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Background: Traumatic injuries, defined as physical injuries with sudden onset, are a major cause of distress and disability, with far-reaching societal consequences. A significant proportion of trauma survivors report persistent symptoms and difficulties after the injury, and studies show unmet health care needs. Self-management programs delivered in the sub-acute phase after traumatic injuries are scarcely evaluated. The aim of the present study is to evaluate the effectiveness of a self-management program (SEMPO), delivered 3-4 months after moderate-to-severe traumatic injury., Methods: This study protocol describes a pragmatic randomized controlled trial (RCT) with two classical RCT arms (intervention and control) and an explorative self-selection arm. 220 patients will be recruited from Oslo University Hospital, the largest Trauma Referral Centre in Norway. Patients aged 18-72 years residing in the south-east region of Norway, admitted to the Trauma Centre directly or within 72 h after having sustained a moderate to severe traumatic injury, defined as a New Injury Severity Score > 9, having at least 2 days hospital stay, and reporting injury-related symptoms and impairment at discharge from the acute hospital will be included. Patients will be randomly assigned to either a classical RCT randomization arm (intervention or control arm) or to a self-selection arm. In the randomization arm, participants are further randomized into intervention or control group. Participants allocated to the self-selection arm will choose to partake either in the intervention or control arm. The primary outcome is the level of self-efficacy in trauma coping assessed 6 months after completion of the intervention, with a similar time point for the control group. Secondary outcomes include symptom burden, physical functioning and disability, return to work and health care utilization, health-related quality of life, and communication competency. In addition, patients will be asked to nominate one domain-related measurement as their preferred outcome measure., Discussion: This RCT will determine the effect of a self-management program tailored to patients with moderate to severe physical trauma, and the self-selection arm incorporates the potential influence of patient treatment preferences on intervention results. If the intervention proves effective, cost-effectiveness and cost-utility analyses will be performed and thereby provide important information for clinicians and policy makers., Trial Registration: The study is registered in Clinical Trials with the identifier: NCT06305819. Registered on March 05, 2004., (© 2024. The Author(s).)

The cerebral hemispheres are specialized for different cognitive functions and receive divergent information from the sensory organs, so that the interaction between the hemispheres is a crucial aspect of perception and cognition. At the same time, the major fiber tract responsible for this interaction, the corpus callosum, shows a structural development across the lifespan which is over-proportional. That is, compared to changes in overall forebrain volume, the corpus callosum shows an accentuated growth during childhood, adolescence, and early adulthood, as well as pronounced decline in older age. However, this over-proportionality of growth and decline along with potential consequences for cognition, have been largely overlooked in empirical research. In the present study we systematically address the proportionality of callosal development in a large mixed cross-sectional and longitudinal sample (1867 datasets from 1014 unique participants), covering the human lifespan (age range 4-93 years), and examine the cognitive consequences of the observed changes. Relative corpus callosum thickness was measured at 60 segments along the midsagittal surface, and lifespan trajectories were clustered to identify callosal subsections of comparable lifespan development. While confirming the expected inverted u-shaped lifespan trajectories, we also found substantial regional variation. Compared with anterior clusters, the most posterior sections exhibited an accentuated growth during development which extends well into the third decade of life, and a protracted decline in older age which is delayed by about 10 years (starting mid to late 50s). We further showed that the observed longitudinal changes in relative thickness of the mid splenium significantly mediates age-related changes in tests assessing verbal knowledge and non-verbal visual-spatial abilities across the lifespan. In summary, we demonstrate that analyzing the proportionality of callosal growth and decline offers valuable insight into lifespan development of structural connectivity between the hemispheres, and suggests consequences for the cognitive development of perception and cognition., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)