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Respiratory InsufficiencyBEHABNCT03431493

Behavioral Activation-Rehabilitation to Improve Depressive Symptoms & Physical Function After Acute Respiratory Failure

A study testing Behavioral Activation - Rehabilitation in people with Respiratory Insufficiency and Depression, run by Johns Hopkins University at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

More and more people are surviving after receiving life support for respiratory failure in the intensive care unit, but these patients often experience problems with depression and physical functioning that lead to reduced quality of life. Read more about this study

Who is it for?
Ages 18 to 100 years
What is being tested?
Behavioral Activation - Rehabilitation
Could I receive a placebo?
No, everyone receives an active treatment
How many people
52 participants
Where
1 siteUnited States
Study dates
2 Mar 2018to 18 Jul 2024
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 100 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • ≥18 years old
  • Living at home before the current admission (not in a facility)
  • Acute respiratory failure managed in the ICU > 24hrs (≥1 of the following):
  • Mechanical ventilation via an endotracheal tube or tracheostomy > 12hrs (and not ventilator-dependent before admission) OR
  • Non-invasive ventilation (CPAP, BiPAP) > 4 hours in a 24 hour period provided for acute respiratory failure (not for Obstructive Sleep Apnoea (OSA) or other stable use) OR
  • High flow nasal cannula with Fraction of Inspired Oxygen (FiO2) ≥ 0.5 for ≥4 hours in a 24hr period
  • At least mild depressive symptoms (score ≥2 on PHQ-2 scale)

Who cannot join

  • Pre-existing cognitive impairment (based on review of medical records, or proxy- administered Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) score >3.3)
  • Declines informed consent or not capable of providing informed consent
  • Non-English speaking
  • Homelessness or living >50 miles away from study site
  • Bedbound prior to the current admission
  • Expected survival < 6 months according to ICU attending
Show all 14Show fewer
  • ICU Length Of Stay (LOS) > 30 days
  • Not discharged home from the hospital
  • Complex medical care expected soon after discharge (e.g. multiple planned surgeries, transplantation evaluation, extensive travel needs for hemodialysis, chemotherapy or radiation therapy, etc)
  • Active substance abuse or psychosis
  • Lack of access to telephone or inability to use telephone independently
  • Pregnancy
  • Suicidality
  • Incarcerated

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Johns Hopkins University

    Baltimore, Maryland, 21205

Other trials in United States

About this study

Official title: A Pilot, Feasibility Randomized Controlled Trial of a Behavioral Activation And Rehabilitation Intervention To Improve Psychological And Physical Impairments In Acute Respiratory Failure Survivors

More and more people are surviving after receiving life support for respiratory failure in the intensive care unit, but these patients often experience problems with depression and physical functioning that lead to reduced quality of life. There is a lack of treatment for these patients, with past research suggesting that treatment may be more successful if mental and physical health are addressed at the same time. This research evaluates whether a therapy delivered via telephone and home visits, combining treatment for depression and physical rehabilitation, is feasible and might help patients recover.

Read the detailed description

A growing number of Acute Respiratory Failure (ARF) survivors are burdened by depressive symptoms and physical impairments that last for years after intensive care unit discharge. Notably, depressive symptoms are independently associated with subsequent development of new impairments in physical functioning. There is a lack of treatment options to address these impairments in ARF survivors, with past research suggesting combining treatment for mental and physical health might be more successful.

Therefore, this study is designed to evaluate:

  1. The feasibility (primary outcome) of participant recruitment and retention in a pilot randomized controlled trial (RCT) of an intervention combining Behavioral Activation (an evidence-based psychological treatment for depression) and physical rehabilitation delivered via telephone and 2 home visits over 12-weeks versus a "usual care" control group.
  2. The efficacy (secondary outcome) of this Behavioral Activation-Rehabilitation intervention to reduce depressive symptoms and improve physical functioning.
  3. Modifiable psychosocial risk factors for depressive symptoms in ARF survivors and the association between the intervention and these modifiable factors.
Being tested
Behavioral Activation - Rehabilitation
Medical subject headings
Respiratory Insufficiency, Depression

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Behavioral Activation - RehabilitationBehavioural

    Participants will first receive a home visit from a physical therapist (PT) who will evaluate home safety and establish/verify the participant's exercise prescription. Within 1 week, an occupational therapist (OT) will visit the home to: 1) explain the purpose of behavioral activation (BA); 2) help the participant identify long-term recovery goals regarding "valued activities"; and 3) then, using the principles of BA, identify short-term goals for the next week and an action plan. The OT will then call the participant weekly (weeks 2-5) to review the status of the prior week's goals and use BA to set new goals for the upcoming week. The PT and OT will repeat home visits at week 6 to assess the participant's progress, and the OT will conduct phone calls every 2 weeks for weeks 8-12.

Study groups in NCT03431493
Study groupRoleWhat they receive
Behavioral Activation - RehabilitationExperimentalBehavioral Activation - Rehabilitation
Receives: Behavioral: Behavioral Activation - Rehabilitation
Usual Care ControlNo interventionUsual Care Control

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Feasibility Measure Per Participant

    Total number of intervention visits completed per patient as a proportion of the number of intervention visits each patient is intended to complete.

