Wade et al.

(2018b)

USA

RCT

PEDro=6

N=152

Population: Teen Online Problem Solving (TOPS) with Family Group (N=49): Mean Age=14.7y (2.1); Gender: Male=71%, Female=29%; Mean time post injury=5.3mo (3.9); GCS=N/A. TOPS with teen only Group (N=51): Mean Age=14.8y (2.0); Gender: Male=69%, Female=31%; Mean time post injury=5.8mo (4.4); GCS=N/A. Internet Resources Comparison (IRC) Group (N=52): Mean Age=15.1y (2.1); Gender: Male=71%, Female=29%; Mean time post injury=6.1mo (3.80); GCS=N/A.

Intervention: The TOPS program is 10 core online modules providing training in stress management, problem-solving, self-regulation, communication, and social skills. The teen only content paralleled the family content but focused exclusively on the teen. The IRC group had access to a website with online resources. Assessments took place at baseline and 6-months later.

Outcomes: Child Behaviour Checklist (CBCL), Behaviour Rating inventory of executive functions (BRIEF), and the self-report equivalents (Youth Self-Report [YSR] and BRIEF Self-report, respectively).

1.        Group differed significantly on the parent-reported BRIEF (p<0.05) with children in the TOPS with family group showing significantly lower levels of executive dysfunction than TOPS with teen only. However, there was no significant difference between TOPS with family and the IRC group.

2.        No significant group differences on the parent-reported CBCL (p>0.05).

3.        No significant group differences on the YSR or the BRIEF self-report (p>0.05).

Narad et al.

(2015)

USA

RCT

PEDro=6

N=132

Population: TBI; Counsellor Assisted Problem Solving (CAPS, n=65): Mean Age=14.7yr; Mean GCS=10.1. Internet Resource Comparison (IRC, n=67): Mean Age=15.0yr; Mean GCS=10.0.

Intervention: Participants were randomly assigned to the CAPS or IRC group. CAPS group underwent 6 45-60 min video conferencing sessions with a counsellor for 6 mo, with both the adolescent and primary care giver. Participants received web-based problem-solving training with guidance from counsellor. Children and their families in the IRC group were given online access to resources and websites only. Assessments were completed at baseline, 6 mo, 12 mo and 18 mo.

Outcome Measure: Family Assessment Device (FAD), Iowa Family Interaction Rating Scale (IFIRS), Problem-Solving Discussion Rating Scale (PSDRS).

1.        All participants improved on FAD (p=0.030), however no significant between group effects were found.

2.        Effective communication on IFIRS for participants with severe TBI decreased for both CAPS (p<0.010) and IRC (p=0.030) from baseline to 6 mo, signifying an improvement in communication. This significant improvement was maintained for CAPS (p<0.010), but not IRC, at 12 mo.

3.        Participants with severe TBI in the CAPS group had less severe conflicts on PSDRS at 18 mo relative to 12mo (p=0.008) and baseline (p=0.040). IRC participants with severe TBI demonstrated less severe conflict at 12 mo relative to 6mo only (p=0.030).

Wade et al.

(2014a)

USA

RCT

PEDro=8

N=132

Population: TBI; Counsellor Assisted Problem Solving (CAPS, n=65): Mean Age: Caregiver=41.9 yr, Child=14.6 yr; Mean Time Post-Injury Child=0.3 yr; Lowest GCS=10.1. Internet Resource Comparison Caregiver Group (IRC, n=67): Mean Age: Caregiver=42.8 yr, Child=15.0 yr; Mean Time Post-Injury Child=0.3 yr; Lowest GCS=10.0.

Intervention: Participants were randomly assigned to CAPS or IRC. The CAPS group received video-conferences with a therapist and completed weekly problem-solving skills training as a family. The IRC group had online access to resources and websites only. The interventions were provided for 6 mo. Assessments for caregiver outcomes were completed post-treatment.

Outcome Measure: Global Severity Index (GSI), Center for Epidemiologic Studies Depression Scale (CES-D), Caregiver Self-Efficacy Scale (CSES).

1.        No significant difference in caregiver depression between groups according to CES-D (p=0.055). However, once removing CAPS participants who attended fewer than 4 sessions, a significant group effect was found (p=0.030) at 6 mo.

2.        Caregivers in CAPS reported significantly higher self-efficacy on CSES than IRC for non-frequent computer users (p=0.010) but not for frequent users.

3.        Both groups demonstrated a significant reduction in GSI distress (both p=0.007).

Petranovich et al.

(2015)

USA

RCT

PEDro=6

N=132

*follow-up to Wade et al. (2014 CAPS caregiver)

Intervention: Assessments were completed 12 mo and 18 mo after initiation of treatment.

