Ignite Creation Date:
2024-05-06 @ 7:29 PM
Last Modification Date:
2024-10-26 @ 3:08 PM
Study NCT ID:
NCT06036147
Status:
RECRUITING
Last Update Posted:
2024-04-26
First Post:
2023-09-06
Brief Title:
Concussion Health Improvement Program
Sponsor:
Seattle Childrens Hospital
Organization:
Seattle Childrens Hospital
Study Overview
Official Title:
Optimizing Collaborative Care for Youth With Persistent Post-Concussive Symptoms
Status:
RECRUITING
Status Verified Date:
2024-04
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
CHIP
Brief Summary:
More than 1 million US youth sustain a concussion each year and up to 30 report persistent post-concussive symptoms PPCS lasting 1 month or more PPCS can interfere with normal adolescent development resulting in issues with socioemotional dysfunction and even school failure However few evidence based treatments are available for youth with PPCS The investigators conducted extensive work adapting a collaborative care framework for youth with PPCS combining concussion-focused cognitive behavioral therapy cf-CBT parent skills training PST and care management CM to create a wraparound treatment for youth with PPCS that can be delivered either in-person or virtually They completed an R01-funded randomized controlled trial with this approach finding effectiveness for youth with PPCS with improvements in concussive symptoms and quality of life at one year and 60 of participants completing the intervention entirely virtually Of note this intervention is unique in that two of the components are focused on parents or parents and youth together PST CM and only one of the components cf-CBT is solely youth focused The investigators now propose to optimize and refine this approach conducting a high efficiency MOST multiphase optimization strategy trial to assess the contribution of each of the three components cf-CBT PST and CM to effectiveness thereby enabling streamlining of the intervention to only include active components The analysis will be factorial with three intervention components and two levels of each present or absent resulting in 8 treatment pathways The benefit of the MOST approach is that it combines all youth who receive a component allowing assessment of all treatment components with only a modest sample size The study will recruit 374 youth with PPCS randomizing them to one of 8 treatment groups Youth andor parents will attend treatment sessions via video conferencing software over three months and complete surveys regarding primary outcomes concussive symptoms and health-related quality of life and secondary outcomes sleep pain mood and parental distress at 6 weeks and 3 6 and 12 months Potential mediators and moderators will also be assessed to allow for future tailoring and refinement At the completion of this study the investigators will have generated a completely optimized and refined intervention for youth with PPCS ready for large scale implementation and dissemination
Detailed Description:
Concussion is common among adolescents affecting up to 19 million US youth per year Although many youth recover quickly up to 30 experience difficulty concentrating headache sleep disruption and other symptoms extending one month or longer characterized as persistent post-concussive symptoms PPCS Youth with PPCS can have symptoms for months leading to declines in academic function and quality of life as well as excessive healthcare costs Research indicates mental health comorbidity is linked to greater likelihood of prolonged concussive symptoms however evidence regarding mental health interventions for PPCS is still developing and mental health approaches are not included in the standard of care The investigators successfully adapted and tested a mental health intervention for youth with PPCS involving collaborative care CC delivery of youth concussion-focused cognitive-behavioral therapy cf-CBT parenting skills training PST and care management CM with medication guidance as needed We completed an R01 level randomized controlled trial of the CC approach for youth with PPCS finding evidence for long-term gains those receiving CC had improvements at 12 months in concussion symptoms Cohens d032 and health-related quality of life HRQoL Cohens d029 compared to usual care Perhaps most importantly more than half of families 60 completed the intervention entirely virtually expanding accessibility While our multicomponent CC approach was effective research suggests duration and complexity of evidence-based mental health interventions affect the likelihood of successful implementation and dissemination
The investigators are now striving to optimize the CC approach by assessing the contribution of each component in order to increase efficiency and scalability while maximizing effectiveness They have chosen to view the CC intervention treatment effects using the frame of the Socioecological Model16 postulating that cf-CBT targets the individual level PST targets the interpersonal level ie relationships with parents and CM targets the organizational level ie linkages to medical school and other services They have also worked to amplify each component noting in previous trials that concussive symptoms sleep and HRQoL improved significantly in the intervention group compared to usual care without a concomitant improvement in headache In response they increased the focus on skills for managing headache in the cf-CBT and PST components with the guidance of a pain psychologist They also increased the rigor and structure of all components with greater oversight regarding delivery and duration The next step is to assess the separate contribution of each different leveled component cf-CBT PST and CM to determine their impact on youth and parent outcomes
