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Gallow S, Beard J, McGinley J, Olver J, Williams G. Cardiorespiratory fitness assessment and training in the early sub-acute phase of recovery following traumatic brain injury: a systematic review. Brain Inj 2024:1-12. [PMID: 38828871 DOI: 10.1080/02699052.2024.2361638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 05/27/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVES To examine the safety of cardiorespiratory fitness (CRF) assessment and training in the early sub-acute phase of recovery (≤3 months) following moderate-to-extremely severe traumatic brain injury (TBI). METHODS A systematic review was completed in accordance with the PRISMA guidelines. Studies investigating adults and adolescents ≥15 years with moderate-to-extremely severe TBI were considered for inclusion. The methodological quality of the included studies was evaluated according to the McMaster Guidelines for Critical Review Form - Quantitative Studies. RESULTS Eleven studies with a total of 380 participants were included in the review. Adverse events (AEs) and symptom monitoring were poorly reported. Only four studies reported on the occurrence of AEs, with a total of eight AEs reported. Three of the reported AEs were concussion-like symptoms with no further exercise-induced symptom exacerbation reported. No serious AEs were reported. CONCLUSION There is no evidence to suggest that CRF assessment and training is unsafe in the early sub-acute phase of recovery following moderate-to-extremely severe TBI. However, despite the low AE and symptom exacerbation rates identified, a timeframe for safe commencement was unable to be established due to poor reporting and/or monitoring of exercise-induced symptoms and AEs in the current literature.
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Affiliation(s)
- Sara Gallow
- Department of Rehabilitation and Mental Health, Epworth HealthCare, Melbourne, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - Jack Beard
- Department of Rehabilitation and Mental Health, Epworth HealthCare, Melbourne, Australia
| | - Jennifer McGinley
- Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - John Olver
- Department of Rehabilitation and Mental Health, Epworth HealthCare, Melbourne, Australia
- Department of Rehabilitation, Epworth Monash Rehabilitation Medicine Unit, Melbourne, Australia
| | - Gavin Williams
- Department of Rehabilitation and Mental Health, Epworth HealthCare, Melbourne, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
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2
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Conklin JP, Wallace T, McCauley KL, Breitenstein J, Gore RK. Level of Evidence of Telehealth Rehabilitation and Behavioral Health Services for Traumatic Brain Injury: A Scoping Review. J Clin Psychol Med Settings 2024; 31:379-402. [PMID: 37903966 DOI: 10.1007/s10880-023-09981-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 11/01/2023]
Abstract
Traumatic brain injury (TBI) can result in significant impairments in functioning associated with partial or permanent disabilities. Examining the evidence for domain-specific telehealth interventions is necessary to guide the development of effective clinical and research programs for this population. The present scoping review characterizes the level of evidence across a range of TBI-related disabilities and impairments. A literature search was performed across comprehensive databases using search terms related to TBI, rehabilitation, telehealth, and outcome. A total of 19 publications from 17 studies met inclusion criteria. Articles focused on telehealth interventions to improve global, cognitive, emotional, and physical functioning post-TBI. Levels of evidence ranged from 1 to 4 across domains, with predominantly experimental designs (level 1). Outcomes demonstrating improvement or benefit from telehealth treatments were reported across all functional domains (50-80% of studies). Results highlight the potential of telehealth interventions across the span of comprehensive interdisciplinary rehabilitation care. Expanded research is needed on remote treatment options for physical symptoms, for subgroups within TBI populations (i.e., mild TBI, military populations), as well as on remote and hybrid comprehensive rehabilitation programs.
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Affiliation(s)
- Jessica P Conklin
- SHARE Military Initiative, Shepherd Center, 80 Peachtree Park Drive NE, Atlanta, GA, 30309, USA
| | - Tracey Wallace
- SHARE Military Initiative, Shepherd Center, 80 Peachtree Park Drive NE, Atlanta, GA, 30309, USA.
| | - Katherine L McCauley
- SHARE Military Initiative, Shepherd Center, 80 Peachtree Park Drive NE, Atlanta, GA, 30309, USA
| | - Jackie Breitenstein
- SHARE Military Initiative, Shepherd Center, 80 Peachtree Park Drive NE, Atlanta, GA, 30309, USA
| | - Russell K Gore
- SHARE Military Initiative, Shepherd Center, 80 Peachtree Park Drive NE, Atlanta, GA, 30309, USA
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3
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Cristofori I, Cohen-Zimerman S, Krueger F, Jabbarinejad R, Delikishkina E, Gordon B, Beuriat PA, Grafman J. Studying the social mind: An updated summary of findings from the Vietnam Head Injury Study. Cortex 2024; 174:164-188. [PMID: 38552358 DOI: 10.1016/j.cortex.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 01/26/2024] [Accepted: 03/01/2024] [Indexed: 04/21/2024]
Abstract
Lesion mapping studies allow us to evaluate the potential causal contribution of specific brain areas to human cognition and complement other cognitive neuroscience methods, as several authors have recently pointed out. Here, we present an updated summary of the findings from the Vietnam Head Injury Study (VHIS) focusing on the studies conducted over the last decade, that examined the social mind and its intricate neural and cognitive underpinnings. The VHIS is a prospective, long-term follow-up study of Vietnam veterans with penetrating traumatic brain injury (pTBI) and healthy controls (HC). The scope of the work is to present the studies from the latest phases (3 and 4) of the VHIS, 70 studies since 2011, when the Raymont et al. paper was published (Raymont et al., 2011). These studies have contributed to our understanding of human social cognition, including political and religious beliefs, theory of mind, but also executive functions, intelligence, and personality. This work finally discusses the usefulness of lesion mapping as an approach to understanding the functions of the human brain from basic science and clinical perspectives.
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Affiliation(s)
- Irene Cristofori
- Institute of Cognitive Sciences Marc Jeannerod CNRS, UMR 5229, Bron, France; University of Lyon, Villeurbanne, France.
| | - Shira Cohen-Zimerman
- Cognitive Neuroscience Laboratory, Brain Injury Research, Shirley Ryan AbilityLab, Chicago, IL, USA; Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA.
| | - Frank Krueger
- School of Systems Biology, George Mason University, Manassas, VA, USA; Department of Psychology, George Mason University, Fairfax, VA, USA.
| | - Roxana Jabbarinejad
- Cognitive Neuroscience Laboratory, Brain Injury Research, Shirley Ryan AbilityLab, Chicago, IL, USA.
| | - Ekaterina Delikishkina
- Cognitive Neuroscience Laboratory, Brain Injury Research, Shirley Ryan AbilityLab, Chicago, IL, USA; Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA.
| | - Barry Gordon
- Cognitive Neurology/Neuropsychology Division, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Cognitive Science, Johns Hopkins University, Baltimore, MD USA.
| | - Pierre-Aurélien Beuriat
- Institute of Cognitive Sciences Marc Jeannerod CNRS, UMR 5229, Bron, France; University of Lyon, Villeurbanne, France; Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Bron, France.
| | - Jordan Grafman
- Cognitive Neuroscience Laboratory, Brain Injury Research, Shirley Ryan AbilityLab, Chicago, IL, USA; Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA; Departments of Neurology, Psychiatry, and Cognitive Neurology & Alzheimer's Disease, Feinberg School of Medicine, Chicago, IL, USA; Department of Psychology, Northwestern University, Chicago, IL, USA.
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4
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Oyesanya TO, Ibemere SO, You H, Emerson MM, Pan W, Palipana A, Kandel M, Ingram D, Soto M, Pioppo A, Albert B, Walker-Atwater T, Hawes J, Komisarow J, Ramos K, Byom L, Gonzalez-Guarda R, Van Houtven CH, Agarwal S, Prvu Bettger J. Efficacy of BETTER transitional care intervention for diverse patients with traumatic brain injury and their families: Study protocol of a randomized controlled trial. PLoS One 2024; 19:e0296083. [PMID: 38394279 PMCID: PMC10890764 DOI: 10.1371/journal.pone.0296083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/08/2023] [Indexed: 02/25/2024] Open
Abstract
OBJECTIVE The purpose of this study is to examine the efficacy of BETTER (Brain Injury, Education, Training, and Therapy to Enhance Recovery) vs. usual transitional care management among diverse adults with traumatic brain injury (TBI) discharged home from acute hospital care and families. METHODS This will be a single-site, two-arm, randomized controlled trial (N = 436 people, 218 patient/family dyads, 109 dyads per arm) of BETTER, a culturally- and linguistically-tailored, patient- and family-centered, TBI transitional care intervention for adult patients with TBI and families. Skilled clinical interventionists will follow a manualized protocol to address patient/family needs. The interventionists will co-establish goals with participants; coordinate post-hospital care, services, and resources; and provide patient/family education and training on self- and family-management and coping skills for 16 weeks following hospital discharge. English- and Spanish-speaking adult patients with mild-to-severe TBI who are discharged directly home from the hospital without inpatient rehabilitation or transfer to other settings (community discharge) and associated family caregivers are eligible and will be randomized to treatment or usual transitional care management. We will use intention-to-treat analysis to determine if patients receiving BETTER have a higher quality of life (primary outcome, SF-36) at 16-weeks post-hospital discharge than those receiving usual transitional care management. We will conduct a descriptive, qualitative study with 45 dyads randomized to BETTER, using semi-structured interviews, to capture perspectives on barriers and facilitators to participation. Data will be analyzed using conventional content analysis. Finally, we will conduct a cost/budget impact analysis, evaluating differences in intervention costs and healthcare costs by arm. DISCUSSION Findings will guide our team in designing a future, multi-site trial to disseminate and implement BETTER into clinical practice to enhance the standard of care for adults with TBI and families. The new knowledge generated will drive advancements in health equity among diverse adults with TBI and families. TRIAL REGISTRATION NCT05929833.
