A Randomized Controlled Trial of Assisted Intention Monitoring for the Rehabilitation of Executive Impairments Following Acquired Brain Injury

Fergus Gracey, Jessica Fish, Eve Greenfield, Andrew Bateman, Donna Malley, Gemma Hardy, Jessica Ingham, Jonathan J. Evans, Tom Manly

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    Abstract

    Background: Acquired brain injury (ABI) can impair executive function, impeding planning and attainment of intentions. Research shows promise for some goal-management rehabilitation interventions. However, evidence that alerts assist monitoring and completion of day-to-day intentions is limited. Objective To examine efficacy of brief goal-directed rehabilitation paired with periodic SMS text messages designed to enhance executive monitoring of intentions (Assisted Intention Monitoring, AIM). Methods: A randomized, double-blind, controlled trial was conducted. Following a baseline phase, 74 people with ABI and executive problems were randomized to receive AIM or control (information and games) for three weeks (phase 1) before crossing over to either AIM or no intervention (phase 2). Primary outcome was change in composite score of proportion of daily intentions achieved. Fifty-nine people completed (71% male; 46% traumatic brain injury). Results: Per protocol cross-over analysis found a significant benefit of AIM for all intentions (F(1,56) = 4.28, P = 0.04; f = 0.28; 3.7% mean difference; 95% CI: 0.1-7.4%) and all intentions excluding a proxy prospective memory task (F(1,55) = 4.79; P = 0.033; f = 0.28, medium effect size; 3% mean difference; 95% CI: 0.3-5.6%), in the absence of significant changes on tests of executive functioning. Intention to treat analyses, comparing AIM against control at end of phase 1 revealed no statistically significant differences in attainment of intentions. Conclusion: Combining brief executive rehabilitation with alerts may be effective for some in improving achievement of daily intentions, but further evaluation of clinical effectiveness and mechanisms is required.
    Original languageEnglish
    JournalNeurorehabilitation and Neural Repair
    Early online date2 Dec 2016
    Publication statusE-pub ahead of print - 2 Dec 2016

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