    Measured: End of intervention (12 weeks)

  2. Total Feasibility Measure

    Total number of intervention visits completed by all study participants as a proportion of total intervention visits expected in the study

    Measured: End of intervention (12 weeks)

  3. Feasibility Measure/Assess Loss to Follow-up

    Number of patients completing all study follow-up sessions as a proportion of the number of patients enrolled.

    Measured: End of intervention (12 weeks)

  4. Feasibility Measure

    Average number of patients enrolled per month over 12 weeks

    Measured: End of intervention (12 weeks)

Secondary outcomes (29)
  1. Hospital Anxiety and Depression Scale (HADS) - Anxiety Subscale

    An instrument used to assess anxiety symptoms. Scores range from 0 to 21. A HADS score ≥8 indicates clinically important symptoms on either subscale (more symptoms).

    Measured: End of intervention (12 weeks)

  2. Hospital Anxiety and Depression Scale (HADS) - Depression Subscale

    An instrument used to assess depressive symptoms. Scores range from 0 to 21. A HADS score ≥8 indicates clinically important symptoms on either subscale (more symptoms).

    Measured: End of intervention (12 weeks)

  3. Personal Health Questionnaire - 8 Item Version (PHQ-8)

    The PHQ-8 uses a 4-point Likert scale to assess depressive symptoms. The score range is 0 to 27. Scores 5-9 indicate "mild" symptoms, 10-14 "moderate", and ≥20 "severe" depressive symptoms. Higher score more symptoms.

    Measured: End of intervention (12 weeks)

  4. Activity Measure for Post-Acute Care Computer Adaptive Test (AMPAC-CAT) - Basic Mobility Score

    The AMPAC-CAT, a measure of physical function, has 269 items across three domains (basic mobility, daily activity and applied cognitive). The computer adaptive test requires a mean of 22 items from the item bank. Scores are norm-based (min 0 and mx 100). Higher scores indicate better function.

    Measured: End of intervention (12 weeks)

  5. EQ-5D-5L - Utility Score

    The EQ-5D-5L is an instrument developed by the EuroQol group to measure health status. The Eq-5D-5L has 5 dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 5 levels, ranging from 1 (no problems) to 5 (extreme problems). The resulting health utility score ranges from -0.11 to 1.00. Higher scores indicate better health status.

    Measured: End of intervention (12 weeks)

  6. Healthcare Utilization - Readmissions

    Patient interview to assess the following end of study (ie ~12 weeks) variable: number of patients with inpatient readmissions

    Measured: End of intervention (12 weeks)

  7. Healthcare Utilization - Ever Utilized Mental Health Care

    Patient interview to assess the following end of study (ie ~12 weeks) variable: number of participants who ever utilized outpatient mental health

    Measured: end of intervention (12 weeks)

  8. Healthcare Utilization - Rehabilitation

    Patient interview to assess the following end of study (ie ~12 weeks) variable: number of patients who ever utilized physical rehabilitation services

    Measured: end of intervention (12 weeks)

  9. Behavioral Activation for Depression SCALE (BAS)

    This is a 25-item scale that measures changes in avoidance and activation over the course of Behavioral Activation treatment using a 7 point scale (0=not at all to 6=completely). The scale is grouped into 4 subscales (Activation, Avoidance/Rumination, Work/School Impairment, and Social Impairment). To calculate a total score, items on all subscales other than Activation are reverse-coded and then an unweighted sum is computed. Score range 0 to 150. Higher scores indicate greater activation.

    Measured: End of intervention (12 weeks)

  10. Connor-Davidson Resilience Scale (CD RISC)

    This is a 25-item scale with each item rated on a 5-point scale (higher scores indicating greater resilience). The total score ranges from 0 to 100.

    Measured: End of intervention (12 weeks)

  11. Number of Phone Attempts Needed by the OT to Reach the Participant for Each Session

    Measure of adherence

    Measured: End of intervention (12 weeks)

  12. Percentage of Sessions Fully Completed and Partially Completed

    Measure of adherence for intervention group

    Measured: End of intervention (12 weeks)

  13. Montreal Cognitive Assessment (MoCA) - BLIND

    Measure of cognitive impairment. Score range 0 - 22. Higher scores indicate better cognitive function.

    Measured: End of intervention (12 weeks)

  14. Impact of Events Scale - Revised (IES-R)

    This is a measure the subjective response to a specific traumatic event (in this case - critical illness and associated ICU experience). The IES-R consists of 22 items, each rated on a 5-point scale; item scores are averaged to generate a mean total score (range: 0-4). Higher score indicates more stress symptoms.

    Measured: End of intervention (12 weeks)

  15. Brief Coping With Problems Experienced (Brief COPE) - Self Distraction Subscale

    A 28-item measure of coping strategies with responses provided using a 4-point Likert scale. Minimum score=2 to Maximum score=8. Higher score indicates greater use of the specified coping strategy.

