Feasibility and Efficacy of a Hybrid Delivery Model of the Categorization Program for Individuals With Chronic Traumatic Brain Injury: A Pilot Study

Purpose: The present study examined the feasibility and preliminary efficacy of a hybrid, telehealth-adapted delivery of the Categorization Program (CP), an evidence-based cognitive rehabilitation intervention, for adults with chronic moderate-to-severe traumatic brain injury (msTBI) who were living in the community and not engaged in ongoing rehabilitation services. It was hypothesized that the telehealth-adapted CP would demonstrate high feasibility and lead to improvements in intervention-specific and standardized neuropsychological outcomes. Method: This study employed a single-group, pre–post intervention design with follow-up assessments. Adults aged 18–65 years with msTBI sustained at least 1 year prior to enrollment were recruited from hospital and rehabilitation center databases. Participants completed a baseline neuropsychological assessment, followed by the eight-level, hierarchically structured CP intervention delivered primarily via telehealth. Neuropsychological measures were administered pre-intervention and post-intervention, while CP-specific measures were administered pre-intervention and post-intervention and at 4- and 8-week follow-ups. Feasibility was evaluated through recruitment, adherence, retention, and acceptability metrics. Effectiveness was measured by changes in cognitive performance using nonparametric Wilcoxon signed-ranks tests. Results: Of 82 individuals screened, 21 enrolled, and 16 (76.2%) completed the full intervention. Retention rates for CP-specific assessments were 93.8% post-intervention, 68.8% at 4 weeks, and 75.0% at 8 weeks. Participants reported functional improvements, particularly in orientation, memory strategy use, and independence. Significant improvements were observed on CP-specific outcome measures and on certain neuropsychological outcomes. Gains were maintained at follow-up among participants. Conclusions: Findings provide preliminary evidence that a telehealth-adapted CP is feasible, acceptable, and effective for individuals with chronic msTBI. Further clinical studies with larger samples are warranted.