Social Work Delivered Intervention for Persons with Mild Traumatic Brain Injury Improves Community Functioning and Alcohol Use Outcomes
Methods: Participants were recruited from consecutive admissions to the emergency department. A total of 58 persons with confirmed mTBI diagnoses were assessed 3 months post-injury. Participants in the Usual Care group (N=32) were identified via medical record; confirmation of mTBI was based on World Health Organization definition. Participants in the SWDI group (N=26) were identified and mTBI diagnosis confirmed by emergency department medical staff. Both groups completed standardized assessments of post-concussion symptoms, depression, anxiety, Posttraumatic Stress Disorder, alcohol use, and community functioning. The SWDI group completed an open-ended patient experience survey. The community functioning variable was compared between Usual Care and SWDI using the paired sample t test. For all other standardized measures, non-parametric Wilcoxon Signed Rank tests were used to compare groups. Qualitative themes were identified through systematic review of all survey responses.
Results: Both groups reported pre-injury drinking in the “hazardous” range. The SWDI group reported significantly reduced alcohol use from pre-injury to post-intervention (p=.05). The Usual Care group maintained their pre-injury level of drinking. Analysis of the community functioning measure revealed the SWDI group maintained pre-injury levels of community functioning, while the Usual Care group reported significant decline in functioning (p=.01). All other analyses of standardized measures (anxiety, depression, PTSD, post-concussive symptoms) trended in favor of the intervention group, but were not statistically significant. Results from the SWDI patient experience survey indicate that 95% of participants who remembered receiving the intervention (N=21) found it helpful. In response to an open ended question about the most helpful aspects of the intervention, 19% of SWDI who remembered receiving intervention independently reported education about ceasing alcohol use was most helpful, and 67% reported it was most helpful to learn about symptoms to expect because this decreased anxiety about symptoms.
Conclusions and Implications: The study provides support for the use of the SWDI in the emergency department. Participants who received the SWDI reported improved community functioning and alcohol use outcomes. These measures are clinically relevant. Alcohol use is a risk factor for re-injury and poor outcome, and the measure of community functioning includes probes about work, school and social activity attendance as well as ability to complete household and daily living activities. The SWDI group overwhelmingly found the intervention helpful. Education about symptoms to expect and alcohol use was particularly salient for participants. The reported decrease in anxiety about symptoms after education may be particularly important due to the link between anxiety and poor outcome. Future studies should consider ways to enhance the intervention in order to increase the impact on additional outcomes of interest.