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Affiliation(s)
- Tolu O. Oyesanya
- Duke University School of Nursing, Durham, NC, United States of America
| | - Stephanie O. Ibemere
- Duke University School of Nursing, Durham, NC, United States of America
- Duke Global Health Institute, Durham, NC, United States of America
| | - HyunBin You
- Duke University School of Nursing, Durham, NC, United States of America
| | | | - Wei Pan
- Duke University School of Nursing, Durham, NC, United States of America
- Duke University School of Medicine, Durham, NC, United States of America
| | - Anushka Palipana
- Duke University School of Nursing, Durham, NC, United States of America
| | - Melissa Kandel
- Department of Rehabilitation Services, Duke University Health System, Durham, NC, United States of America
| | - Darius Ingram
- Department of Rehabilitation Services, Duke University Health System, Durham, NC, United States of America
| | - Mayra Soto
- Department of Rehabilitation Services, Duke University Health System, Durham, NC, United States of America
| | - Anne Pioppo
- Department of Rehabilitation Services, Duke University Health System, Durham, NC, United States of America
| | - Brittany Albert
- Department of Rehabilitation Services, Duke University Health System, Durham, NC, United States of America
| | | | - Jodi Hawes
- Duke University School of Medicine, Durham, NC, United States of America
| | - Jordan Komisarow
- Duke University School of Medicine, Durham, NC, United States of America
| | - Katherine Ramos
- Duke University School of Medicine, Durham, NC, United States of America
| | - Lindsey Byom
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | | | - Courtney H. Van Houtven
- Duke University School of Medicine, Durham, NC, United States of America
- Durham VA Health Care System, Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham, NC, United States of America
| | - Suresh Agarwal
- Duke University School of Medicine, Durham, NC, United States of America
| | - Janet Prvu Bettger
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, PA, United States of America
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Sandroff BM, Weber E, Wylie GR, Wender CLA, Goverover Y, Lercher K, Tong TT, Robinson B, Moore N, Salter A, DeLuca J, Chiaravalloti ND. The effects of cognitive rehabilitation combined with aerobic exercise or stretching-and-toning on new learning and memory in persons with moderate-to-severe TBI: Protocol for a randomized controlled trial. Contemp Clin Trials 2023; 134:107331. [PMID: 37734538 DOI: 10.1016/j.cct.2023.107331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 09/23/2023]
Abstract
This paper describes the protocol for a Phase I/II, parallel-group, blinded randomized controlled trial that compares the effects of 12-weeks of combined learning and memory rehabilitation with either aerobic cycling exercise or stretching on cognitive, neuroimaging, and everyday life outcomes in 60 persons with moderate-to-severe traumatic brain injury (TBI) who demonstrate impairments in new learning. Briefly, participants will undergo baseline testing consisting of neuropsychological testing, neuroimaging, daily life measures, and cardiorespiratory fitness. Following baseline testing, participants will be randomized to one of 2 conditions (30 participants per condition) using concealed allocation. Participants will be masked as to the intent of the conditions. The conditions will both involve supervised administration of an enhanced, 8-week version of the Kessler Foundation modified Story Memory Technique, embedded within either 12-weeks of supervised and progressive aerobic cycling exercise training (experimental condition) or 12-weeks of supervised stretching-and-toning (active control condition). Following the 12-week intervention period, participants will complete the same measures as at baseline that will be administered by treatment-blinded assessors. The primary study outcome is new learning and memory impairment based on California Verbal Learning Test (CVLT)-III slope, the secondary outcomes include neuroimaging measures of hippocampal volume, activation, and connectivity, and the tertiary outcomes involve measures of daily living along with other cognitive outcomes. We further will collect baseline sociodemographic data for examining predictors of response heterogeneity. If successful, this trial will provide the first Class I evidence supporting combined memory rehabilitation and aerobic cycling exercise training for treating TBI-related new learning and memory impairment.
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Affiliation(s)
- Brian M Sandroff
- Centers for Neuropsychology, Neuroscience, Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, United States of America; Department of Physical Medicine & Rehabilitation, Rutgers NJ Medical School, Newark, NJ, United States of America.
| | - Erica Weber
- Centers for Neuropsychology, Neuroscience, Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, United States of America; Department of Physical Medicine & Rehabilitation, Rutgers NJ Medical School, Newark, NJ, United States of America
| | - Glenn R Wylie
- Centers for Neuropsychology, Neuroscience, Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, United States of America; Department of Physical Medicine & Rehabilitation, Rutgers NJ Medical School, Newark, NJ, United States of America
| | - Carly L A Wender
- Centers for Neuropsychology, Neuroscience, Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, United States of America; Department of Physical Medicine & Rehabilitation, Rutgers NJ Medical School, Newark, NJ, United States of America
| | - Yael Goverover
- Centers for Neuropsychology, Neuroscience, Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, United States of America; Department of Occupational Therapy, New York University, New York, NY, United States of America
| | - Kirk Lercher
- Kessler Institute for Rehabilitation, West Orange, NJ, United States of America
| | - Tien T Tong
- Centers for Neuropsychology, Neuroscience, Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, United States of America
| | - Brionna Robinson
- Centers for Neuropsychology, Neuroscience, Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, United States of America
| | - Nancy Moore
- Centers for Neuropsychology, Neuroscience, Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, United States of America
| | - Amber Salter
- Department of Neurology, University of Texas Southwestern, Dallas, TX, United States of America
| | - John DeLuca
- Centers for Neuropsychology, Neuroscience, Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, United States of America; Department of Physical Medicine & Rehabilitation, Rutgers NJ Medical School, Newark, NJ, United States of America
| | - Nancy D Chiaravalloti
- Centers for Neuropsychology, Neuroscience, Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, United States of America; Department of Physical Medicine & Rehabilitation, Rutgers NJ Medical School, Newark, NJ, United States of America
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6
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Oyesanya TO, Loflin C, You H, Myers J, Kandel M, Johnson K, Strauman T, Hawes J, Byom L, Gonzalez-Guarda R, Houtven CV, Agarwal S, Bettger JP. The BETTER Traumatic Brain Injury Transitional Care Intervention: A Feasibility Study. West J Nurs Res 2023; 45:902-912. [PMID: 37542381 PMCID: PMC10947151 DOI: 10.1177/01939459231189786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
This study aimed to investigate the feasibility, acceptability, and clinical outcome measures of BETTER (Brain Injury Education, Training, and Therapy to Enhance Recovery), a culturally tailored traumatic brain injury (TBI) transitional care intervention, among diverse younger adult patients with TBI (age 18-64) and their caregivers. Trained clinical interventionists addressed patient/family needs; established goals; coordinated post-hospital care and resources; and provided patient/family training on self- and family-management coping skills. Fifteen dyads enrolled (N = 31, 15 patients, 16 caregivers). All completed baseline data; 74.2% (n = 23; 10 patients, 13 caregivers) completed 8-week data; 83.8% (n = 26; 13 each) completed 16-week data. Approximately 38% (n = 12, 3 patients, 9 caregivers) completed acceptability data, showing positive experiences (mean = 9.25, range 0-10; SD = 2.01). Overall and mental quality of life (QOL) scores did not differ over time but physical QOL scores did improve over time (baseline: 30.3, 8 weeks: 46.5, 16 weeks: 61.6; p = 0.0056), which was considered to be a suitable outcome measure for a future trial. BETTER is a promising intervention with implications to improve TBI care standards. Research is needed to determine efficacy in a randomized trial.
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Affiliation(s)
| | - Callan Loflin
- Duke University School of Nursing
- Duke University School of Medicine
| | | | | | - Melissa Kandel
- Duke University Health System, Department of Physical and Occupational Therapy
| | - Karen Johnson
- Duke University Health System, Department of Physical and Occupational Therapy
| | | | | | - Lindsey Byom
- University of North Carolina at Chapel Hill, Department of Allied Health Sciences
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Oyesanya TO, Ibemere SO, Loflin C, McReynolds V, Anaya B, Huang M, Gonzalez-Guarda R, Strauman TJ, Prvu Bettger J. "If you respect me, you are respecting my culture": methods and recommendations for personalizing a TBI transitional care intervention. Brain Inj 2023:1-12. [PMID: 37144496 DOI: 10.1080/02699052.2023.2208881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Despite research, national legislation, and clinical guidelines supporting transitional care, there is minimal benefit from existing transitional care interventions for racial/ethnic minorities with traumatic brain injury (TBI) discharged home from acute hospital care. Existing TBI transitional care interventions are not tailored to address the needs/preferences of patients from various racial/ethnic minority groups. The purpose of this study was to describe use of personalization to tailor a TBI transitional care intervention for various racial/ethnic groups. DESIGN Following preliminary intervention manual development, a qualitative descriptive study was conducted using eight focus groups with 40 English-and Spanish-speaking participants (12 patients, 12 caregivers, and 16 providers). RESULTS Three personalization-related themes emerged: 1) what is important to me, 2) finding someone to deliver the intervention who can adapt to my needs, and 3) respect over culture. Findings informed personalization strategies within our final manual. CONCLUSIONS We recommend researchers who wish to use personalization to tailor interventions to consider: 1) allowing stakeholders to dictate what is most important and 2) implementing an iterative intervention development process with input from diverse stakeholders. Findings have implications for informing the development of transitional care interventions to increase the likelihood that interventions are inclusive of needs and preferences of various races/ethnicities.