Outcome Measure: Global Severity Index (GSI), Center for Epidemiologic Studies Depression Scale (CES-D), Caregiver Self-Efficacy Scale (CSES).

1.        Significantly lower global distress levels on GSI for low-income parents in CAPS group relative to IRC group at 6 mo (p=0.040), 12 mo (p=0.010), and 18 mo (p=0.004).

2.        All parents with high levels of depression on CES-D at baseline demonstrated a significant reduction over time (p=0.002), but no significant between group differences were found.

3.        CAPS had significantly higher scores on CSES compared to IRC (p=0.020), but no significant group x time interaction was reported.

Wade et al.

(2012)

USA

RCT

PEDro=6

N_I=41, N_F=35

Population: TBI; Teen Online Problem Solving Parents Group (TOPS, n=20): Mean Age=40.8 yr. Internet Resource Comparison Parents Group (IRC, n=21): Mean Age=41.6 yr.

Intervention: Families were randomly assigned to receive either TOPS or IRC. TOPS included a visit from a therapist at the outset and 10 web-based sessions of 45-60 min each for adolescents and their family members. IRC group was given access to online resources only. The interventions were provided for 6 mo. Follow-up assessments were completed at a mean of 7.83mo (TOPS) and 7.92mo (IRC).

Outcome Measure: Social Problem Solving Inventory-Revised Short Form (SPSI), Global Severity Index (GSI), Center for Epidemiologic Studies Depression Scale (CES-D).

1.       Low income families in the TOPS group improved significantly from baseline to post-treatment in depressive symptoms on CES-D (p=0.040), and positive problem orientation and rational problem solving on SPSI (p<0.050). No significant difference found in the low income IRC group from baseline to post-treatment.

2.       High income families in the IRC group experienced significant reduction in depressive symptoms on CES-D (p=0.010) and positive problem orientation on SPSI (p<0.050) from baseline to post-treatment. No significant reductions were found for high income TOPS participants.

3.       Upon regression analyses, change in overall problem solving explained 16% of variance in depression (CES-D, p=0.010) and 7% of variance in global distress (GSI, p=0.040).

Wade et al.

(2008)

USA

RCT

PEDro=5

N=9

Population: TBI; Mean Age=15.0yr; Gender: Male=5, Female=4; Mean Time Post Injury=9.3mo; Mean GCS=10.9.

Intervention: Patients participating in the Teen Online Problem Solving (TOPS) program were randomly assigned to receive audio support (n=5) in the form of text being read aloud to them after clicking a “play” button or no audio support (n=4). The TOPS program consisted of 10 internet sessions providing training in stress management, problem solving, planning, organization, communication and self-regulation, six supplemental sessions addressing the stressors and burden of individual families, and therapy via videoconferencing. All sessions were provided every 1-2 wk. Assessments were conducted at baseline and post-treatment.

Outcome Measure: Child Behavior Checklist (CBCL), Conflict Behavior Questionnaire (CBQ), Center for Epidemiologic Studies Depression Scale (CES-D), Children’s Depression Inventory (CDI), Number of Behavioural Issues, Severity of Behavioural Issues.

2.        Patients within the Audio Group improved significantly on the CBCL Internalizing scale (p=0.030), CES-D (p=0.020) and demonstrated a significant reduction in the number of behavioural issues (p=0.020) from baseline to post-treatment.

3.        Patients within the Non-Audio Group improved significantly on the CBQ (p=0.040) and demonstrated a significant reduction in the severity of behavioural issues (p=0.050) from baseline to post-treatment.

4.        Overall, all nine patients improved significantly on the CBCL Internalizing scale (p=0.030), CES-D (p=0.010), CDI (p=0.020), CBQ (p=0.040), number of behavioural issues (p=0.010) and the severity of behavioural issues (p=0.010) from baseline to post-treatment after participating in the TOPS program.

Wade et al.

(2006b)

USA

RCT

PEDro = 7

N_i=46, N_F=40

Population: TBI: Family Problem-Solving Group (FPS, n=20): Mean Age=10.9yr; Gender: Male=16, Female=4; Mean Time Post Injury=13.5mo; Mean Lowest GCS=12.2. Internet Resource Comparison Group (IRC, n=20): Mean Age=11.0yr; Gender: Male=12, Female=8; Mean Time Post Injury=14.1mo; Mean Lowest GCS=10.5.

Intervention: Patients were randomly assigned to either the FPS intervention or the IRC group. The FPS group received 14 online problem-solving sessions (8 core sessions), followed by an additional 6 individualized sessions to address unresolved stressors. Videoconferences with a therapist occurred every 1-2 wk. The IRC group received access to online brain injury resources only. Assessments were conducted at baseline and post-treatment.

