Exploring the Feasibility of a Multimodal Intervention Designed to Address Post Traumatic Brain Injury Fatigue

Research Objectives: We developed and tested a remote intervention (Education/Problem-solving/Walking program: The EmPoWer program) targeting fatigue after Acquired Brain Injury (ABI).

To determine: 1) the feasibility and acceptability of EmPoWer for individuals with fatigue after ABI and 2) the initial efficacy of EmPoWer for improving outcomes in individuals with ABI.

Design: Single Arm Feasibility study

Setting: Community-based remote intervention

Participants: Five adults ≥ 6-months post moderate to severe ABI who live in the community and endorse fatigue

Interventions: EmPoWer is an 8-week (1x-week) remote intervention that includes fatigue-based psycho-education and problem-solving training (PST), plus a walking program. Participants received 4 weeks of interactive follow-up text messages to encourage maintenance.

Main Outcome Measures: feasibility data: sessions completed, reasons for non-completion, technical issues

satisfaction: mHealth App Usability Questionnaire (MAUQ), Telehealth Usability Questionnaire (TUQ); Acceptability of Intervention Measure (AIM)

clinical: Modified Fatigue Impact Scale (MFIS), Pittsburgh Sleep Quality Index (PSQI), Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference, Participation Assessment with Recombined Tools-Objective (PART-O), and number of participants who met the 40% step increase target at week 8.

Results: Participants consisted of two Caucasian males (one Hispanic) and three Caucasian females. Four sustained a TBI and one a stroke. All participants completed every PST session. Participants were satisfied with the intervention (MAUQ mean = 5.5, SD = 1.7; TUQ mean = 6.8, SD = 0.1; AIM mean = 4.2, SD = 0.5) and demonstrated improvements from baseline to intervention completion (Week 8) and baseline to follow-up completion (Week 12) for fatigue (MFIS: Baseline Mean = 40.6, SD = 18.7; Week 8 Mean = 25.2, SD = 14.0; Week 12 Mean = 34.0, SD = 15.0) and sleep (PSQI: Baseline Mean = 6.4, SD = 3.1; Week 8 Mean = 5.0, SD = 2.5; Week 12 Mean = 4.8, SD = 2.5). Participants showed little change in pain (PROMIS T-scores: Baseline Mean = 46.9, SD = 8.0; Week 8 Mean = 43.6, SD = 5.5; Week 12 Mean = 45.9, SD = 6.8) and community participation (PART-O Summary: Baseline Mean = 1.8, SD = 0.8; Week 8 Mean = 2.0, SD = 0.9; Week 12 Mean = 2.2, SD = 0.8). Three participants had a 40% step increase by week 8.

Conclusions: The EmPoWer intervention demonstrates feasibility and may be an effective intervention for the debilitating effects of fatigue after ABI. Future studies will include a Randomized Control Trial to determine effectiveness.

Author(s) Disclosures: Authors have nothing to disclose.