Assessing implementation outcome measures of a self-regulation intervention for providers and older adults with and without traumatic brain injury

Research Objectives: To evaluate the feasibility, acceptability, and appropriateness of mental contrasting with implementation intentions (MCII) as a self-regulation intervention targeting fall prevention in older adults with and without traumatic brain injury (TBI)

Design: Mixed methods, pre-post pilot study

Setting: university clinic; telepractice

Participants: Fourteen older adults (aged 65+), 5 with a history of TBI and 9 without TBI, and 8 graduate speech-language pathology student clinicians

Interventions: MCII was used to promote behavior change in fall prevention. Graduate student clinicians in speech-language pathology were trained to conduct the intervention. Participants were in an experimental group that learned MCII as a self-regulation strategy for behavior change. After at least three weeks, participants reported if the strategy was used.

Main Outcome Measures: Participants and clinicians completed Likert scale ratings of implementation outcome measures (IOM; Weiner et al., 2017), which included Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure (FIM). Additional measures addressed therapist adherence to protocol, client participation, modifications to treatment, and open-ended written responses. Participants also completed a semi-structured interview related to overall perceptions of MCII.

Results: Participants in both injury status groups rated MCII (out of 5; “highly agree”) as acceptable: 4.8 (SD=.40), appropriate: 4.9 (SD=.23), and feasible: 4.9(SD=.43), and elaborated on how MCII was used to achieve goals. Similarly, clinicians rated the intervention (out of 5) as acceptable: 4.6 (SD=.53), appropriate: 4.4 (SD=.63), and feasible: 4.6 (SD=.53) for clinical care. Clinician adherence in both conditions was high (98% for MCII and 100% for control). Client participation was lower (78% for TBI compared to 88% in typical) and more modifications to treatment were needed for the TBI group to participate in MCII (6.83 modifications compared to 3.3 in typical).

Conclusions: MCII is a feasible, acceptable, and appropriate strategy for promoting fall prevention in older adults with and without TBI. Additionally, novice clinicians can be trained to effectively provide MCII to actively engage older adults in fall prevention efforts.

Author(s) Disclosures: The authors have no relevant financial or nonfinancial relationships to disclose.