Outcome Measure: Social Problem Solving Index (SPSI), Symptom Checklist-Revised Global Severity Index (SCL 90-GSI), Center for Epidemiologic Studies Depression Scale (CES-D), Anxiety Inventory (AI).

1.        Parents in the FPS group reported less anxiety on the AI, less depression on the CES-D, and less psychiatric symptoms on the SCL 90-GSI compared to the IRC at post-treatment (p<0.050).

2.        There we no significant between group differences in parental problem solving on SPSI (p=0.100). There was also no association between problem solving and parental outcomes on CES-D and SCL 90-GSI (p>0.050).

3.        Six parents (30%) in FPS reported clinically significant depression on CES-D and two (10%) reported clinically significant distress on SCL 90-GSI compared to 12 (60) and 6 (31.6%) parents in the IRC. Neither of these reports were significant (p=0.057, p=0.950 respectively).

Wade et al .

(2006a)

USA

RCT

PEDro= 6

N_i=46, N_F=40

Population: TBI: Family Problem-Solving Group (FPS, n=20): Mean Age=10.9yr; Gender: Male=11, Female=9; Mean Time Post Injury=13.5mo; Mean Lowest GCS=12.2. Internet Resource Comparison Group (IRC, n=20): Mean Age=11.0yr; Gender: Male=12, Female=8; Mean Time Post Injury=14.1mo; Mean Lowest GCS=10.5.

Intervention: Patients were randomly assigned to either the FPS intervention or the IRC group. The FPS group received 14 online problem-solving sessions (8 core sessions) followed by an additional 6 individualized sessions to address unresolved stressors along with videoconferences every 1-2 wk. The IRC group received access to online brain injury resources and links but no access to the FPS content. Assessments were conducted at baseline and post-treatment.

Outcome Measure: Child Behavior Checklist (CBCL), Home and Community Social Behavior Scale (HCSBS).

1.        The FPS group reported significantly higher HCSBS Self-Management/Compliance subscale scores at post-treatment compared to patients in the IRC group (p<0.050).

2.        Greater improvement was noted for the FPS group on the HCSBS Social Competence subscale, CBCL Internalizing subscale, and CBCL Total score compared to the IRC group post-treatment but no significant between-group differences were reported.

3.        Patients aged >11yr in the FPS group reported significantly higher HCSBS Self-Management/Compliance scores post-treatment compared to patients of the same age in the IRC group (p=0.030) but no significant difference was found between groups for patients aged <11 yr.

Wade et al.

(2018a)

USA

Pre-Post

N_l=12

Population:  TBI Group (N=8): Mean Age=16.59yr (1.18); Gender: Male=50%, Female=50%; Age at injury=6.27y (5.5); GCS=N/A. Brain tumor (BT) group (N=4): Mean age=18.25yr (1.88); Gender: Male=25%, Female=75%; Age at injury=5.46yr (4.6); GCS=N/A.

Intervention: ABI patients were nonrandomized to the intervention group. The intervention consisted of using an app-based coaching intervention (Social Participation and Navigation; SPAN) to help patients attain social goals.

Outcomes: ease of use and satisfaction of intervention, Child Behaviour Checklist (CBC), Youth Self-Report (YSR).

1.        Significant difference between-groups in self-reported ease of use of the app (p=0.04) with 100% of the BT Group stating it was easy to use (strongly agree/agree) versus 37.5% of the TBI group.

2.        No significant group differences on whether the app was useful (both groups mostly agreed).

3.        In an analysis of the full sample (N=12), on the CBC there was a significant increase pre to post on confidence in participation (p<0.01). No other significant results.

4.        In an analysis of the full sample (N=12), on the YSR there was a significant increase pre to post on participation frequency (p=0.01) and decreases on total problems, internalizing problems, externalizing problems, and social problems (p<0.05).

Raj et al.

(2018)

USA

RCT

PEDro=6

N=113

Population:  InTERACT Group (N=39): Mean Age=6.15yr (1.99); Gender: Male=66.7%, Female=33.3%; Mean time post injury=1.02yr (1.52); GCS=<12. InTERACT express Group (N=36): Mean Age=6.16y (2.07); Gender: Male=58.3%, Female=41.7%; Mean time post injury=0.84yr (1.18); GCS=<12. IRC Group (N=38): Mean Age=6.58y (1.83); Gender: Male=57.9%, Female=42.1%; Mean time post injury=0.90y (1.46); GCS=<12.

