SWIFT Study in the ED
| Status: | Completed |
|---|---|
| Conditions: | Hospital, Neurology |
| Therapuetic Areas: | Neurology, Other |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 4/2/2016 |
| Start Date: | April 2013 |
| End Date: | October 2014 |
| Contact: | Megan Moore, MSW, PhD |
| Email: | mm99@uw.edu |
Social Work Intervention for Adults With Mild Traumatic Brain Injury: SWIFT Pilot Study
Mild traumatic brain injury (mTBI) is a prevalent and costly public health problem with
disabling consequences. More than one million civilians with mTBI are treated in US
hospitals and emergency departments each year (Faul, et al., 2010). While the exact number
is debated, approximately 10-15% of individuals with mTBI will experience prolonged and
disabling post-concussive symptoms (Stranjalis, et al., 2008; Ruff and Weyer Jamora, 2009),
and 34% will experience a psychiatric illness in the first year after injury (Fann, et al.,
2004). In addition, at least 188,270 military service members sustained a TBI from 2000 to
mid August 2010, and nearly 77% of these injuries were mild (Defense and Veterans Brain
Injury Center, 2010). Many individuals require treatment for resulting mTBI symptoms.
The proposed study builds on preliminary research conducted by the investigators to develop
and test the effectiveness of a social work delivered education and reassurance intervention
for adults with mTBI (SWIFT-Acute) against usual care. The proposed study will assess
acceptability and obtain preliminary effectiveness data for an enhanced social work
assessment and intervention for adults with mTBI (SWIFT) discharged from the Emergency
Department (ED). SWIFT includes early education, reassurance, coping strategies, resources
and a brief alcohol use intervention in the ED plus follow up telephone counseling, needs
assessment and case management referral to necessary services. The intervention targets
cognitive, physical, psychiatric and functional outcomes; specifically, post-concussive
symptoms, depression, anxiety, posttraumatic stress disorder, alcohol use, community
functioning and successful linkage to community resources.
It is hypothesized that SWIFT will be acceptable to patients and that participants in the
SWIFT group will report superior outcomes on measures of post-concussive symptoms,
depression and anxiety, alcohol use and community functioning and will report increased
successful linkages to needed resources when compared to the SWIFT-Acute group.
The specific aims of the study are:
1. Implement an innovative social work intervention for adults with mTBI (SWIFT).
2. Assess acceptability of SWIFT using qualitative interviews with participants.
3. Assess preliminary effectiveness of SWIFT compared to SWIFT-Acute alone on reduction or
prevention of post-concussive symptoms, depression, anxiety, posttraumatic stress
disorder (PTSD) symptoms, and alcohol use, and on improvement of community functioning
and successful linkage to community resources. 80 participants will be randomized to
receive SWIFT or SWIFT-Acute. Preliminary intervention effectiveness will be assessed
using standard measures of post-concussive symptoms, the primary outcome, depression,
anxiety, PTSD, alcohol use, and community functioning. A structured survey will be used
to assess linkage to community resources.
disabling consequences. More than one million civilians with mTBI are treated in US
hospitals and emergency departments each year (Faul, et al., 2010). While the exact number
is debated, approximately 10-15% of individuals with mTBI will experience prolonged and
disabling post-concussive symptoms (Stranjalis, et al., 2008; Ruff and Weyer Jamora, 2009),
and 34% will experience a psychiatric illness in the first year after injury (Fann, et al.,
2004). In addition, at least 188,270 military service members sustained a TBI from 2000 to
mid August 2010, and nearly 77% of these injuries were mild (Defense and Veterans Brain
Injury Center, 2010). Many individuals require treatment for resulting mTBI symptoms.
The proposed study builds on preliminary research conducted by the investigators to develop
and test the effectiveness of a social work delivered education and reassurance intervention
for adults with mTBI (SWIFT-Acute) against usual care. The proposed study will assess
acceptability and obtain preliminary effectiveness data for an enhanced social work
assessment and intervention for adults with mTBI (SWIFT) discharged from the Emergency
Department (ED). SWIFT includes early education, reassurance, coping strategies, resources
and a brief alcohol use intervention in the ED plus follow up telephone counseling, needs
assessment and case management referral to necessary services. The intervention targets
cognitive, physical, psychiatric and functional outcomes; specifically, post-concussive
symptoms, depression, anxiety, posttraumatic stress disorder, alcohol use, community
functioning and successful linkage to community resources.
It is hypothesized that SWIFT will be acceptable to patients and that participants in the
SWIFT group will report superior outcomes on measures of post-concussive symptoms,
depression and anxiety, alcohol use and community functioning and will report increased
successful linkages to needed resources when compared to the SWIFT-Acute group.
The specific aims of the study are:
1. Implement an innovative social work intervention for adults with mTBI (SWIFT).
2. Assess acceptability of SWIFT using qualitative interviews with participants.
3. Assess preliminary effectiveness of SWIFT compared to SWIFT-Acute alone on reduction or
prevention of post-concussive symptoms, depression, anxiety, posttraumatic stress
disorder (PTSD) symptoms, and alcohol use, and on improvement of community functioning
and successful linkage to community resources. 80 participants will be randomized to
receive SWIFT or SWIFT-Acute. Preliminary intervention effectiveness will be assessed
using standard measures of post-concussive symptoms, the primary outcome, depression,
anxiety, PTSD, alcohol use, and community functioning. A structured survey will be used
to assess linkage to community resources.
Inclusion Criteria:
Inclusion criteria are based on the World Health Organization definition of mTBI. For
inclusion in the study, participants must meet following criteria:
1. At least 18 years of age and English speakers
2. Present to ED with mechanism of trauma to the head, non-penetrating injury, or recent
history of trauma to the head
3. Glasgow Coma Scale score of 13-15 after 30 minutes post injury or later upon
presentation for healthcare
4. Discharged from the ED in <48 hours from time of admission
5. In addition participants must have one or more of the following symptoms at time of
injury:
1. confusion or disorientation
2. loss of consciousness for 30 minutes or less,
3. post-traumatic amnesia for less than 24 hours
4. other transient neurological abnormalities such as focal signs, seizure and
intracranial lesion not requiring surgery
Exclusion Criteria:
1. the manifestations of mTBI are determined to be caused by penetrating craniocerebral
injury
2. patients <18 years of age or non-English speaking
3. patients with intracranial lesion requiring surgery
4. patients admitted to the hospital from ED
5. patients in police custody
6. patients without a telephone contact number
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