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Affiliation(s)
- Tolu O Oyesanya
- Department of School of Nursing, Duke University, Durham, North Carolina, USA
| | - Stephanie O Ibemere
- Department of School of Nursing, Duke University, Durham, North Carolina, USA
| | - Callan Loflin
- Department of School of Nursing, Duke University, Durham, North Carolina, USA
- Department is Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Victoria McReynolds
- Department of School of Nursing, Duke University, Durham, North Carolina, USA
| | - Brian Anaya
- Department of School of Nursing, Duke University, Durham, North Carolina, USA
| | - Michelle Huang
- Department of School of Nursing, Duke University, Durham, North Carolina, USA
| | | | - Timothy J Strauman
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, USA
| | - Janet Prvu Bettger
- Department of School of Nursing, Duke University, Durham, North Carolina, USA
- Department is Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
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Avramovic P, Rietdijk R, Attard M, Kenny B, Power E, Togher L. Cognitive and Behavioral Digital Health Interventions for People with Traumatic Brain Injury and Their Caregivers: A Systematic Review. J Neurotrauma 2023; 40:159-194. [PMID: 35819294 DOI: 10.1089/neu.2021.0473] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Traumatic brain injury (TBI) leads to cognitive linguistic deficits that significantly impact on quality of life and well-being. Digital health offers timely access to specialized services; however, there are few synthesized reviews in this field. This review evaluates and synthesizes reports of digital health interventions in TBI rehabilitation and caregiver education. Systematic searches of nine databases (PsycINFO, MEDLINE, CINAHL, Embase, Cochrane Library, Scopus, Web of Science Core Collection, speechBITE, and PsycBITE) were conducted from database inception to February 2022. Studies were included of interventions where the primary treatment focus (> 50%) was on improving communication, social, psychological or cognitive skills of people with TBI and/or communication partners. Data on participants, characteristics of the interventions, outcome measures and findings were collected. Risk of bias was accounted for through methodological quality assessments (PEDro-P and PEDro+, Risk of Bias in N-of-1 Trials) and intervention description. Qualitative data was analyzed using thematic synthesis. Forty-four articles met eligibility criteria: 20 randomized controlled trials, three single-case experimental designs, six non-randomized controlled trials, nine case series studies, and two case studies. Studies comprised 3666 people with TBI and 213 carers. Methodological quality was varied and intervention description was poor. Most interventions were delivered via a single digital modality (e.g., telephone), with few using a combination of modalities. Five interventions used co-design with key stakeholders. Digital health interventions for people with TBI and their caregivers are feasible and all studies reported positive outcomes; however, few included blind assessors. Improved methodological rigor, clearly described intervention characteristics and consistent outcome measurement is recommended. Further research is needed regarding multi-modal digital health interventions.
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Affiliation(s)
- Petra Avramovic
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.,NHMRC Center of Research Excellence in Aphasia Rehabilitation, Australia
| | - Rachael Rietdijk
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.,NHMRC Center of Research Excellence in Aphasia Rehabilitation, Australia
| | - Michelle Attard
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.,NHMRC Center of Research Excellence in Aphasia Rehabilitation, Australia
| | - Belinda Kenny
- School of Health Sciences, University of Western Sydney, Sydney, New South Wales, Australia
| | - Emma Power
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.,NHMRC Center of Research Excellence in Aphasia Rehabilitation, Australia
| | - Leanne Togher
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.,NHMRC Center of Research Excellence in Aphasia Rehabilitation, Australia
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9
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Wade DT, Nayar M, Haider J. Management of traumatic brain injury: practical development of a recent proposal. Clin Med (Lond) 2022; 22:353-357. [PMID: 38589136 DOI: 10.7861/clinmed.2021-0719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A recent article identified weaknesses in the management of patients with traumatic brain injury (TBI). The authors suggested some reasons but overlooked two of the reasons for the low quality of services: a lack of resources and a systemic failure to organise rehabilitation services. They suggested early involvement of a condition-specific service with a new 'neuroscience clinician' and additional neuro-navigators, but the evidence shows this approach does not work. Their proposal failed to acknowledge the neuroscience skills of existing rehabilitation medicine consultants and teams, and ignored the many non-TBI problems patients will have and the consequent need for expert rehabilitation input. We revise and develop their proposal, suggesting an alternative way to improve services. Rehabilitation teams should work in parallel with acute services and remain responsible for the rehabilitation of patients as they move through different settings. This suggested development of rehabilitation mirrors the development followed by geriatric medicine from 40 years ago.
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Suarilah I, Zulkarnain H, Saragih ID, Lee BO. Effectiveness of telehealth interventions among traumatic brain injury survivors: A systematic review and meta-analysis. J Telemed Telecare 2022:1357633X221102264. [PMID: 35656767 DOI: 10.1177/1357633x221102264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Traumatic brain injury (TBI) represents a major cause of death and disability worldwide. Brain damage is associated with physical and psychological difficulties among TBI survivors. Diverse face-to-face and telehealth programs exist to help survivors cope with these burdens. However, the effectiveness of telehealth interventions among TBI survivors remains inconclusive. METHODS A systematic review and meta-analysis of randomized control trials were conducted. Relevant full-text articles were retrieved from seven databases, from database inception to January 2022, including Academic Search Complete, CINAHL, EMBASE, Cochrane, MEDLINE, PubMed, and Web of Science. Bias was assessed with the revised Cochrane risk-of-bias tool for randomized trials. A meta-analysis was performed using a random-effects model to calculate the pooled effect size of telehealth interventions for TBI survivors. STATA 16.0 was used for statistical analysis. RESULTS In total, 17 studies (N = 3158) applying telehealth interventions among TBI survivors were included in the analysis. Telehealth interventions decreased neurobehavioural symptom (standardized mean difference: -0.13; 95% confidence interval [CI]: -0.36 to 0.10), reduce depression (standardized mean difference: -0.32; 95% CI: -0.79 to 0.14), and increase symptom management self-efficacy (standardized mean difference: 0.22; 95% CI: 0.02-0.42). DISCUSSION Telehealth interventions are promising avenues for healthcare delivery due to advances in technology and information. Telehealth programs may represent windows of opportunity, combining traditional treatment with rehabilitation to increase symptom management self-efficacy among TBI patients during recovery. Future telehealth programs can focus on developing the contents of telehealth modules based on evidence from this study.
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Affiliation(s)
- Ira Suarilah
- College of Nursing, 38023Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Nursing, 148005Universitas Airlangga, Surabaya, Indonesia
| | - Hakim Zulkarnain
- Faculty of Nursing, 148005Universitas Airlangga, Surabaya, Indonesia
| | | | - Bih-O Lee
- College of Nursing, 38023Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Nursing, 148005Universitas Airlangga, Surabaya, Indonesia
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11
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Oyesanya TO, Loflin C, You H, Kandel M, Johnson K, Strauman T, Yang Q, Hawes J, Byom L, Gonzalez-Guarda R, Van Houtven C, Agarwal S, Bettger JP. Design, methods, and baseline characteristics of the Brain Injury Education, Training, and Therapy to Enhance Recovery (BETTER) feasibility study: a transitional care intervention for younger adult patients with traumatic brain injury and caregivers. Curr Med Res Opin 2022; 38:697-710. [PMID: 35174756 PMCID: PMC9131748 DOI: 10.1080/03007995.2022.2043657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES We developed a patient- and family-centered traumatic brain injury (TBI) transitional care intervention, called BETTER (Brain Injury Education, Training, and Therapy to Enhance Recovery), to improve quality of life (via SF-36) of younger TBI patients of different racial groups discharged home from acute hospital care and caregivers. We describe our design, methods, and baseline characteristics for our feasibility study. METHODS We co-developed BETTER with input from key stakeholders (TBI patients and caregivers, healthcare providers, and interdisciplinary research team members). BETTER is guided by the Individual and Family Self-Management Theory, our team's prior research, as well as literature used to support, educate, and train patients and families recovering from TBI and other conditions. The intervention is delivered by trained clinical interventionists (transitional care managers), beginning 24-72 h pre-discharge to 16 weeks post-discharge. BETTER offers tailored transitional care support to patient/family dyads, including assessing needs; establishing goals; coordinating post-hospital care, services, and resources; and providing patient/family education and training on brain injury coping skills. The majority of the intervention is delivered remotely via phone and remote video conferencing platform (Clinicaltrials.gov: NCT04584554). RESULTS We enrolled 15 dyads (N = 31, 15 patients, 16 caregivers) in this single arm, single center feasibility study. Most patients were men (n = 11, 73.33%), had a mean age of 39.07 (SD: 15.15), and were Black (n = 9, 60%), White (n = 5, 33.3%), or American Indian (n = 1, 0.66%). Injury severities were mild (n = 6, 40%), moderate (n = 4, 26.6%) or severe (n = 5, 33.33%). Most patients were insured (n = 10; 66.7%), had a high school education (n = 6; 40%); and earned $30,000 or less per year (n = 11; 73.3%). Most caregivers were married (n = 9, 56.25%) women (n = 14, 87.5%) with a mean age of 43.38 (SD: 10.45) and were Black (n = 8, 50%), White (n = 7, 43.75%), or American Indian (n = 1, 0.62%). Most caregivers identified as the spouse (n = 7; 43.75%) or parent (n = 6; 37.5%) of the patient. CONCLUSIONS BETTER is among the first TBI transitional care intervention to address needs/preferences for younger TBI patients of different racial groups after discharge home from acute hospital care and families. Findings can be used to inform future work.
