Flanagan JC (1978). A research approach to improving our quality of life. American Psychologist, 33, 138-147.
citation: Ottenbreit ND, Dobson KS. Avoidance and depression: the construction of the cognitive-behavioral avoidance scale. Behav Res Ther. 2004 Mar;42(3):293-313. doi: 10.1016/S0005-7967(03)00140-2.
citation: Evans TC, Britton JC. Social avoidance behaviour modulates automatic avoidance actions to social reward-threat conflict. Cogn Emot. 2020 Dec;34(8):1711-1720. doi: 10.1080/02699931.2020.1787353. Epub 2020 Jul 7.