The investigators propose to conduct an optimization trial with the CC approach for youth with PPCS utilizing a highly efficient analytic approach the multiphase optimization strategy MOSTThe design will be factorial with three components cf-CBT PST and CM each with two levels present or absent They will recruit adolescents aged 11-18 with PPCS lasting at least 1 month from outpatient clinics randomizing families to one of 8 groups to assess all combinations of treatment components Families will participate in sessions virtually and complete surveys at 3 6 and 12 months to measure proximal and distal outcomes They will examine potential mechanisms of action for each component and explore differential effectiveness across baseline factors via moderation They will sample youth from two distinct geographic regions to enhance diversity and improve generalizability
Aim 1 Determine which components of the CC approach cf-CBT PST and CM contribute significantly to improvements in distal outcomes particularly concussive symptoms and youth HRQoL among a diverse sample of youth with PPCS
1a Examine the effect of intervention components on proximal outcomes including youth headache mood and sleep and parental distress regarding their childs illness
Aim 2 Assess potential mediation of intervention component effects by postulated mechanistic factors including improvements in a youth self-efficacy b parental protectiveness and c parental self-efficacy regarding navigating their childs concussion care
Aim 3 Explore moderation of intervention component effects by demographic parental education level youth raceethnicity youth sex and clinical factors youth depression and level of parent emotional distress
The proposed study will advance concussion research by continuing to refine an evidence-based intervention for youth with PPCS that addresses mental health while engaging both parents and youth It will also elucidate the scientific understanding of how the intervention works and for whom The end product of this research will be a PPCS intervention optimized for effectiveness and efficiency that will form the basis for a future hybrid implementation effectiveness trial
The investigators are now striving to optimize the CC approach by assessing the contribution of each component in order to increase efficiency and scalability while maximizing effectiveness They have chosen to view the CC intervention treatment effects using the frame of the Socioecological Model16 postulating that cf-CBT targets the individual level PST targets the interpersonal level ie relationships with parents and CM targets the organizational level ie linkages to medical school and other services They have also worked to amplify each component noting in previous trials that concussive symptoms sleep and HRQoL improved significantly in the intervention group compared to usual care without a concomitant improvement in headache In response they increased the focus on skills for managing headache in the cf-CBT and PST components with the guidance of a pain psychologist They also increased the rigor and structure of all components with greater oversight regarding delivery and duration The next step is to assess the separate contribution of each different leveled component cf-CBT PST and CM to determine their impact on youth and parent outcomes
The investigators propose to conduct an optimization trial with the CC approach for youth with PPCS utilizing a highly efficient analytic approach the multiphase optimization strategy MOSTThe design will be factorial with three components cf-CBT PST and CM each with two levels present or absent They will recruit adolescents aged 11-18 with PPCS lasting at least 1 month from outpatient clinics randomizing families to one of 8 groups to assess all combinations of treatment components Families will participate in sessions virtually and complete surveys at 3 6 and 12 months to measure proximal and distal outcomes They will examine potential mechanisms of action for each component and explore differential effectiveness across baseline factors via moderation They will sample youth from two distinct geographic regions to enhance diversity and improve generalizability
Aim 1 Determine which components of the CC approach cf-CBT PST and CM contribute significantly to improvements in distal outcomes particularly concussive symptoms and youth HRQoL among a diverse sample of youth with PPCS
1a Examine the effect of intervention components on proximal outcomes including youth headache mood and sleep and parental distress regarding their childs illness
Aim 2 Assess potential mediation of intervention component effects by postulated mechanistic factors including improvements in a youth self-efficacy b parental protectiveness and c parental self-efficacy regarding navigating their childs concussion care
Aim 3 Explore moderation of intervention component effects by demographic parental education level youth raceethnicity youth sex and clinical factors youth depression and level of parent emotional distress
The proposed study will advance concussion research by continuing to refine an evidence-based intervention for youth with PPCS that addresses mental health while engaging both parents and youth It will also elucidate the scientific understanding of how the intervention works and for whom The end product of this research will be a PPCS intervention optimized for effectiveness and efficiency that will form the basis for a future hybrid implementation effectiveness trial
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
False
Is a FDA Regulated Device?:
False
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None
Secondary IDs
| Secondary ID | Type | Domain | Link |
|---|---|---|---|
| R01HD090230 | NIH | None | httpsreporternihgovquickSearchR01HD090230 |