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Affiliation(s)
| | - Callan Loflin
- Duke University School of Nursing
- Duke University School of Medicine
| | | | - Melissa Kandel
- Duke University Health System, Department of Physical and Occupational Therapy
| | - Karen Johnson
- Duke University Health System, Department of Physical and Occupational Therapy
| | | | | | | | - Lindsey Byom
- University of North Carolina at Chapel Hill, Department of Allied Health Sciences
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Lu J, Gormley M, Donaldson A, Agyemang A, Karmarkar A, Seel RT. Identifying factors associated with acute hospital discharge dispositions in patients with moderate-to-severe traumatic brain injury. Brain Inj 2022; 36:383-392. [PMID: 35213272 DOI: 10.1080/02699052.2022.2034180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Identify sociodemographic, injury, and hospital-level factors associated with acute hospital discharge dispositions following acute hospitalization for moderate-to-severe traumatic brain injury (TBI) in the United States. METHODS The 2011-2014 National Trauma Data Bank data was used, including 466 acute care hospitals and 114,736 patients ≥16 years old who survived moderate-to-severe TBI. Outcome was acute hospital discharge dispositions: home with/without care (HC), skilled nursing home/other care facility (SNF/ICF) and inpatient rehabilitation/long-term care facility (IRF). Independent variables were patients' sociodemographic, injury, and hospital-level factors. Multilevel modeling was used to assess associations and compare likelihood of discharges. RESULTS Of all patients, 74.5%, 14.6% ,and 10.9% were discharged to HC, SNF/ICF ,and IRF, respectively. Intraclass correlation coefficients indicated that hospitals explained 14.3% and 14.8% of variations in probabilities of institution dispositions. Sociodemographic factors including older age, females, Non-Hispanic Whites, recipients of commercial insurance, and Medicare/Medicaid were significantly associated with higher institution discharges. Hospital-related factors including bed size, teaching status, trauma accreditations, and hospital locations were significantly associated with discharge dispositions. CONCLUSION Identifying factors associated with discharge dispositions after acute hospitalization of TBI is pertinent to ensure quality of care and optimal patient outcomes. Further research into hospital-related variations in acute care discharge dispositions is recommended.
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Affiliation(s)
- Juan Lu
- Division of Epidemiology, Department of Family Medicine and Population Health, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Mirinda Gormley
- Division of Epidemiology, Department of Family Medicine and Population Health, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Alexis Donaldson
- Division of Epidemiology, Department of Family Medicine and Population Health, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Amma Agyemang
- Center for Rehabilitation Science and Engineering (CERSE), Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Amol Karmarkar
- Center for Rehabilitation Science and Engineering (CERSE), Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Ronald T Seel
- Center for Rehabilitation Science and Engineering (CERSE), Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
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Cost-effectiveness analysis of combined cognitive and vocational rehabilitation in patients with mild-to-moderate TBI: results from a randomized controlled trial. BMC Health Serv Res 2022; 22:185. [PMID: 35151285 PMCID: PMC8840547 DOI: 10.1186/s12913-022-07585-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 01/28/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Traumatic brain injury (TBI) represents a financial burden to the healthcare system, patients, their families and society. Rehabilitation interventions with the potential for reducing costs associated with TBI are demanded. This study evaluated the cost-effectiveness of a randomized, controlled, parallel group trial that compared the effectiveness of a combined cognitive and vocational intervention to treatment as usual (TAU) on vocational outcomes.
Methods
One-hundred sixteen participants with mild-to-moderate TBI were recruited from an outpatient clinic at Oslo University Hospital, Norway. They were randomized to a cognitive rehabilitation intervention (Compensatory Cognitive Training, CCT) and Supported Employment (SE) or TAU in a 1:1 ratio. Costs of CCT-SE and TAU, healthcare services, informal care and productivity loss were assessed 3, 6 and 12 months after study inclusion. Cost-effectiveness was evaluated from the difference in number of days until return to pre-injury work levels between CCT-SE and TAU and quality-adjusted life years (QALYs) derived from the EQ-5D-5L across 12 months follow-up. Cost-utility was expressed in incremental cost-effectiveness ratio (ICER).
Results
The mean total costs of healthcare services was € 3,281 in the CCT-SE group and € 2,300 in TAU, informal care was € 2,761 in CCT-SE and € 3,591 in TAU, and productivity loss was € 30,738 in CCT-SE and € 33,401 in TAU. Costs related to productivity loss accounted for 84% of the total costs. From a healthcare perspective, the ICER was € 56 per day earlier back to work in the CCT-SE group. Given a threshold of € 27,500 per QALY gained, adjusting for baseline difference in EQ-5D-5L index values revealed a net monetary benefit (NMB) of € -561 (0.009*27,500–979) from the healthcare perspective, indicating higher incremental costs for the CCT-SE group. From the societal perspective, the NMB was € 1,566 (0.009*27,500-(-1,319)), indicating that the CCT-SE intervention was a cost-effective alternative to TAU.
Conclusions
Costs associated with productivity loss accounted for the majority of costs in both groups and were lower in the CCT-SE group. The CCT-SE intervention was a cost-effective alternative to TAU when considering the societal perspective, but not from a healthcare perspective.
Trial registration
ClinicalTrails.gov NCT03092713.
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Portnoy GA, Relyea MR, Presseau C, Orazietti S, Martino S, Brandt CA, Haskell SG. Longitudinal Analysis of Persistent Postconcussion Symptoms, Probable TBI, and Intimate Partner Violence Perpetration Among Veterans. J Head Trauma Rehabil 2022; 37:34-42. [PMID: 34985032 PMCID: PMC8740780 DOI: 10.1097/htr.0000000000000759] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To determine veterans' intimate partner violence (IPV) perpetration following report of traumatic brain injury (TBI) and persistent postconcussion symptoms (PPCSs). SETTING Five Department of Veterans Affairs (VA) medical centers. PARTICIPANTS Veterans with nonmissing data on main measures, resulting in N = 1150 at baseline and N = 827 at follow-up. DESIGN Prospective cohort study with secondary data analysis of self-reported TBI, PPCSs, and IPV perpetration, controlling for common predictors of IPV, including binge drinking, marijuana use, pain intensity, and probable posttraumatic stress disorder. MAIN MEASURES VA TBI Screening Tool to assess for probable TBI and PPCSs; Conflict Tactics Scale-Revised (CTS-2S) to assess for IPV perpetration. RESULTS Almost half (48%) of participants reported IPV perpetration at follow-up. Both probable TBI and higher PPCSs at baseline were associated with overall IPV perpetration and more frequent IPV perpetration at follow-up. Only PPCSs significantly predicted IPV perpetration after controlling for common predictors of IPV perpetration. Neither probably TBI nor PPCSs predicted frequency of IPV perpetration. CONCLUSION When considered alongside common risk factors for IPV perpetration, PPCS was uniquely associated with the likelihood of IPV perpetration in this veteran sample. Given post-9/11 veterans' elevated risk for head injury, findings emphasize the distinctive value of PPCSs in understanding risk for IPV perpetration. We recommend increased assessment for PPCSs in clinical practice among veterans enrolled in VA care and highlight several important areas for future research and intervention development.
