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Clinical and cost effectiveness of memory rehabilitation following traumatic brain injury: a pragmatic cluster randomized controlled trial

Roshan das Nair, Lucy E Bradshaw, Florence EC Day, Avril Drummond, Shaun Robert Sorrell Harris Orcid Logo, Deborah Fitzsimmons Orcid Logo, Alan A Montgomery, Gavin Newby, Catherine Sackley, Nadina B Lincoln

Clinical Rehabilitation, Volume: 33, Issue: 7, Pages: 1171 - 1184

Swansea University Authors: Shaun Robert Sorrell Harris Orcid Logo, Deborah Fitzsimmons Orcid Logo

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DOI (Published version): 10.1177/0269215519840069

Abstract

OBJECTIVE:To evaluate the clinical and cost effectiveness of a group-based memory rehabilitation programme for people with traumatic brain injury.DESIGN:Multicentre, pragmatic, observer-blinded, randomized controlled trial in England.SETTING:Community.PARTICIPANTS:People with memory problems followi...

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Published in: Clinical Rehabilitation
ISSN: 0269-2155 1477-0873
Published: SAGE Publications 2019
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URI: https://cronfa.swan.ac.uk/Record/cronfa50077
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Secondary outcomes were assessed at 6 and 12&#x2009;months post randomization.RESULTS:We randomized 328 participants. There were no clinically important differences in the primary outcome between arms at six-month follow-up (mean EMQ-p score: 38.8 (SD 26.1) in intervention and 44.1 (SD 24.6) in control arms, adjusted difference in means: -2.1, 95% confidence interval (CI): -6.7 to 2.5, p&#x2009;=&#x2009;0.37) or 12-month follow-up. Objectively assessed memory ability favoured the memory rehabilitation arm at the 6-month, but not at the 12-month outcome. There were no between-arm differences in mood, experience of brain injury, or relative/friend assessment of patient's everyday memory outcomes, but goal attainment scores favoured the memory rehabilitation arm at both outcome time points. Health economic analyses suggested that the intervention was unlikely to be cost effective. No safety concerns were raised.CONCLUSION:This memory rehabilitation programme did not lead to reduced forgetting in daily life for a heterogeneous sample of people with traumatic brain injury. 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spelling 2021-01-07T17:00:06.3140756 v2 50077 2019-04-24 Clinical and cost effectiveness of memory rehabilitation following traumatic brain injury: a pragmatic cluster randomized controlled trial 457cd214bb252dcba9530ace43ae743d NULL Shaun Robert Sorrell Harris Shaun Robert Sorrell Harris true true e900d99a0977beccf607233b10c66b43 0000-0002-7286-8410 Deborah Fitzsimmons Deborah Fitzsimmons true false 2019-04-24 OBJECTIVE:To evaluate the clinical and cost effectiveness of a group-based memory rehabilitation programme for people with traumatic brain injury.DESIGN:Multicentre, pragmatic, observer-blinded, randomized controlled trial in England.SETTING:Community.PARTICIPANTS:People with memory problems following traumatic brain injury, aged 18-69 years, able to travel to group sessions, communicate in English, and give consent.INTERVENTIONS:A total of 10 weekly group sessions of manualized memory rehabilitation plus usual care (intervention) vs. usual care alone (control).MAIN MEASURES:The primary outcome was the patient-reported Everyday Memory Questionnaire (EMQ-p) at six months post randomization. Secondary outcomes were assessed at 6 and 12 months post randomization.RESULTS:We randomized 328 participants. There were no clinically important differences in the primary outcome between arms at six-month follow-up (mean EMQ-p score: 38.8 (SD 26.1) in intervention and 44.1 (SD 24.6) in control arms, adjusted difference in means: -2.1, 95% confidence interval (CI): -6.7 to 2.5, p = 0.37) or 12-month follow-up. Objectively assessed memory ability favoured the memory rehabilitation arm at the 6-month, but not at the 12-month outcome. There were no between-arm differences in mood, experience of brain injury, or relative/friend assessment of patient's everyday memory outcomes, but goal attainment scores favoured the memory rehabilitation arm at both outcome time points. Health economic analyses suggested that the intervention was unlikely to be cost effective. No safety concerns were raised.CONCLUSION:This memory rehabilitation programme did not lead to reduced forgetting in daily life for a heterogeneous sample of people with traumatic brain injury. Further research will need to examine who benefits most from such interventions. Journal Article Clinical Rehabilitation 33 7 1171 1184 SAGE Publications 0269-2155 1477-0873 Traumatic brain injury; memory