Abstract
BackgroundImpairment of prospective memory (PM) is common following traumatic brain injury (TBI) and negatively impacts on independent living. Compensatory approaches to PM rehabilitation have been found to minimize the impact of PM impairment in adults with TBI; however, poor self-awareness after TBI poses a major barrier to the generalization of compensatory strategies in daily life. Metacognitive skills training (MST) is a cognitive rehabilitation approach that aims to facilitate the development of self-awareness in adults with TBI. This paper describes the protocol of a study that aims to evaluate the efficacy of a MST approach to compensatory PM rehabilitation for improving everyday PM performance and psychosocial outcomes after TBI.Methods/designThis randomized controlled trial has three treatment groups: compensatory training plus metacognitive skills training (COMP-MST), compensatory training only (COMP), and waitlist control. Participants in the COMP-MST and COMP groups will complete a 6-week intervention consisting of six 2-h weekly training sessions. Each 1.5-h session will involve compensatory strategy training and 0.5 h will incorporate either MST (COMP-MST group) or filler activity as an active control (COMP group). Participants in the waitlist group receive care as usual for 6 weeks, followed by the COMP-MST intervention. Based on the sample size estimate, 90 participants with moderate to severe TBI will be randomized into the three groups using a stratified sampling approach. The primary outcomes include measures of PM performance in everyday life and level of psychosocial reintegration. Secondary outcomes include measures of PM function on psychometric testing, strategy use, self-awareness, and level of support needs following TBI. Blinded assessments will be conducted pre and post intervention, and at 3-month and 6-month follow-ups.DiscussionThis study seeks to determine the efficacy of COMP-MST for improving and maintaining everyday PM performance and level of psychosocial integration in adults with moderate to severe TBI. The findings will advance theoretical understanding of the role of self-awareness in compensatory PM rehabilitation and skills generalization. COMP-MST has the potential to reduce the cost of rehabilitation and lifestyle support following TBI because the intervention could enhance generalization success and lifelong application of PM compensatory strategies.Trial registrationNew Zealand Clinical Trials Registry, ACTRN12615000996561. Registered on 23 September 2015; retrospectively registered 2 months after commencement.
Highlights
Impairment of prospective memory (PM) is common following traumatic brain injury (TBI) and negatively impacts on independent living
This study seeks to determine the efficacy of compensatory training only (COMP)-Metacognitive skills training (MST) for improving and maintaining everyday PM performance and level of psychosocial integration in adults with moderate to severe TBI
COMP-MST has the potential to reduce the cost of rehabilitation and lifestyle support following TBI because the intervention could enhance generalization success and lifelong application of PM compensatory strategies
Summary
Impairment of PM is common following TBI and may have serious repercussions for an individual’s independent living, social engagement, and employability [48]. Whilst research shows that compensatory approaches to PM rehabilitation minimize the impact of PM impairments in adults with TBI [8, 9], poor self-awareness after TBI poses a major barrier to the generalization of compensatory strategies in daily life [32]. The findings are expected to have important theoretical and practical implications for treatment approaches that can potentially be used to enhance individuals’ capacity to generalize compensatory training strategies to daily life, which in turn will increase independent living and reduce the personal and social burden of TBI in the community. The main methodological challenge in this study relates to avoiding therapist bias, as the same occupational therapist will deliver both intervention programs to participants. (DOC 112 kb) Additional file 2: SPIRIT Checklist.
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