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Affiliation(s)
- Galina A Portnoy
- VA Connecticut Healthcare System, West Haven, Connecticut (Drs Portnoy, Relyea, Presseau, Martino, Brandt, and Haskell and Ms Orazietti); Yale University School of Medicine, New Haven, Connecticut (Drs Portnoy, Relyea, Presseau, Martino, Brandt, and Haskell)
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Welch V, Mathew CM, Babelmorad P, Li Y, Ghogomu ET, Borg J, Conde M, Kristjansson E, Lyddiatt A, Marcus S, Nickerson JW, Pottie K, Rogers M, Sadana R, Saran A, Shea B, Sheehy L, Sveistrup H, Tanuseputro P, Thompson‐Coon J, Walker P, Zhang W, Howe TE. Health, social care and technological interventions to improve functional ability of older adults living at home: An evidence and gap map. CAMPBELL SYSTEMATIC REVIEWS 2021; 17:e1175. [PMID: 37051456 PMCID: PMC8988637 DOI: 10.1002/cl2.1175] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Background By 2030, the global population of people older than 60 years is expected to be higher than the number of children under 10 years, resulting in major health and social care system implications worldwide. Without a supportive environment, whether social or built, diminished functional ability may arise in older people. Functional ability comprises an individual's intrinsic capacity and people's interaction with their environment enabling them to be and do what they value. Objectives This evidence and gap map aims to identify primary studies and systematic reviews of health and social support services as well as assistive devices designed to support functional ability among older adults living at home or in other places of residence. Search Methods We systematically searched from inception to August 2018 in: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, CENTRAL, CINAHL, PsycINFO, AgeLine, Campbell Library, ASSIA, Social Science Citation Index and Social Policy & Practice. We conducted a focused search for grey literature and protocols of studies (e.g., ProQuest Theses and Dissertation Global, conference abstract databases, Help Age, PROSPERO, Cochrane and Campbell libraries and ClinicalTrials.gov). Selection Criteria Screening and data extraction were performed independently in duplicate according to our intervention and outcome framework. We included completed and on-going systematic reviews and randomized controlled trials of effectiveness on health and social support services provided at home, assistive products and technology for personal indoor and outdoor mobility and transportation as well as design, construction and building products and technology of buildings for private use such as wheelchairs, and ramps. Data Collection and Analysis We coded interventions and outcomes, and the number of studies that assessed health inequities across equity factors. We mapped outcomes based on the International Classification of Function, Disability and Health (ICF) adapted categories: intrinsic capacities (body function and structures) and functional abilities (activities). We assessed methodological quality of systematic reviews using the AMSTAR II checklist. Main Results After de-duplication, 10,783 records were screened. The map includes 548 studies (120 systematic reviews and 428 randomized controlled trials). Interventions and outcomes were classified using domains from the International Classification of Function, Disability and Health (ICF) framework. Most systematic reviews (n = 71, 59%) were rated low or critically low for methodological quality.The most common interventions were home-based rehabilitation for older adults (n = 276) and home-based health services for disease prevention (n = 233), mostly delivered by visiting healthcare professionals (n = 474). There was a relative paucity of studies on personal mobility, building adaptations, family support, personal support and befriending or friendly visits. The most measured intrinsic capacity domains were mental function (n = 269) and neuromusculoskeletal function (n = 164). The most measured outcomes for functional ability were basic needs (n = 277) and mobility (n = 160). There were few studies which evaluated outcome domains of social participation, financial security, ability to maintain relationships and communication.There was a lack of studies in low- and middle-income countries (LMICs) and a gap in the assessment of health equity issues. Authors' Conclusions There is substantial evidence for interventions to promote functional ability in older adults at home including mostly home-based rehabilitation for older adults and home-based health services for disease prevention. Remotely delivered home-based services are of greater importance to policy-makers and practitioners in the context of the COVID-19 pandemic. This map of studies published prior to the pandemic provides an initial resource to identify relevant home-based services which may be of interest for policy-makers and practitioners, such as home-based rehabilitation and social support, although these interventions would likely require further adaptation for online delivery during the COVID-19 pandemic. There is a need to strengthen assessment of social support and mobility interventions and outcomes related to making decisions, building relationships, financial security, and communication in future studies. More studies are needed to assess LMIC contexts and health equity issues.
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Affiliation(s)
- Vivian Welch
- Methods CentreBruyère Research InstituteOttawaCanada
| | | | | | - Yanfei Li
- Evidence‐Based Social Science Research Center, School of Public HealthLanzhou UniversityLanzhouChina
| | | | | | - Monserrat Conde
- Cochrane Campbell Global Ageing Partnership FieldFaroPortugal
| | | | | | - Sue Marcus
- Radcliffe Department of MedicineUniversity of OxfordOxfordUK
| | | | | | - Morwenna Rogers
- NIHR ARC, South West Peninsula (PenARC)University of Exeter Medical SchoolExeterUK
| | | | | | - Beverly Shea
- Bruyère Research InstituteUniversity of OttawaOttawaCanada
| | - Lisa Sheehy
- Bruyère Research InstituteUniversity of OttawaOttawaCanada
| | - Heidi Sveistrup
- Bruyère Research InstituteUniversity of OttawaOttawaCanada
- Faculty of Health SciencesUniversity of OttawaOttawaCanada
| | | | - Joanna Thompson‐Coon
- NIHR ARC South West Peninsula (PenARC)University of Exeter Medical SchoolExeterUK
| | - Peter Walker
- Faculty of MedicineUniversity of OttawaOttawaCanada
| | - Wei Zhang
- Access to Medicines, Vaccines and Health ProductsWorld Health OrganizationGenevaSwitzerland
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Who benefits from computerized cognitive training? Lower processing speed predicts greater cognitive improvement. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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17
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Gupta S. Racial and ethnic disparities in subjective cognitive decline: a closer look, United States, 2015-2018. BMC Public Health 2021; 21:1173. [PMID: 34162356 PMCID: PMC8223389 DOI: 10.1186/s12889-021-11068-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 05/14/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Subjective cognitive decline (SCD), characterized by self-experience of deterioration in cognitive performance may be a precursor to Alzheimer's disease (AD). Given the association of AD with dependence and disability for a long duration, earlier the detection, the sooner people and their families can receive information regarding better management. It is critical to explore disparities amongst racial and ethnic populations with SCD in order to facilitate targeted interventions. The primary objective was to identify disparities in prevalence of SCD amongst Whites, Blacks and Hispanics by select sociodemographic characteristics and functional limitations in a U.S. population-based sample of non-institutionalized adults aged 45 and older. The secondary objective was to assess the association between SCD and select chronic conditions (angina, heart attack, stroke, diabetes, high blood pressure and high cholesterol) by race/ethnicity. METHODS Combined data (2015-2018) were obtained from the Behavioral Risk Factor Surveillance System (BRFSS) to conduct a population -based study. Analyses included 179,852 respondents aged 45 years or older who answered the SCD screening question as "yes" (n = 19,276) or "no" (n = 160,576). Descriptive statistics examined sociodemographic characteristics including functional limitations amongst racial/ethnic groups with SCD. Association of SCD with chronic conditions by race/ethnicity was also calculated. RESULTS Overall, 10.8% (CI: 10.6-11.1) of adults aged 45 years or older reported SCD.10.7% Whites, 12.3% Blacks and 9.9% Hispanics experienced SCD. Blacks and Hispanics with SCD were more likely to be in the younger age group (45-54 years), less educated, low income, without access to health care, living alone and with functional limitations. Only half had discussed cognitive decline with a health care professional. Prevalence of selected chronic conditions was significantly higher in all racial/ethnic groups with SCD. CONCLUSIONS Demographic trends predict a larger proportion of Hispanics and Blacks with SCD in the coming years. This information can lead to identification of opportunities for addressing negative SCD outcomes in minorities affected by inequitable conditions.
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Affiliation(s)
- Sangeeta Gupta
- Department of Public and Allied Health Sciences, Delaware State University, 1200 N DuPont Highway, Dover, Delaware, 19901, USA.
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Narayanan SJ, Baby CJ, Perumal B, Bhatt RB, Cheng X, Ghalib MR, Shankar A. Fuzzy decision trees embedded with evolutionary fuzzy clustering for locating users using wireless signal strength in an indoor environment. INT J INTELL SYST 2021. [DOI: 10.1002/int.22459] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Cyril Joe Baby
- School of Electronics Engineering VIT Vellore India
- R&D CogNet Research Chennai India
| | | | - Rajen B. Bhatt
- Director, Video AI Division, Chief Technology Office, Poly Inc Pittsburgh Pennsylvania USA
| | - Xiaochun Cheng
- Department of Computer Science Middlesex University London UK
| | | | - Achyut Shankar
- Department of Computer Science and Engineering, ASET Amity University Noida India
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Afsar M, Shukla D, Bhaskarapillai B, Rajeswaran J. Cognitive Retraining in Traumatic Brain Injury: Experience from Tertiary Care Center in Southern India. J Neurosci Rural Pract 2021; 12:295-301. [PMID: 33927520 PMCID: PMC8064862 DOI: 10.1055/s-0041-1722817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Objective
Traumatic brain injury (TBI) is a leading cause of mortality and chronic disability across the globe. This study aimed to understand the effects of cognitive retraining (CR) intervention on neuropsychological functions, symptom reporting, and quality of life in patients with moderate to severe TBI.
Materials and Methods
The present single-group intervention study with a pre–post design included 12 patients diagnosed with moderate to severe TBI within 3–24 months post injury. Outcome measures included National Institute of Mental Health and Neuro Sciences (NIMHANS) Neuropsychology Battery, Perceived Stress Scale, Rivermead Post-Concussion Symptom Questionnaire, World Health Organization Quality of Life Scale—Brief, and Visual Analogue Scale. All patients underwent a total of 20 sessions of hospital-based CR, spanning over a period of 2 months. The CR included tasks targeting to enhance processing speed, attention, executive function, learning, and memory. Outcome assessments were conducted at baseline and immediately at post intervention.
Statistical Analysis
Mean, standard deviation, frequency, and percentage were used as measures of descriptive statistics. Pre- and post-intervention scores were compared using Wilcoxon signed-rank test.
Results
The results showed that at post intervention, significant improvements were found in processing speed, working memory, planning, visuo-spatial construction, visual memory, and verbal encoding. Subjective symptom reporting, perceived stress, and quality of life in psychological domain also improved.
