Validation of Strategic Memory Advanced Reasoning Training as an efficient and effective approach to treating warfighters with persistent cognitive complaints associated with mild traumatic brain injury
IntroductionThis study directly compared the relative effectiveness of Strategic Memory Advanced Reasoning Training (SMART), which focuses on metacognitive strategies, to a traditional cognitive rehabilitation (CR) program previously developed and validated for the Study of Cognitive Rehabilitation...
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Frontiers Media S.A.
2025-04-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2025.1541894/full |
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| author | Andrew J. Darr Andrew J. Darr Andrew J. Darr Angela Basham Angela Basham Angela Basham Jessica L. Ryan Melissa Caswell Melissa Caswell Melissa Caswell Juan Lopez Juan Lopez Juan Lopez Jennifer Zientz Erin Venza Ida Babakhanyan Ida Babakhanyan Ida Babakhanyan Sandra Chapman Jason M. Bailie Jason M. Bailie Jason M. Bailie |
| author_facet | Andrew J. Darr Andrew J. Darr Andrew J. Darr Angela Basham Angela Basham Angela Basham Jessica L. Ryan Melissa Caswell Melissa Caswell Melissa Caswell Juan Lopez Juan Lopez Juan Lopez Jennifer Zientz Erin Venza Ida Babakhanyan Ida Babakhanyan Ida Babakhanyan Sandra Chapman Jason M. Bailie Jason M. Bailie Jason M. Bailie |
| author_sort | Andrew J. Darr |
| collection | DOAJ |
| description | IntroductionThis study directly compared the relative effectiveness of Strategic Memory Advanced Reasoning Training (SMART), which focuses on metacognitive strategies, to a traditional cognitive rehabilitation (CR) program previously developed and validated for the Study of Cognitive Rehabilitation Effectiveness study (SCORE), in treating warfighters with a history of mild traumatic brain injury (mTBI) and persistent post-concussive symptoms (PCS).MethodsA total of 148 active-duty service members (SMs) were recruited for this randomized controlled trial (RCT). Participants were randomly assigned to either the SMART (n = 80) or SCORE (n = 68) intervention arms. Outcome measures were administered at the start (T1) and end of treatment (T2), and at 3 months post-treatment (T3). Only participants with data from all timepoints and adequate performance validity (SMART: n = 51; SCORE: n = 43) were used in analyses. The primary outcome measure was the Global Deficit Scale (GDS), a composite of seven different objective measures of cognitive performance. Secondarily, participants completed the Neurobehavioral Symptom Inventory (NSI) and Key Behaviors Change Inventory (KBCI) self-report measures of post concussive symptoms (PCS). Lastly, a cost effectiveness analysis (CEA) was performed directly comparing the relative efficiencies of the two CR interventions.ResultsMixed Analysis of Variance (ANOVA) showed a significant decrease in GDS scores from T1 to T3 (p < 0.001, ηp2 = 0.217), irrespective of intervention type (p = 0.986, ηp2 = 0.000). The greatest improvement occurred between T1 (SMART: M = 0.70, SD = 0.79; SCORE: M = 0.70, SD = 0.72) and T2 (SMART: M = 0.29, SD = 0.58; SCORE: M = 0.29, SD = 0.40), with scores plateauing at T3 (SMART: M = 0.28, SD = 0.52; SCORE: M = 0.29, SD = 0.57). Similarly, there was a significant decrease in NSI scores over the same period (p < 0.001, ηp2 = 0.138), regardless of intervention type (p = 0.412, ηp2 = 0.010). Additionally, treatment improved patient perceived functionality (KBCI) from T1 to T2 and these gains remained stable at T3 (p < 0.001, ηp2 = 0.377). CEA revealed SMART represented a 60% reduction in cost compared to SCORE.DiscussionThis study demonstrates that SMART is an effective strategy for reducing cognitive deficits and PCS in SMs with a history of mTBI, producing comparable outcomes to a traditional CR program in less time and with improved cost efficiencies. |
| format | Article |
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| institution | OA Journals |
| issn | 1664-2295 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Neurology |
| spelling | doaj-art-c5a3c4185ee649858812fc65cba33f802025-08-20T02:16:44ZengFrontiers Media S.A.Frontiers in Neurology1664-22952025-04-011610.3389/fneur.2025.15418941541894Validation of Strategic Memory Advanced Reasoning Training as an efficient and effective approach to treating warfighters with persistent cognitive complaints associated with mild traumatic brain injuryAndrew J. Darr0Andrew J. Darr1Andrew J. Darr2Angela Basham3Angela Basham4Angela Basham5Jessica L. Ryan6Melissa Caswell7Melissa Caswell8Melissa Caswell9Juan Lopez10Juan Lopez11Juan Lopez12Jennifer Zientz13Erin Venza14Ida Babakhanyan15Ida Babakhanyan16Ida Babakhanyan17Sandra Chapman18Jason M. Bailie19Jason M. Bailie20Jason M. Bailie21Traumatic Brain Injury Center of Excellence (TBICoE), Silver Spring, MD, United StatesGeneral Dynamics Information Technology, Silver Spring, MD, United StatesIntrepid Spirit, Naval Hospital Camp Pendleton, Oceanside, CA, United StatesTraumatic Brain Injury Center of Excellence (TBICoE), Silver Spring, MD, United StatesGeneral Dynamics Information Technology, Silver Spring, MD, United StatesIntrepid Spirit, Naval Hospital Camp Pendleton, Oceanside, CA, United StatesTampa VA Research and Education Foundation at James A. Haley Veterans’ Hospital, Department of Emergency Medicine, University of South Florida, Tampa, FL, United StatesTraumatic Brain Injury Center of Excellence (TBICoE), Silver Spring, MD, United StatesGeneral Dynamics Information Technology, Silver Spring, MD, United StatesIntrepid Spirit, Naval Hospital Camp Pendleton, Oceanside, CA, United StatesTraumatic Brain Injury Center of Excellence (TBICoE), Silver Spring, MD, United