Intervention: Caregivers of TBI children were randomized into one of three groups. The InTERACT program combines features of Parent-Child interaction therapy with training in managing challenging child behaviours, TBI education, stress management, and communication. This group attended 10 sessions. Caregivers independently reviewed content and videoconferenced with a clinician. The InTERACT Express group had an abbreviated version including 7 sessions. The IRC group received access to a web site with links to various online resources on TBI and parenting. Assessed at baseline and 6 mo.

Outcomes: Caregiver Depression (CES-D), caregiver psychological stress (GSI), Parenting Stress Index (PSI), Parenting Efficacy (CSES).

1.        No significant effect between-groups on the GSI, PSI, CSES, CES-D at follow-up at any time point.

Raj et al.

(2015)

USA

RCT

PEDro=5

N=37

Population: TBI; Internet-Based Interacting Together Everyday (I-InTERACT, n=20): Mean Age=5.6yr; Gender: Male=14, Female=6; Mean Time Post-Injury=31.6 mo. Internet Resource Comparison (IRC, n=17): Mean Age=5.2yr; Gender: Male=11, Female=6; Mean Time Post-Injury=24.4 mo.

Intervention: Parents and children were randomized to either I-InTERACT or IRC programs. The I-InTERACT program encouraged everyday interactions between child and parent, with 10 core sessions of videoconferencing with a therapist and self-guided online skill training. The IRC group was provided with online resources about TBI in children. The interventions were provided for 6 mo. Assessments were completed at baseline and post-treatment.

Outcome Measure: Parenting Stress Index (PSI), Caregiver Self-Efficacy Scale (CSES), Global Severity Index (GSI), Center for Epidemiological Studies Depression Scale (CES-D).

1.       Post-hoc analyses of GSI scores revealed that low-income parents in the I-InTERACT group demonstrated significant reductions in psychological distress from baseline to post-treatment (p=0.010) whereas low-income parents in the IRC group experienced a nonsignificant increase in distress.

2.       There were no significant differences between groups for high-income parents.

3.       No significant differences were observed between groups from baseline to post-treatment on the PSI (p=0.200), CES-D (p=0.580) and CSES (p=0.460). Further, no significant interactions with family income were observed.

Antonini et al.

(2014)

USA

RCT

PEDro=6

N=37

Population: TBI; Internet-Based Interacting Together Everyday (I-InTERACT, n=20): Mean Age=5.6yr; Gender: Male=14, Female=6. Internet Resource Comparison (IRC, n=17): Mean Age=5.2yr; Gender: Male=11, Female=6.

Intervention: Parents and children were randomly assigned to either I-InTERACT or IRC groups. The I-InTERACT program encouraged everyday interaction between child and parent, with 10 sessions of videoconferencing with a therapist and self-guided online skill training. The IRC received online resource for children following a TBI. Assessments were completed at baseline and post-treatment (6 mo).

Outcome Measure: Dyadic Parent–Child Interaction Coding System (DPICS), Child Behavior Checklist (CBCL), Eyberg Child Behavior Inventory (ECBI).

1.        Undesirable parenting behaviours on DPICS were significantly reduced in both groups (p=0.0002).

2.        According to DPICS, parents in the I-InTERACT group were more likely to report positive parenting statements post-treatment compared to IRC group (p<0.0001).

3.        Following intervention, parents in I-InTERACT group were recorded to administer a greater number of praises on DPICS following child compliance than were those in IRC (p<0.009).

4.        Children in I-InTERACT in low income families improved on CBCL compared to those in IRC (p=0.001) whereas children in I-InTERACT with higher income had worse scores on CBCL than those in IRC (p=0.04).

5.        No significant difference on ECBI between groups was identified.

Mast et al.

(2014)

USA

RCT

PEDro=4

N=7

*a subanalysis of Antonini et al. (2014)

Population: TBI; I-InTERACT (n=4): Age Range=3-9 yr. IRC (n=3): Age Range=3-9 yr.

Intervention: Participants that sustained abusive head trauma were further analyzed.

Outcome Measure: Dyadic Parent–Child Interaction Coding System (DPICS), Child Behavior Checklist (CBCL), Eyberg Child Behavior Inventory (ECBI).

1.        According to the DPICS, parents in the I-InTERACT group were significantly more likely to provide praise (p=0.027) and reflective statements (p<0.0001), but less likely to ask their child questions (p<0.0001), than parents in the IRC group during child-lead interactions.

2.        No difference was found between the I-InTERACT and IRC groups in the likelihood of giving commands to their children (p=0.150).

3.        Children in the I-InTERACT group complied with 90% of parental demands compared to 50% in the IRC group (p=0.020).

4.        The children of the parents in both groups did not differ on the CBCL but children of the I-InTERACT group scored significantly lower on the ECBI Total Intensity compared to children in the IRC group at follow-up (p=0.020).