Conclusion
CR can be helpful in improving not only cognition but also symptom reporting and quality of life in moderate to severe TBI.
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Affiliation(s)
- Mohammed Afsar
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Dhaval Shukla
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Binukumar Bhaskarapillai
- Department of Biostatistics, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Jamuna Rajeswaran
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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Raso MG, Arcuri F, Liperoti S, Mercurio L, Mauro A, Cusato F, Romania L, Serra S, Pignolo L, Tonin P, Cerasa A. Telemonitoring of Patients With Chronic Traumatic Brain Injury: A Pilot Study. Front Neurol 2021; 12:598777. [PMID: 33868141 PMCID: PMC8047126 DOI: 10.3389/fneur.2021.598777] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 03/05/2021] [Indexed: 11/25/2022] Open
Abstract
Telehealth systems have shown success in the remote management of several neurological disorders, but there is a paucity of evidence in disorders of consciousness (DOC). In this study, we explore the effectiveness of a new telemonitoring system, for monitoring Vegetative State (VS) and Minimally Conscious State (MCS) patients. This was a prospective, mono-center randomized controlled study. We included only traumatic brain injury (TBI) patients who required long-term motor/cognitive assistance having a stable clinical condition. We examined their clinical evolution over ~4 years of the follow-up period. Twenty-two TBI patients were enrolled and equally divided into two groups: one telemonitored at home with our service and the second admitted to a standard long-stay hospitalization (LSH) program. Patients enrolled in the telehealth service (age: 49.9 ± 20.4; 45% female; diagnosis: 36% VS/64% MCS) were demographically and clinically-matched with those admitted to the LSH program (age: 55.1 ± 15; 18% female; diagnosis: 54% VS/46% MCS). Thirty-six percent of patients in the LSH program died before completing follow up evaluation with respect to 18% of death in the group of TBI patients telemonitored at home. At follow-up, patients in LSH and telemonitoring groups showed similar clinical progression, as measured by CRS-r, NCS, WHIM, and LCF scales, as well as by the number of medical complications (i.e., bedsores, infections). Finally, we estimated the total daily cost per patient. Severe TBI patients enrolled in the conventional LSH program cost 262€ every single day, whereas the cost per patient in the telehealth service resulted to be less expensive (93€). Here, we highlight that our telehealth monitoring service is as efficacious as in-person usual care to manage a severe neurological disorder such as TBI in a cost-effective way.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Antonio Cerasa
- Sant'Anna Institute, Crotone, Italy.,Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
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Computerized Cognitive Training: A Review of Mechanisms, Methodological Considerations, and Application to Research in Depression. JOURNAL OF COGNITIVE ENHANCEMENT 2021. [DOI: 10.1007/s41465-021-00209-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Oyesanya TO, Loflin C, Byom L, Harris G, Daly K, Rink L, Bettger JP. Transitions of care interventions to improve quality of life among patients hospitalized with acute conditions: a systematic literature review. Health Qual Life Outcomes 2021; 19:36. [PMID: 33514371 PMCID: PMC7845026 DOI: 10.1186/s12955-021-01672-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 01/08/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Although transitional care interventions can improve health among patients hospitalized with acute conditions, few interventions use patient quality of life (QOL) as the primary outcome. Existing interventions use a variety of intervention components, are not effective for patients of all races and ethnicities, do not address age-related patient needs, and do not incorporate the needs of families. The purpose of this study was to systematically review characteristics of transitional care intervention studies that aimed to improve QOL for younger adult patients of all race and ethnicities who were hospitalized with acute conditions. METHODS A systematic review was conducted of empirical literature available in PubMed, Embase, CINAHL, and PsycINFO by November 19, 2019 to identify studies of hospital to home care transitions with QOL as the primary outcome. Data extraction on study design and intervention components was limited to studies of patients aged 18-64. RESULTS Nineteen articles comprising 17 studies met inclusion criteria. There were a total of 3,122 patients across all studies (range: 28-536). Populations of focus included cardiovascular disease, chronic obstructive pulmonary disease, stroke, breast cancer, and kidney disease. Seven QOL instruments were identified. All interventions were multi-component with a total of 31 different strategies used. Most interventions were facilitated by a registered nurse. Seven studies discussed intervention facilitator training and eight discussed intervention materials utilized. No studies specified cultural tailoring of interventions or analyzed findings by racial/ethnic subgroup. CONCLUSIONS Future research is needed to determine which intervention components, either in isolation or in combination, are effective in improving QOL. Future studies should also elaborate on the background and training of intervention facilitators and on materials utilized and may also consider incorporating differences in culture, race and ethnicity into all phases of the research process in an effort to address and reduce any health disparities.
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Affiliation(s)
- Tolu O Oyesanya
- Duke University School of Nursing, 307 Trent Dr., Durham, NC, 27710, USA.
| | - Callan Loflin
- Duke University School of Nursing, 307 Trent Dr., Durham, NC, 27710, USA
| | - Lindsey Byom
- Department of Allied Health Sciences, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Gabrielle Harris
- Duke University School of Nursing, 307 Trent Dr., Durham, NC, 27710, USA
| | - Kaitlyn Daly
- Duke University School of Nursing, 307 Trent Dr., Durham, NC, 27710, USA
| | - Lesley Rink
- Duke University School of Nursing, 307 Trent Dr., Durham, NC, 27710, USA
| | - Janet Prvu Bettger
- Duke University School of Nursing, 307 Trent Dr., Durham, NC, 27710, USA
- Duke University School of Medicine, Durham, NC, USA
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Kim HS, Lim KB, Yoo J, Kim YW, Lee SW, Son S, Kim C, Kim J. The efficacy of computerized cognitive rehabilitation in improving attention and executive functions in acquired brain injury patients, in acute and postacute phase. Eur J Phys Rehabil Med 2021; 57:551-559. [PMID: 33448753 DOI: 10.23736/s1973-9087.21.06497-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cognitive deficits, particularly executive dysfunction is common following acquired brain injury (ABI) and has detrimental effect on functional status and autonomy in daily life. Among various cognitive training methods, computerized cognitive rehabilitation (CCR) has been investigated as an alternative method to therapist-driven cognitive rehabilitation (TCR). However, previous studies have shown conflicting results on the superiority or inferiority of CCR and TCR. AIM To investigate the efficacy of TCR and CCR in improving executive function in patients with acute-to-subacute ABI. DESIGN A prospective, assessor-blinded randomized controlled trial. SETTING Hospitalized care setting in the department of rehabilitation in a university hospital. POPULATION Thirty-two acute-to-subacute (less than 3 months after onset) ABI patients with executive dysfunctions were included in this study. The mean time after injury was 25.1±18.1 days. METHODS Participants were assigned to the TCR group (N.=14) or the CCR group (N.=18). Each group performed TCR or CCR for 30 minutes each day for two weeks in addition to routine rehabilitation. Neurocognitive function tests to assess complex attention, executive function, general cognitive function (mini-mental status examination [MMSE] and Montreal Cognitive Assessment [MoCA]), and functional evaluations [modified Barthel Index, MBI]) were performed at baseline (T0) and at the end of treatment (T1). RESULTS The TCR and CCR groups showed significant improvements in the MMSE (P=0.004, 0.000), MoCA (P=0.003, 0.006), and MBI (P=0.000, 0.000) scores. TCR and CCR groups both showed significant improvements in some of the complex attention tests (trail-making test A, P=0.002, 0.005) and executive function tests (trail-making test B, P=0.016, 0.016). The TCR group showed significant improvements in the additional executive function tests (phonemic fluency test, P=0.004, semantic fluency test, P=0.001), while the CCR group showed significant improvements in the additional complex attention tests (symbol search, P=0.02, digit symbol coding, P=0.002). In the intergroup comparison of the changes from pre- to postintervention, only the TCR group showed a significant improvement in the phonemic fluency test (P=0.013). CONCLUSIONS TCR might be more effective than CCR in improving frontal lobe-related executive function in ABI patients. CCR might be beneficial for improving psychomotor speed and working memory. CLINICAL REHABILITATION IMPACT TCR or CCR should be chosen according to the targeted domain of cognitive dysfunction in acute-to-subacute ABI patients.
