Online Program

322779
A Pilot Randomized Controlled Trial of Interdisciplinary Rehabilitation for Victims of Torture and War with Affective Disorders and Chronic Pain in Kosovo


Tuesday, November 3, 2015 : 1:24 p.m. - 1:42 p.m.

Shr-Jie Wang, MPH, PhD, Danish Institute Against Torture (DIGNITY), Copenhagen, Denmark
Ardiana Byty├ži, AB, Kosova Rehabilitation Centre for Torture Victims, Pristina, Kosovo
Selvi Izeti, SI, Kosova Rehabilitation Centre for Torture Victims, Pristina, Kosovo
Melita Kallaba, MK, Kosova Rehabilitation Centre for Torture Victims, Pristina, Kosovo
Edith Montgomery, EM, Danish Institute Against Torture (DIGNITY), Copenhagen, Denmark
Background: Interdisciplinary rehabilitation has proven effective for treating the war-related trauma in the military population in Western countries but it remains unclear if this approach is applicable to the civilians in resource-poor war-affected countries.

Methods: A single-center, randomized, parallel-arm, single-masked controlled trial was implemented in Northern Kosovo. Thirty-four participants meeting the recruiting criteria were recruited and randomized to receive a once-daily multivitamin plus integrated treatments or multivitamin alone. The integrated treatments consist of 10 weekly sessions of individual 60-min cognitive behavior therapy (based on the adapted prolonged exposure therapy manual), 20-min breathing and relaxation exercise with emWave biofeedback device and 90-min group physiotherapy. Follow-up assessments were conducted at 3 and 6 months after baseline. Primary outcome measures are Harvard Trauma Questionnaire and Hopkins Symptoms Checklist, Short-Form McGill Pain Questionnaire, Visual Analogue Scale, anger frequency. The secondary outcome measures include: body mass index, handgrip strength, standing balance, employment rate and WHO-Disability Assessment Schedule II.

Results: There is little difference in primary outcomes (the overall scores of PTSD, depression, anxiety disorders and chronic pain) between the two groups, while the impact of intervention on secondary outcomes (the physical conditions, quality of life and community participation scores, employment) was slightly more noticeable, although most of the changes did not reach statistical significance.

Conclusions: The potential of interdisciplinary intervention in improving physical and social condition of victims in the post-conflict setting was demonstrated. Larger scale randomized controlled trial in a similar setting is needed with close monitoring of treatment integrity and data reliability.

Learning Areas:

Chronic disease management and prevention
Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs
Other professions or practice related to public health
Provision of health care to the public
Public health or related research

Learning Objectives:
Design an interdisciplinary rehabilitation program for long-term consequences of war trauma and evaluate both feasibility and the effectiveness of intervention in the post-conflict setting with limited resources. Describe the difference in primary outcomes (the overall scores of PTSD, depression, anxiety disorders and chronic pain) and secondary outcomes ( physical conditions, quality of life and community participation scores, employment rate) between the experimental and waiting-list groups.

Keyword(s): Treatment Outcomes, War

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I received MPH from Yale University School of Public Health and PhD in Clinical and Intervention Epidemiology from Swiss Tropical and Public Health Institute, Basel University. I have been working with war-affected population and marginalised population in Africa, Middle-east and south-east Asia with NGOs and UN agencies since 1998.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.