Neurology · Medical Literature
Feasibility of the Italian version of the Teen Online Problem Solving Program (I-TOPS) in a sample of adolescents with acquired brain injury: Results from a randomized controlled trial.
Abstract
Numerous neurocognitive and behavioral deficits in adolescents with acquired brain injury have been associated with impairments in executive functions. Nevertheless, many adolescents do not receive targeted rehabilitation. One of the most validated interventions addressing executive dysfunction in this population is the web-based Teen Online Problem Solving (TOPS) program, developed in the United States in the early 2000s. This study aimed to evaluate the feasibility of the Italian version of TOPS (I-TOPS) in its first implementation in Italy, compared with an active control wellness intervention in adolescents aged 11-19 years. Data on the feasibility of both the training and the study design and procedures are reported from the randomized controlled trial conducted to assess feasibility prior to a full evaluation of efficacy. Forty-two adolescents participated, 21 allocated to I-TOPS and 21 to the wellness intervention. Overall willingness to participate in the study, assessed before randomization across the full sample, was moderate (61.73%). The I-TOPS group, but not the wellness group, demonstrated adequate training adherence, training satisfaction and participation rates. No technological issues hindering program completion, accessibility difficulties with the web-based platform or significant loss to follow-up among participants who completed the training were reported in either group. However, challenges in collecting outcome measures on parent functioning due to refusal were observed in both groups. Adherence to the planned assessment timeline was satisfactory but not fully met. In sum, the findings suggest that I-TOPS represents a feasible approach that is subjectively perceived as useful and engaging by adolescents with acquired brain injury and their families. Nevertheless, the moderate acceptance rate in the study and the potential stigma associated with reporting mental health concerns among some parents may limit the generalizability of the findings. These factors should be taken into account when planning efficacy studies. This study was registered at ClinicalTrials.gov (NCT05169788).
Clinical relevance
Adolescents with acquired brain injury (ABI) frequently suffer executive dysfunction that impairs neurocognitive and behavioral outcomes, yet targeted rehabilitation remains largely inaccessible in non-English-speaking countries. This RCT addresses the critical implementation gap of adapting and deploying the evidence-based, web-based Teen Online Problem Solving (TOPS) program—developed in the US in the early 2000s—for Italian adolescents aged 11–19, a population with limited access to validated interventions. Feasibility data are essential before large-scale efficacy trials, making these findings immediately relevant for neurorehabilitation clinicians and health systems planning ABI services in Europe.
Key findings
1. Overall pre-randomization willingness to participate in the study across the full sample was moderate, at 61.73%, indicating meaningful barriers to recruitment that must be addressed in future efficacy trials. 2. Of the 42 enrolled adolescents, 21 were allocated to I-TOPS and 21 to an active control wellness intervention, confirming feasibility of a 1:1 randomization scheme in this population. 3. The I-TOPS group—but not the wellness control group—demonstrated adequate training adherence, training satisfaction, and participation rates, supporting the specific acceptability of the intervention arm. 4. No technological barriers (platform accessibility issues or technical failures) hindering program completion were reported in either group, validating the web-based delivery model for this age range. 5. No significant loss to follow-up was observed among participants who completed the training in either group, supporting retention feasibility for a future full-scale RCT. 6. Collection of parent-reported outcome measures was notably challenged by parental refusal in both groups, potentially reflecting stigma associated with disclosing mental health concerns, and adherence to the planned assessment timeline was satisfactory but not fully met—two critical limitations to address in efficacy study design.
Practice implications
Neurorehabilitation teams in Italy and other non-English-speaking countries may consider I-TOPS a feasible, web-based adjunct for adolescents aged 11–19 with ABI and executive dysfunction, particularly given the absence of technological barriers and strong participant-level adherence and satisfaction in the intervention arm. Clinician-led recruitment strategies should proactively address the moderate acceptance rate (~62%) and parental stigma around mental health disclosure—for example, through pre-enrollment psychoeducation and destigmatization counseling—to optimize enrollment and completeness of family-reported outcomes in future efficacy trials. Until full efficacy data are available from a powered RCT, I-TOPS should be positioned as a promising but investigational complement to standard neurorehabilitation rather than a replacement for established face-to-face executive function therapies.