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Affiliation(s)
- Ha Seong Kim
- Department of Physical Medicine and Rehabilitation, Ilsan Paik Hospital, Inje University, Goyang, South Korea.,Yonsei University College of Medicine, Seoul, South Korea
| | - Kil-Byung Lim
- Department of Physical Medicine and Rehabilitation, Ilsan Paik Hospital, Inje University, Goyang, South Korea
| | - Jeehyun Yoo
- Department of Physical Medicine and Rehabilitation, Ilsan Paik Hospital, Inje University, Goyang, South Korea
| | - Yong Wook Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Sang Wan Lee
- Department of Physical Medicine and Rehabilitation, Ilsan Paik Hospital, Inje University, Goyang, South Korea
| | - Sungsik Son
- Department of Physical Medicine and Rehabilitation, Ilsan Paik Hospital, Inje University, Goyang, South Korea
| | - Changgyu Kim
- Department of Physical Medicine and Rehabilitation, Ilsan Paik Hospital, Inje University, Goyang, South Korea
| | - Jiyong Kim
- Department of Physical Medicine and Rehabilitation, Ilsan Paik Hospital, Inje University, Goyang, South Korea -
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Complement Drives Synaptic Degeneration and Progressive Cognitive Decline in the Chronic Phase after Traumatic Brain Injury. J Neurosci 2021; 41:1830-1843. [PMID: 33446516 DOI: 10.1523/jneurosci.1734-20.2020] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 12/15/2020] [Accepted: 12/23/2020] [Indexed: 01/02/2023] Open
Abstract
Cognitive deficits following traumatic brain injury (TBI) remain a major cause of disability and early-onset dementia, and there is increasing evidence that chronic neuroinflammation occurring after TBI plays an important role in this process. However, little is known about the molecular mechanisms responsible for triggering and maintaining chronic inflammation after TBI. Here, we identify complement, and specifically complement-mediated microglial phagocytosis of synapses, as a pathophysiological link between acute insult and a chronic neurodegenerative response that is associated with cognitive decline. Three months after an initial insult, there is ongoing complement activation in the injured brain of male C57BL/6 mice, which drives a robust chronic neuroinflammatory response extending to both hemispheres. This chronic neuroinflammatory response promotes synaptic degeneration and predicts progressive cognitive decline. Synaptic degeneration was driven by microglial phagocytosis of complement-opsonized synapses in both the ipsilateral and contralateral brain, and complement inhibition interrupted the degenerative neuroinflammatory response and reversed cognitive decline, even when therapy was delayed until 2 months after TBI. These findings provide new insight into our understanding of TBI pathology and its management; and whereas previous therapeutic investigations have focused almost exclusively on acute treatments, we show that all phases of TBI, including at chronic time points after TBI, may be amenable to therapeutic interventions, and specifically to complement inhibition.SIGNIFICANCE STATEMENT There is increasing evidence of a chronic neuroinflammatory response after traumatic brain injury (TBI), but little is known about the molecular mechanisms responsible for triggering and maintaining chronic inflammation. We identify complement, and specifically complement-mediated microglial phagocytosis of synapses, as a pathophysiological link between acute insult and a chronic neurodegenerative response, and further that this response is associated with cognitive decline. Complement inhibition interrupted this response and reversed cognitive decline, even when therapy was delayed until 2 months after injury. The data further support the concept that TBI should be considered a chronic rather than an acute disease condition, and have implications for the management of TBI in the chronic phase of injury, specifically with regard to the therapeutic application of complement inhibition.
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O'Keefe S, Stanley M, Sansonetti D, Schneider EJ, Kras M, Morarty J, Lannin NA. Designing an intervention process that embeds work-focussed interventions within inpatient rehabilitation: An intervention mapping approach. Aust Occup Ther J 2020; 68:65-77. [PMID: 33078431 DOI: 10.1111/1440-1630.12705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 09/13/2020] [Accepted: 09/16/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Returning to work is a goal for many people after brain injury. The failure to return to work after injury brings both economic and personal (quality of life) costs to those living with stroke or brain injury, their families, and society. This study explored the barriers to providing work-focused interventions during hospital-based rehabilitation and co-created solutions with rehabilitation providers to increase the provision of work-focused intervention during inpatient rehabilitation. METHODS This study used an Intervention Mapping approach (a six-step protocol that guides the design of complex interventions) based on an action research methodology. Focus group data, in addition to best evidence from systematic reviews, practice guidelines and key articles were combined with theoretical models for changing behaviour and clinician experience. This was then systematically operationalised into an intervention process using consensus among clinicians. The process was further refined through piloting and feedback from key stakeholders, and group consensus on the final process. RESULTS A detailed five phase return to work intervention process for inpatient rehabilitation was developed. The key features of the process include; having one key allied health clinician to coordinate the process, choosing assessments based on pre-injury work demands, emphasising the importance of core work skills and considering the most appropriate service for referral at the conclusion of rehabilitation. CONCLUSION We used a systematic approach, guided by the intervention mapping approach and behaviour change theory to tailor existing workfocused interventions to the inpatient setting.
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Affiliation(s)
- Sophie O'Keefe
- Occupational Therapy, School of Science, Health and Engineering, La Trobe University, Melbourne, Vic, Australia
| | | | | | - Emma J Schneider
- Occupational Therapy Department, Alfred Health, Melbourne, Vic, Australia
| | - Marni Kras
- Acquired Brain Injury Unit, Alfred Health, Melbourne, Vic, Australia
| | | | - Natasha A Lannin
- Alfred Health, Melbourne, Vic, Australia.,Brain Recovery & Rehabilitation Group, Department of Neuroscience, Central Clinical School, Alfred Health, Melbourne, Vic, Australia
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das Nair R, Bradshaw LE, Carpenter H, Clarke S, Day F, Drummond A, Fitzsimmons D, Harris S, Montgomery AA, Newby G, Sackley C, Lincoln NB. A group memory rehabilitation programme for people with traumatic brain injuries: the ReMemBrIn RCT. Health Technol Assess 2020; 23:1-194. [PMID: 31032782 DOI: 10.3310/hta23160] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND People with traumatic brain injuries (TBIs) commonly report memory impairments. These are persistent, debilitating and reduce quality of life, but patients do not routinely receive memory rehabilitation after discharge from hospital. OBJECTIVE To assess the clinical effectiveness and cost-effectiveness of a group memory rehabilitation programme for people with TBI. DESIGN Multicentre, pragmatic, cluster randomised controlled trial. Qualitative and health economic evaluations were also undertaken. SETTING Community settings in nine sites in England. PARTICIPANTS Participants were aged 18-69 years, had undergone a TBI > 3 months prior to recruitment, reported memory problems, were able to travel to a site to attend group sessions, could communicate in English and gave informed consent. RANDOMISATION AND BLINDING Clusters of four to six participants were randomised to the memory rehabilitation arm or the usual-care arm on a 1 : 1 ratio. Randomisation was based on a computer-generated pseudo-random code using random permuted blocks of randomly varying size, stratified by study site. Participants and therapists were aware of the treatment allocation whereas outcome assessors were blinded. INTERVENTIONS In the memory rehabilitation arm 10 weekly sessions of a manualised memory rehabilitation programme were provided in addition to usual care. Participants were taught restitution strategies to retrain impaired memory functions and compensation strategies to enable them to cope with memory problems. The usual-care arm received usual care only. MAIN OUTCOME MEASURES Outcomes were assessed at 6 and 12 months after randomisation. Primary outcome: patient-completed Everyday Memory Questionnaire - patient version (EMQ-p) at 6 months' follow-up. Secondary outcomes: Rivermead Behavioural Memory Test - third edition (RBMT-3), General Health Questionnaire 30-item version, European Brain Injury Questionnaire, Everyday Memory Questionnaire - relative version and individual goal attainment. Costs (based on a UK NHS and Personal Social Services perspective) were collected using a service use questionnaire, with the EuroQol-5 Dimensions, five-level version, used to derive quality-adjusted life-years (QALYs). A Markov model was developed to explore cost-effectiveness at 5 and 10 years, with a 3.5% discount applied. RESULTS We randomised 328 participants (memory rehabilitation, n = 171; usual care, n = 157), with 129 in the memory rehabilitation arm and 122 in the usual-care arm included in the primary analysis. We found no clinically important difference on the EMQ-p between the two arms at 6 months' follow-up (adjusted difference in mean scores -2.1, 95% confidence interval -6.7 to 2.5; p = 0.37). For secondary outcomes, differences favouring the memory rehabilitation arm were observed at 6 months' follow-up for the RBMT-3 and goal attainment, but remained only for goal attainment at 12 months' follow-up. There were no differences between arms in mood or quality of life. The qualitative results suggested positive experiences of participating in the trial and of attending the groups. Participants reported that memory rehabilitation was not routinely accessible in usual care. The primary health economics outcome at 12 months found memory rehabilitation to be £26.89 cheaper than usual care but less effective, with an incremental QALY loss of 0.007. Differences in costs and effects were not statistically significant and non-parametric bootstrapping demonstrated considerable uncertainty in these findings. No safety concerns were raised and no deaths were reported. LIMITATIONS As a pragmatic trial, we had broad inclusion criteria and, therefore, there was considerable heterogeneity within the sample. The study was not powered to perform further subgroup analyses. Participants and therapists could not be blinded to treatment allocation. CONCLUSIONS The group memory rehabilitation delivered in this trial is very unlikely to lead to clinical benefits or to be a cost-effective treatment for people with TBI in the community. Future studies should examine the selection of participants who may benefit most from memory rehabilitation. TRIAL REGISTRATION Current Controlled Trials ISRCTN65792154. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 16. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Roshan das Nair
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK.,Institute of Mental Health, Nottingham, UK.,Department of Clinical Psychology and Neuropsychology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Lucy E Bradshaw
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Hannah Carpenter
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
| | - Sara Clarke
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
| | - Florence Day
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Avril Drummond
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | | | - Shaun Harris
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - Alan A Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Gavin Newby
- Newby Psychological Services Ltd, Northwich, UK
| | - Catherine Sackley
- Division of Health and Social Care, King's College London, London, UK
| | - Nadina B Lincoln
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
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Testing the Mechanism of Action of Computerized Cognitive Training in Young Adults with Depression: Protocol for a Blinded, Randomized, Controlled Treatment Trial. ACTA ACUST UNITED AC 2020; 5. [PMID: 32743079 PMCID: PMC7394311 DOI: 10.20900/jpbs.20200014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Depression is associated with a broad range of cognitive deficits, including processing speed (PS) and executive functioning (EF). Cognitive symptoms commonly persist with the resolution of affective symptoms and increase risk of relapse and recurrence. The cognitive control network is comprised of brain areas implicated in EF and mood regulatory functions. Prior research has demonstrated the effectiveness of computerized cognitive training (CCT) focused on PS and EF in mitigating both cognitive and affective symptoms of depression. Methods: Ninety participants aged 18–29 with a current diagnosis of major depressive disorder or persistent depressive disorder, or a Hamilton Depression Rating Scale score ≥12, will be randomized to either PS/EF CCT, verbal CCT, or waitlist control. Participants in the active groups will complete 15 min of training 5 days/week for 8 weeks. Clinical and neuropsychological assessments will be completed at baseline, week 4, week 8, and 3-month follow-up. Structural and functional magnetic resonance imaging (fMRI) will be completed at baseline and week 8. We will compare changes in mood, cognition, daily functioning, and fMRI data. We will explore cognitive control network functioning using resting-state and task-based fMRI. Results: Recruitment began in October 2019; we expect to finish recruitment by April 2022 and subsequently begin data analysis. Conclusions: This study is innovative in that it will include both active and waitlist control conditions and will explore changes in neural activation. Identifying the neural networks associated with improvements following CCT will allow for the development of more precise and effective interventions. Trial Registration: ClinicalTrials.govNCT03869463; https://clinicaltrials.gov/ct2/show/NCT03869463.
