Citation

Zhang N, Kaizar EE, Narad ME, Kurowski BG, Yeates KO, Taylor HG, Wade SL. J. Neurotrauma 2019; 36(7): 1147-1155.

Affiliation

Cincinnati Children's Hospital Medical Center, Pediatrics , 3333 Burnet Avenue MLC 4009 , Cincinnati, Ohio, United States , 45229-3039 ; shari.wade@cchmc.org.

Copyright

(Copyright © 2019, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2018.5885

PMID

30328749

Abstract

A series of five randomized controlled clinical trials (RCTs) conducted between 2002 and 2015 support the potential efficacy of online family problem-solving treatment (OFPST) in improving both child and parent/family outcomes after pediatric traumatic brain injury (TBI). However, small sample sizes and heterogeneity across individual studies have precluded examination of potentially important moderators. We jointly analyzed individual participant data (IPD) from these five RCTs, involving 359 children between the ages of 5 and 18 years, to confirm the role of previously identified moderators (child's age and pre-treatment symptom levels, parental education) and to examine other potential moderators (race, sex, IQ), using IPD meta-analysis. This reanalysis revealed statistically strong evidence that parental education, child age at baseline, IQ, sex, and parental depression level pre-treatment moderated the effect of OFPST on various outcomes. In particular, children of parents with a less than high school education exhibited less internalizing problems and better social competence. Children injured at an older age exhibited fewer externalizing behaviors and less executive dysfunction following OFPST. Child IQ moderated the effect of OFPST on social competence, with significantly better competence for children with lower IQ that received OFPST. Lower levels of parental depression followed OFPST among subgroups with lower IQ, boys, and higher parental depression scores at baseline. Our findings indicate that the optimal application of OFPST is likely to involve older children, those with lower IQ scores, or those from families with lower socioeconomic status (SES).

Language: en

Keywords

HEAD TRAUMA; PEDIATRIC BRAIN INJURY; REHABILITATION; TRAUMATIC BRAIN INJURY