StatesGeneral Dynamics Information Technology, Silver Spring, MD, United StatesIntrepid Spirit, Naval Hospital Camp Pendleton, Oceanside, CA, United StatesCenter for BrainHealth, Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, TX, United StatesCenter for BrainHealth, Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, TX, United StatesTraumatic Brain Injury Center of Excellence (TBICoE), Silver Spring, MD, United StatesGeneral Dynamics Information Technology, Silver Spring, MD, United StatesIntrepid Spirit, Naval Hospital Camp Pendleton, Oceanside, CA, United StatesCenter for BrainHealth, Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, TX, United StatesTraumatic Brain Injury Center of Excellence (TBICoE), Silver Spring, MD, United StatesGeneral Dynamics Information Technology, Silver Spring, MD, United StatesIntrepid Spirit, Naval Hospital Camp Pendleton, Oceanside, CA, United StatesIntroductionThis study directly compared the relative effectiveness of Strategic Memory Advanced Reasoning Training (SMART), which focuses on metacognitive strategies, to a traditional cognitive rehabilitation (CR) program previously developed and validated for the Study of Cognitive Rehabilitation Effectiveness study (SCORE), in treating warfighters with a history of mild traumatic brain injury (mTBI) and persistent post-concussive symptoms (PCS).MethodsA total of 148 active-duty service members (SMs) were recruited for this randomized controlled trial (RCT). Participants were randomly assigned to either the SMART (n = 80) or SCORE (n = 68) intervention arms. Outcome measures were administered at the start (T1) and end of treatment (T2), and at 3 months post-treatment (T3). Only participants with data from all timepoints and adequate performance validity (SMART: n = 51; SCORE: n = 43) were used in analyses. The primary outcome measure was the Global Deficit Scale (GDS), a composite of seven different objective measures of cognitive performance. Secondarily, participants completed the Neurobehavioral Symptom Inventory (NSI) and Key Behaviors Change Inventory (KBCI) self-report measures of post concussive symptoms (PCS). Lastly, a cost effectiveness analysis (CEA) was performed directly comparing the relative efficiencies of the two CR interventions.ResultsMixed Analysis of Variance (ANOVA) showed a significant decrease in GDS scores from T1 to T3 (p < 0.001, ηp2 = 0.217), irrespective of intervention type (p = 0.986, ηp2 = 0.000). The greatest improvement occurred between T1 (SMART: M = 0.70, SD = 0.79; SCORE: M = 0.70, SD = 0.72) and T2 (SMART: M = 0.29, SD = 0.58; SCORE: M = 0.29, SD = 0.40), with scores plateauing at T3 (SMART: M = 0.28, SD = 0.52; SCORE: M = 0.29, SD = 0.57). Similarly, there was a significant decrease in NSI scores over the same period (p < 0.001, ηp2 = 0.138), regardless of intervention type (p = 0.412, ηp2 = 0.010). Additionally, treatment improved patient perceived functionality (KBCI) from T1 to T2 and these gains remained stable at T3 (p < 0.001, ηp2 = 0.377). CEA revealed SMART represented a 60% reduction in cost compared to SCORE.DiscussionThis study demonstrates that SMART is an effective strategy for reducing cognitive deficits and PCS in SMs with a history of mTBI, producing comparable outcomes to a traditional CR program in less time and with improved cost efficiencies.https://www.frontiersin.org/articles/10.3389/fneur.2025.1541894/fullmild traumatic brain injuryconcussionpost concussive symptomscognitive rehabilitationmilitary health |
| spellingShingle | Andrew J. Darr Andrew J. Darr Andrew J. Darr Angela Basham Angela Basham Angela Basham Jessica L. Ryan Melissa Caswell Melissa Caswell Melissa Caswell Juan Lopez Juan Lopez Juan Lopez Jennifer Zientz Erin Venza Ida Babakhanyan Ida Babakhanyan Ida Babakhanyan Sandra Chapman Jason M. Bailie Jason M. Bailie Jason M. Bailie Validation of Strategic Memory Advanced Reasoning Training as an efficient and effective approach to treating warfighters with persistent cognitive complaints associated with mild traumatic brain injury Frontiers in Neurology mild traumatic brain injury concussion post concussive symptoms cognitive rehabilitation military health |
| title | Validation of Strategic Memory Advanced Reasoning Training as an efficient and effective approach to treating warfighters with persistent cognitive complaints associated with mild traumatic brain injury |
| title_full | Validation of Strategic Memory Advanced Reasoning Training as an efficient and effective approach to treating warfighters with persistent cognitive complaints associated with mild traumatic brain injury |
| title_fullStr | Validation of Strategic Memory Advanced Reasoning Training as an efficient and effective approach to treating warfighters with persistent cognitive complaints associated with mild traumatic brain injury |
| title_full_unstemmed | Validation of Strategic Memory Advanced Reasoning Training as an efficient and effective approach to treating warfighters with persistent cognitive complaints associated with mild traumatic brain injury |
| title_short | Validation of Strategic Memory Advanced Reasoning Training as an efficient and effective approach to treating warfighters with persistent cognitive complaints associated with mild traumatic brain injury |
| title_sort | validation of strategic memory advanced reasoning training as an efficient and effective approach to treating warfighters with persistent cognitive complaints associated with mild traumatic brain injury |
| topic | mild traumatic brain injury concussion post concussive symptoms cognitive rehabilitation military health |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2025.1541894/full |
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