Continuity Therapy for couples living with acquired brain injury: a non-randomised uncontrolled feasibility study

BACKGROUND: Brain injuries can have a significant negative impact on marriages/partnerships. Available interventions either require specialists trained in relationship therapy (which most rehabilitation services have no access to) or offer more structured manualised approaches that are restricted in scope and have generally led to only small improvements. Continuity Therapy was developed to provide a manualised approach that can be delivered by brain injury clinicians without specialist training in relationship therapy, and that addresses a broader range of relationship issues. Study aims were to complete a preliminary evaluation of the benefits of the therapy to determine whether progression to a randomised controlled trial is justified; to obtain feedback that will be used to refine the therapy; and to evaluate selection criteria and patient-reported outcome measures. METHODS: Fifteen couples living with brain injury received the therapy. They completed questionnaires about their relationship and psychological wellbeing before and after the therapy, and at 3-month follow-up, and rated how helpful they found the therapy. They and the therapists were also interviewed (or provided written feedback) about their experience of the therapy. Criteria about progression to an RCT were established in terms of numbers showing statistically reliable improvement on relationship questionnaires, ratings of helpfulness, and non-completion rates. RESULTS: Progression criteria were met. Although not everyone benefitted, participants showed a mean large effect improvement on post-therapy questionnaires about their relationship, and this was sustained at 3 months. They showed a mean moderate effect improvement in their psychological wellbeing, again sustained at 3 months. Couples and therapists made suggestions about improvements to the therapy, the circumstances of couples that may impact the effectiveness of the therapy (relevant to selection criteria), and the suitability of outcome measures. CONCLUSIONS: Effect sizes should be treated with caution because of the limitations of the study. Nevertheless, the therapy showed sufficient promise to support progression to an RCT. A broader range of outcome measures is required to capture the benefits of the therapy for the relationship. Refinement of the selection criteria is also needed. TRIAL REGISTRATION: The study was registered with ISRCTN: The UK's Clinical Study Registry (registration number-93611293) on 6.6.2023.