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Effect of a combined brief narrative exposure therapy with case management versus treatment as usual in primary care for patients with traumatic stress sequelae following intensive care medicine: study protocol for a multicenter randomized controlled trial (PICTURE)

Effect of a combined brief narrative exposure therapy with case management versus treatment as usual in primary care for patients with traumatic stress sequelae following intensive care medicine: study protocol for a multicenter randomized controlled trial (PICTURE)

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GENSICHEN, Jochen, Susanne SCHULTZ, Maggie SCHAUER, Antje BERGMANN, Stefanie JOOS, Thomas G SCHULZE, Ulrich MANSMANN, Roland KOCH, Andreas WALTHER, Thomas ELBERT, 2018. Effect of a combined brief narrative exposure therapy with case management versus treatment as usual in primary care for patients with traumatic stress sequelae following intensive care medicine: study protocol for a multicenter randomized controlled trial (PICTURE). In: Trials. 19, 480. ISSN 1468-6708. eISSN 1745-6215. Available under: doi: 10.1186/s13063-018-2853-7

@article{Gensichen2018-09-10Effec-44469, title={Effect of a combined brief narrative exposure therapy with case management versus treatment as usual in primary care for patients with traumatic stress sequelae following intensive care medicine: study protocol for a multicenter randomized controlled trial (PICTURE)}, year={2018}, doi={10.1186/s13063-018-2853-7}, volume={19}, issn={1468-6708}, journal={Trials}, author={Gensichen, Jochen and Schultz, Susanne and Schauer, Maggie and Bergmann, Antje and Joos, Stefanie and Schulze, Thomas G and Mansmann, Ulrich and Koch, Roland and Walther, Andreas and Elbert, Thomas}, note={Article Number: 480} }

eng Joos, Stefanie Koch, Roland Bergmann, Antje Mansmann, Ulrich Schulze, Thomas G Background:<br />Traumatic events like critical illness and intensive care are threats to life and bodily integrity and pose a risk factor for posttraumatic stress disorder (PTSD). PTSD affects the quality of life and morbidity and may increase health-care costs. Limited access to specialist care results in PTSD patients being treated in primary care settings. Narrative exposure therapy (NET) is based on the principles of cognitive behavioral therapy and has shown positive effects when delivered by health-care professionals other than psychologists. The primary aims of the PICTURE trial (from “PTSD after ICU survival”) are to investigate the effectiveness and applicability of NET adapted for primary care with case management in adults diagnosed with PTSD after intensive care.<br /><br />Methods/design:<br />This is an investigator-initiated, multi-center, primary care-based, randomized controlled two-arm parallel group, observer-blinded superiority trial conducted throughout Germany. In total, 340 adult patients with a total score of at least 20 points on the posttraumatic diagnostic scale (PDS-5) 3 months after receiving intensive care treatment will be equally randomized to two groups: NET combined with case management and improved treatment as usual (iTAU). All primary care physicians (PCPs) involved will be instructed in the diagnosis and treatment of PTSD according to current German guidelines. PCPs in the iTAU group will deliver usual care during three consultations. In the experimental group, PCPs will additionally be trained to deliver an adapted version of NET (three sessions) supported by phone-based case management by a medical assistant. At 6 and 12 months after randomization, structured blinded telephone interviews will assess patient-reported outcomes. The primary composite endpoint is the absolute change from baseline at month 6 in PTSD symptom severity measured by the PDS-5 total score, which also incorporates the death of any study patients. Secondary outcomes cover the domains depression, anxiety, disability, health-related quality-of-life, and cost-effectiveness. The principal analysis is by intention to treat.<br /><br />Discussion:<br />If the superiority of the experimental intervention over usual care can be demonstrated, the combination of brief NET and case management could be a treatment option to relieve PTSD-related symptoms and to improve primary care after intensive care. Effect of a combined brief narrative exposure therapy with case management versus treatment as usual in primary care for patients with traumatic stress sequelae following intensive care medicine: study protocol for a multicenter randomized controlled trial (PICTURE) 2018-09-10 Schulze, Thomas G Elbert, Thomas Mansmann, Ulrich 2019-01-09T10:06:31Z Walther, Andreas Schauer, Maggie Koch, Roland terms-of-use Schauer, Maggie Joos, Stefanie Elbert, Thomas Gensichen, Jochen Walther, Andreas 2019-01-09T10:06:31Z Schultz, Susanne Gensichen, Jochen Bergmann, Antje Schultz, Susanne

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