Usability evaluation of the SMART application for youth with mTBI.

OBJECTIVE: There is a dearth of evidence-based treatments available to address the significant morbidity associated with mild traumatic brain injury (mTBI). To address this gap, we designed a novel user-friendly, web-based application. We describe the preliminary evaluation of feasibility and usability of the application to promote recovery following mTBI in youth, the Self-Monitoring Activity-Restriction and Relaxation Treatment (SMART). SMART incorporates real-time recommendations for individualized symptom management and activity restriction along with training in cognitive-behavioral coping strategies. METHODS: We conducted a usability evaluation to assess and modify the SMART system prior to further study and deployment. Children ages 11-18 years presenting to the emergency department were recruited after symptoms resolved. Usability was assessed using a 60-min think-aloud protocol of teens and parents describing their interaction with the application. Upon completion of the tasks, each participant also completed the system usability scale (SUS). RESULTS: We performed tests with 4 parent/child dyads. The average age of the children was 13 years (standard deviation=1.8). The parents were an average of 41.5 years old (standard deviation=6.2). Research revealed that the participants were enthusiastic about the interactive portions of the tool particularly the video based sessions. Parents were concerned about the speed at which their child might move through the program and the children thought that the system required large amounts of reading. Based on user feedback, researchers modified SMART to include an audio file in every module and improved the system's aesthetic properties. The mean SUS score was 85, with high SUS scores (>68) indicating satisfactory usability. CONCLUSION: High initial usability and favorable user feedback provide a foundation for further iterative development and testing of the SMART application as a tool for managing recovery from concussion.

A computerized kiosk to teach injury prevention: is it as effective as human interaction?

BACKGROUND: An emergency department (ED) visit may be an effective place to screen and educate families about injury prevention. The purpose of this study was to determine if a computerized kiosk in a pediatric ED can screen families for injury risk and encourage them to make more safety changes at follow-up survey compared with an injury prevention specialist (IPS). METHODS: A prospective, randomized controlled study was performed with families of children younger than 14 years in an ED lobby. Families were screened for injury risk by computerized kiosk based on child's age category at triage (birth to 1 year, 1-4 years, 5-9 years, or 10-14 years). Families were randomized to receive either injury behavior instructions by kiosk printout or by IPS when answers to specific practices were deemed unsafe. Three weeks after intervention, families were telephoned to determine change in safety practices. RESULTS: Three hundred seventeen families completed ED kiosk screen at enrollment (172 kiosk, 145 IPS). On initial screen, kiosk families practiced 79.6% of behaviors safely versus 75.9% in the IPS group (p = 0.011). A total of 221 families (69.7%) were reached for follow-up (121 kiosk, 100 IPS). On average, IPS families improved their safe behavior responses by 8.3% versus 1.0% in the kiosk group (p < 0.0001). Significantly more families in the IPS group than in the kiosk group (36% vs. 23%, p < 0.03) used additional safety equipment after the intervention. CONCLUSION: A computerized kiosk based in a pediatric ED can help screen families for their injury risk. However, to elicit significant behavior change, an IPS discussing safety changes may be more effective.

Is an emergency department encounter for a motor vehicle collision truly a teachable moment?

BACKGROUND: Some have suggested that a pediatric emergency department (PED) visit for an injury represents a "teachable moment." Our aim was to determine if a motor vehicle collision (MVC) instigates greater change in booster seat use compared with children presenting for non-injury-related complaints. METHODS: A prospective pilot study of children 4 years to 8 years who never used a booster seat and were in a minor MVC were compared with children presenting to the PED for non-injury-related complaints. After completing a survey of demographics and knowledge about booster seats, all parents received brief, standardized counseling about booster seats. Two weeks after the PED visit, follow-up telephone calls were made to assess behavior change. RESULTS: Sixty-seven youth were enrolled (37 MVC group, 30 controls). Initially, 65 (97%) used a seat belt alone (36 MVC, 29 controls); the rest were unrestrained. There was no difference between the groups in mean age, sex of child, or insurance type. Significantly more families in the MVC group claimed that they would get a booster seat after their PED encounter (46% vs. 19%, p = 0.02) and their child would consistently use a booster seat (54% vs. 23%, p = 0.01). At follow-up, 45 families (67%) were reached (25 cases [68%] and 20 controls [67%]). There was no significant difference between the groups in having a booster seat at follow-up (12 cases [48%] and 9 controls [45%]) and reports of booster seat use more than 75% of the time (9 cases [36%] and 7 controls [35%]). CONCLUSION: A minor MVC did not serve as a teachable moment to entice families to consistently use a booster seat more than families presenting to a PED for non-injury-related complaints. However, more than one third of the families who learned about booster seats in the PED reported using a booster seat regularly. LEVEL OF EVIDENCE: Therapeutic study, level II.