rehabilitation; randomized controlled trial 1 7 2019 2019-07-01 10.1177/0269215519840069 COLLEGE NANME School of Management COLLEGE CODE Swansea University 2021-01-07T17:00:06.3140756 2019-04-24T12:09:28.4825887 Faculty of Medicine, Health and Life Sciences School of Health and Social Care Roshan das Nair 1 Lucy E Bradshaw 2 Florence EC Day 3 Avril Drummond 4 Shaun Robert Sorrell Harris NULL 5 Deborah Fitzsimmons 0000-0002-7286-8410 6 Alan A Montgomery 7 Gavin Newby 8 Catherine Sackley 9 Nadina B Lincoln 10 0050077-03052019145720.pdf 50077.pdf 2019-05-03T14:57:20.5270000 Output 409691 application/pdf Version of Record true Released under the terms of a Creative Commons Attribution-NonCommercial 4.0 License (CC-BY-NC). true eng http://www.creativecommons.org/licenses/by-nc/4.0/
title Clinical and cost effectiveness of memory rehabilitation following traumatic brain injury: a pragmatic cluster randomized controlled trial
spellingShingle Clinical and cost effectiveness of memory rehabilitation following traumatic brain injury: a pragmatic cluster randomized controlled trial
Shaun Robert Sorrell Harris
Deborah Fitzsimmons
title_short Clinical and cost effectiveness of memory rehabilitation following traumatic brain injury: a pragmatic cluster randomized controlled trial
title_full Clinical and cost effectiveness of memory rehabilitation following traumatic brain injury: a pragmatic cluster randomized controlled trial
title_fullStr Clinical and cost effectiveness of memory rehabilitation following traumatic brain injury: a pragmatic cluster randomized controlled trial
title_full_unstemmed Clinical and cost effectiveness of memory rehabilitation following traumatic brain injury: a pragmatic cluster randomized controlled trial
title_sort Clinical and cost effectiveness of memory rehabilitation following traumatic brain injury: a pragmatic cluster randomized controlled trial
author_id_str_mv 457cd214bb252dcba9530ace43ae743d
e900d99a0977beccf607233b10c66b43
author_id_fullname_str_mv 457cd214bb252dcba9530ace43ae743d_***_Shaun Robert Sorrell Harris
e900d99a0977beccf607233b10c66b43_***_Deborah Fitzsimmons
author Shaun Robert Sorrell Harris
Deborah Fitzsimmons
author2 Roshan das Nair
Lucy E Bradshaw
Florence EC Day
Avril Drummond
Shaun Robert Sorrell Harris
Deborah Fitzsimmons
Alan A Montgomery
Gavin Newby
Catherine Sackley
Nadina B Lincoln
format Journal article
container_title Clinical Rehabilitation
container_volume 33
container_issue 7
container_start_page 1171
publishDate 2019
institution Swansea University
issn 0269-2155
1477-0873
doi_str_mv 10.1177/0269215519840069
publisher SAGE Publications
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str School of Health and Social Care{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}School of Health and Social Care
document_store_str 1
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description OBJECTIVE:To evaluate the clinical and cost effectiveness of a group-based memory rehabilitation programme for people with traumatic brain injury.DESIGN:Multicentre, pragmatic, observer-blinded, randomized controlled trial in England.SETTING:Community.PARTICIPANTS:People with memory problems following traumatic brain injury, aged 18-69 years, able to travel to group sessions, communicate in English, and give consent.INTERVENTIONS:A total of 10 weekly group sessions of manualized memory rehabilitation plus usual care (intervention) vs. usual care alone (control).MAIN MEASURES:The primary outcome was the patient-reported Everyday Memory Questionnaire (EMQ-p) at six months post randomization. Secondary outcomes were assessed at 6 and 12 months post randomization.RESULTS:We randomized 328 participants. There were no clinically important differences in the primary outcome between arms at six-month follow-up (mean EMQ-p score: 38.8 (SD 26.1) in intervention and 44.1 (SD 24.6) in control arms, adjusted difference in means: -2.1, 95% confidence interval (CI): -6.7 to 2.5, p = 0.37) or 12-month follow-up. Objectively assessed memory ability favoured the memory rehabilitation arm at the 6-month, but not at the 12-month outcome. There were no between-arm differences in mood, experience of brain injury, or relative/friend assessment of patient's everyday memory outcomes, but goal attainment scores favoured the memory rehabilitation arm at both outcome time points. Health economic analyses suggested that the intervention was unlikely to be cost effective. No safety concerns were raised.CONCLUSION:This memory rehabilitation programme did not lead to reduced forgetting in daily life for a heterogeneous sample of people with traumatic brain injury. Further research will need to examine who benefits most from such interventions.
published_date 2019-07-01T04:01:23Z
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