. 2019 Sep 18;9(9):e028711. doi: 10.1136/bmjopen-2018-028711

Table 3.

A summary of recommendations from pilot study findings and expert panel review

Pilot study	Expert panel review
Design: a case–controlled study Study components: Non-randomisation—to identify participant’s willingness to attend therapy as a measure of good compliance. Treatment application—treatment was given at early stage of injury (2 weeks postinjury) to measure the treatment effect vs spontaneous’ recovery. Treatment accessibility—outpatient hospital-based treatment is feasible. Treatment compliance–high attrition rate (50%), which compromised the treatment fidelity. Reasons for poor treatment compliance were: Treatment frequency and intensity (>1 hour/weekly for the first 3 months followed by monthly session the following 3 months) Mental fatigue. ‘Unreadiness’ to receive treatment. Treatment and transportation costs. Work demand (limited time off work and income lost). Treatment method—clinical application of treatment was acceptable to participants. Treatment effect—the application of effect size measurement is consistent with MOST recommendation. Outcome measure application—S-NAB was able to measure score differences in its five domains. DTI parameters reported changes consistent with current literature evidence in mTBI population.	Design: Randomisation was recommended in clinical trial design Review components: Fidelity of treatment Clear information on purpose, method and treatment goals during treatment sessions. An appointment card with specific date and time of therapy sessions. A reminder through phone calls a week and a day before each therapy Review at 72 hours, 2 weeks, 6 weeks and 3 months (baseline) to increase sensitivity towards participant selection, early medical intervention if required and to improve adherence. Treatment method As outpatient setting, with frequency 1 hour/week for 12 weeks duration. Individualised treatment approach with standardisation through direct attention training and metacognitive strategy To clarify the metacognitive strategies applied in therapy such as ‘self-monitoring’, self-instructional procedure’, ‘self-evaluation’, ‘rehearsal’, ‘self-pacing’, ‘positive self-statement’, use of internal/external strategy. Outcome measure Neuropsychological assessment as a practice standard Guided individualised goals (GAS application) to standardise the functional goal outcome measurement for both groups.

Pilot study

Expert panel review

Design: a case–controlled study
Study components:
Non-randomisation—to identify participant’s willingness to attend therapy as a measure of good compliance.
Treatment application—treatment was given at early stage of injury (2 weeks postinjury) to measure the treatment effect vs spontaneous’ recovery.
Treatment accessibility—outpatient hospital-based treatment is feasible.
Treatment compliance–high attrition rate (50%), which compromised the treatment fidelity. Reasons for poor treatment compliance were:

Treatment frequency and intensity (>1 hour/weekly for the first 3 months followed by monthly session the following 3 months)
Mental fatigue.
‘Unreadiness’ to receive treatment.
Treatment and transportation costs.
Work demand (limited time off work and income lost).

Treatment method—clinical application of treatment was acceptable to participants.
Treatment effect—the application of effect size measurement is consistent with MOST recommendation.
Outcome measure application—S-NAB was able to measure score differences in its five domains. DTI parameters reported changes consistent with current literature evidence in mTBI population.

Design: Randomisation was recommended in clinical trial design
Review components:
Fidelity of treatment

Clear information on purpose, method and treatment goals during treatment sessions.
An appointment card with specific date and time of therapy sessions.
A reminder through phone calls a week and a day before each therapy
Review at 72 hours, 2 weeks, 6 weeks and 3 months (baseline) to increase sensitivity towards participant selection, early medical intervention if required and to improve adherence.

Treatment method

As outpatient setting, with frequency 1 hour/week for 12 weeks duration.
Individualised treatment approach with standardisation through direct attention training and metacognitive strategy
To clarify the metacognitive strategies applied in therapy such as ‘self-monitoring’, self-instructional procedure’, ‘self-evaluation’, ‘rehearsal’, ‘self-pacing’, ‘positive self-statement’, use of internal/external strategy.

Outcome measure
Neuropsychological assessment as a practice standard
Guided individualised goals (GAS application) to standardise the functional goal outcome measurement for both groups.

DTI, Diffusion Tensor Imaging; GAS, Goal Attainment Scaling; MOST, Multiphase Optimisation Strategy; mTBI, mild traumatic brain injury; S-NAB, Neuropsychological Assessment Battery-Screening Module.