Cognitive Symptom Management and Rehabilitation Therapy (CogSMART) for Veterans with traumatic brain injury: Pilot randomized controlled trial

TLDR

Traumatic brain injury can cause persistent cognitive deficits and postconcussive symptoms that hinder functional recovery, including return to work. The study examined whether a 12‑week compensatory cognitive training program (CogSMART) added to supported employment improves outcomes for veterans with mild‑to‑moderate TBI. Participants were randomized to 12 weeks of supported employment plus CogSMART or enhanced supported employment that matched therapist contact; CogSMART was delivered by employment specialists and included psychoeducation on TBI, strategies for sleep, fatigue, headaches, tension, and compensatory techniques for prospective memory, attention, learning, memory, and executive function. Compared with controls, the CogSMART group showed large reductions in postconcussive symptoms (d = 0.97) and improved prospective memory (d = 0.72), with small‑to‑medium benefits for PTSD, depression, and competitive work attainment, and high participant satisfaction, indicating that CogSMART may enhance postconcussive recovery and memory, though larger trials are needed.

Abstract

Traumatic brain injury (TBI) can result in cognitive impairments and persistent postconcussive symptoms that limit functional recovery, including return to work. We evaluated a 12 wk compensatory cognitive training intervention (Cognitive Symptom Management and Rehabilitation Therapy [CogSMART]) in the context of supported employment for Veterans with mild to moderate TBI. Participants were randomly assigned to receive 12 wk of supported employment plus CogSMART or enhanced supported employment that controlled for therapist attention (control). CogSMART sessions were delivered by the employment specialist and included psychoeducation regarding TBI; strategies to improve sleep, fatigue, headaches, and tension; and compensatory cognitive strategies in the domains of prospective memory, attention, learning and memory, and executive functioning. Compared with controls, those assigned to supported employment plus CogSMART demonstrated significant reductions in postconcussive symptoms (Cohen d = 0.97) and improvements in prospective memory functioning (Cohen d = 0.72). Effect sizes favoring CogSMART for posttraumatic stress disorder symptom severity, depressive symptom severity, and attainment of competitive work within 14 wk were in the small to medium range (Cohen d = 0.35-0.49). Those who received CogSMART rated the intervention highly. Results suggest that adding CogSMART to supported employment may improve postconcussive symptoms and prospective memory. These effects, as well as smaller effects on psychiatric symptoms and ability to return to work, warrant replication in a larger trial.