    Measured: End of intervention (12 weeks)

  16. Brief Coping With Problems Experienced (Brief COPE) - Active Coping Subscale

    A 28-item measure of coping strategies with responses provided using a 4-point Likert scale. Minimum score=2 to Maximum score=8. Higher score indicates greater use of the specified coping strategy.

    Measured: End of intervention (12 weeks)

  17. Brief Coping With Problems Experienced (Brief COPE) - Denial Subscale

    A 28-item measure of coping strategies with responses provided using a 4-point Likert scale. Minimum score=2 to Maximum score=8. Higher score indicates greater use of the specified coping strategy.

    Measured: end of intervention (12 weeks)

  18. Brief Coping With Problems Experienced (Brief COPE) - Substance Use Subscale

    A 28-item measure of coping strategies with responses provided using a 4-point Likert scale. Minimum score=2 to Maximum score=8. Higher score indicates greater use of the specified coping strategy.

    Measured: End of intervention (12 weeks)

  19. Brief Coping With Problems Experienced (Brief COPE) - Emotional Support Subscale

    A 28-item measure of coping strategies with responses provided using a 4-point Likert scale. Minimum score=2 to Maximum score=8. Higher score indicates greater use of the specified coping strategy.

    Measured: End of intervention (12 weeks)

  20. Brief Coping With Problems Experienced (Brief COPE) - Instrumental Support Subscale

    A 28-item measure of coping strategies with responses provided using a 4-point Likert scale. Minimum score=2 to Maximum score=8. Higher score indicates greater use of the specified coping strategy.

    Measured: End of intervention (12 weeks)

  21. Brief Coping With Problems Experienced (Brief COPE) - Behavioral Disengagement Subscale

    A 28-item measure of coping strategies with responses provided using a 4-point Likert scale. Minimum score=2 to Maximum score=8. Higher score indicates greater use of the specified coping strategy.

    Measured: End of intervention (12 weeks)

  22. Brief Coping With Problems Experienced (Brief COPE) - Venting Subscale

    A 28-item measure of coping strategies with responses provided using a 4-point Likert scale. Minimum score=2 to Maximum score=8. Higher score indicates greater use of the specified coping strategy.

    Measured: End of intervention (12 weeks)

  23. Brief Coping With Problems Experienced (Brief COPE) - Positive Reframing Subscale

    A 28-item measure of coping strategies with responses provided using a 4-point Likert scale. Minimum score=2 to Maximum score=8. Higher score indicates greater use of the specified coping strategy.

    Measured: End of intervention (12 weeks)

  24. Brief Coping With Problems Experienced (Brief COPE) - Planning Subscale

    A 28-item measure of coping strategies with responses provided using a 4-point Likert scale. Minimum score=2 to Maximum score=8. Higher score indicates greater use of the specified coping strategy.

    Measured: End of intervention (12 weeks)

  25. Brief Coping With Problems Experienced (Brief COPE) - Humor Subscale

    A 28-item measure of coping strategies with responses provided using a 4-point Likert scale. Minimum score=2 to Maximum score=8. Higher score indicates greater use of the specified coping strategy.

    Measured: End of intervention (12 weeks)

  26. Brief Coping With Problems Experienced (Brief COPE) - Acceptance Subscale

    A 28-item measure of coping strategies with responses provided using a 4-point Likert scale. Minimum score=2 to Maximum score=8. Higher score indicates greater use of the specified coping strategy.

    Measured: End of intervention (12 weeks)

  27. Brief Coping With Problems Experienced (Brief COPE) - Religion Subscale

    A 28-item measure of coping strategies with responses provided using a 4-point Likert scale. Minimum score=2 to Maximum score=8. Higher score indicates greater use of the specified coping strategy.

    Measured: End of intervention (12 weeks)

  28. Brief Coping With Problems Experienced (Brief COPE) - Self-Blame Subscale

    A 28-item measure of coping strategies with responses provided using a 4-point Likert scale. Minimum score=2 to Maximum score=8. Higher score indicates greater use of the specified coping strategy.

    Measured: End of intervention (12 weeks)

  29. Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (SCID-5)

    A clinical interview to assess depressive symptoms. This is a qualitative assessment.

    Measured: End of intervention (12 weeks)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted13 Feb 2018
  2. Study start2 Mar 2018
  3. Primary completion18 Jul 2024
  4. Study completion18 Jul 2024

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
52 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03431493
Sponsor's protocol ID
IRB00143231
Other IDs
K23HL138206
Acronym
BEHAB
Status last verified
Sep 2025
First submitted
6 Feb 2018
Last updated
22 Sep 2025
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A study testing Behavioral Activation - Rehabilitation in people with Respiratory Insufficiency and Depression, run by Johns Hopkins University at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 7 inclusion and 14 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 22 Sep 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 19 Sep 2025). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Feasibility Measure Per Participant (time frame: End of intervention (12 weeks)). The study lists 4 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 22 Sep 2025.

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