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Verhoef JAC, Bal MI, Roelofs PDDM, Borghouts JAJ, Roebroeck ME, Miedema HS. Effectiveness and characteristics of interventions to improve work participation in adults with chronic physical conditions: a systematic review. Disabil Rehabil 2020; 44:1007-1022. [PMID: 32686963 DOI: 10.1080/09638288.2020.1788180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Chronic physical conditions often negatively affect work participation. The objective of this systematic review is to investigate the effectiveness and characteristics of vocational rehabilitation interventions for people with a chronic physical condition. METHODS Searches in five databases up to April 2020 identified 30 studies meeting our inclusion criteria. Two reviewers independently assessed and extracted data. The Grading of Recommendation, Assessment, Development and Evaluation (GRADE) framework was used to evaluate quality of evidence for three outcome measures related to work participation. RESULTS All vocational rehabilitation interventions consisted of multiple components, but their characteristics varied widely. Analysis of 22 trials yielded a moderate positive effect with moderate certainty of interventions on work status; analysis of five trials with low risk of bias showed a large positive effect with moderate certainty (risk ratio 1.33 and 1.57, respectively). In addition, in eight studies we found a moderate to small positive effect with low certainty on work attitude (standardized mean difference = 0.59 or 0.38, respectively). We found no effect on work productivity in nine studies. CONCLUSION The systematic review of the literature showed positive effects of vocational rehabilitation interventions on work status and on work attitude; we found no effect on work productivity.Implications for rehabilitationIn rehabilitation, addressing work participation of persons with a chronic physical condition using targeted interventions is beneficial to improve or sustain work participation, irrespective of the intervention characteristics and diagnosis.Interventions that include multiple components and offer individual support, whether or not combined with group sessions, are likely to be more effective in improving work participation in persons with a chronic physical condition.The overview of vocational interventions in this systematic review may assist healthcare professionals in making informed decisions as to which intervention to provide.Vocational rehabilitation, as well as studies on work participation in chronic disease, should include a long follow-up period to explore if work participation is sustainable and contributes to health and wellbeing.
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Affiliation(s)
- Joan A C Verhoef
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.,Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marjolijn I Bal
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.,Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Pepijn D D M Roelofs
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Jeroen A J Borghouts
- Research Centre Caring Society, Avans University of Applied Sciences, Breda, The Netherlands
| | - Marij E Roebroeck
- Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.,Rijndam Rehabilitation Institute, Rotterdam, The Netherlands
| | - Harald S Miedema
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
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Effects of Computerized Cognitive Training and Tai Chi on Cognitive Performance in Older Adults With Traumatic Brain Injury. J Head Trauma Rehabil 2020; 35:187-197. [DOI: 10.1097/htr.0000000000000533] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Stolwyk RJ, Gooden JR, Kim J, Cadilhac DA. What is known about the cost-effectiveness of neuropsychological interventions for individuals with acquired brain injury? A scoping review. Neuropsychol Rehabil 2019; 31:316-344. [PMID: 31769336 DOI: 10.1080/09602011.2019.1692672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The aim of this scoping review was to examine the literature related to economic evaluations of neuropsychological rehabilitation in individuals with acquired brain injury (ABI). PsychINFO, Medline, EMBASE, Cochrane and CINHAL databases were searched in accordance with formal scoping review methodology. Studies were included if published between 1995 and 2019 with a study population of adults aged 18 years or more with any ABI aetiology and there was reported data on resource use, costs or comparative economic analyses as part of an outcome study for rehabilitation interventions. Case studies and trial protocols were excluded. Of 3575 records screened, 30 articles were identified as meeting the inclusion criteria. The majority of studies documented cost savings from provision of various models of multidisciplinary inpatient or outpatient rehabilitation. However, these benefits were estimated without a control group. Eight studies included a cost-effectiveness analysis, and in three, the intervention was reported to be cost-effective compared to the control, one of which saved $9,654 per treated patient. Overall, few eligible studies were identified. Those that included a cost-effectiveness analysis yielded mixed evidence for interventions to be considered cost-effective for ABI. Recommendations for how to incorporate cost-effectiveness analyses into intervention studies are discussed.
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Affiliation(s)
- Renerus J Stolwyk
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia.,Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
| | - James R Gooden
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia.,Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
| | - Joosup Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia.,Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia.,Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
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Nasoohi S, Parveen K, Ishrat T. Metabolic Syndrome, Brain Insulin Resistance, and Alzheimer's Disease: Thioredoxin Interacting Protein (TXNIP) and Inflammasome as Core Amplifiers. J Alzheimers Dis 2019; 66:857-885. [PMID: 30372683 DOI: 10.3233/jad-180735] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Empirical evidence indicates a strong association between insulin resistance and pathological alterations related to Alzheimer's disease (AD) in different cerebral regions. While cerebral insulin resistance is not essentially parallel with systemic metabolic derangements, type 2 diabetes mellitus (T2DM) has been established as a risk factor for AD. The circulating "toxic metabolites" emerging in metabolic syndrome may engage several biochemical pathways to promote oxidative stress and neuroinflammation leading to impair insulin function in the brain or "type 3 diabetes". Thioredoxin-interacting protein (TXNIP) as an intracellular amplifier of oxidative stress and inflammasome activation may presumably mediate central insulin resistance. Emerging data including those from our recent studies has demonstrated a sharp TXNIP upregulation in stroke, aging and AD and well underlining the significance of this hypothesis. With the main interest to illustrate TXNIP place in type 3 diabetes, the present review primarily briefs the potential mechanisms contributing to cerebral insulin resistance in a metabolically deranged environment. Then with a particular focus on plausible TXNIP functions to drive and associate with AD pathology, we present the most recent evidence supporting TXNIP as a promising therapeutic target in AD as an age-associated dementia.
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O'Keefe S, Stanley M, Adam K, Lannin NA. A Systematic Scoping Review of Work Interventions for Hospitalised Adults with an Acquired Neurological Impairment. JOURNAL OF OCCUPATIONAL REHABILITATION 2019; 29:569-584. [PMID: 30515620 DOI: 10.1007/s10926-018-9820-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose Addressing return to work early after neurological impairment from stroke or moderate and severe traumatic brain injury may improve likelihood of returning to employment, yet little is known about how best to organize work interventions for delivery in the inpatient hospital setting. The purpose of this scoping review was to identify knowledge gaps and inform program development in hospital-based work interventions. Method We searched MEDLINE, CINAHL, OTSeeker and Embase for English-language articles published from database inception until March 2018. Citations were then manually searched using reference lists of included papers and Google Scholar. Articles were included if they described programs providing return to work intervention within a hospital to adults with newly acquired neurological conditions, such as traumatic brain injury or stroke. After identifying and selecting relevant studies, we charted the data and then synthesized the results. Results Twenty-eight articles explored work intervention in an inpatient hospital setting. Interventions targeted a diagnostically heterogeneous population, mostly including adults who had suffered either a traumatic brain injury or stroke. Most interventions included a structured process for assessment, highlighted the importance of collaboration, and aimed to improve performance of work skills that could be facilitated within a hospital setting only (as opposed to all work skills). Thematic analysis of included studies resulted in four themes: structure, collaboration, clinician training, and belief in future work capacity. Conclusion Return to work intervention appears to be an important component of neurological rehabilitation. While studies to date have identified enablers for the integration of work interventions into the inpatient hospital setting, there is limited description of specific components of programs, and a lack of studies evaluating program effectiveness.
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Affiliation(s)
- Sophie O'Keefe
- School of Allied Health (Occupational Therapy), La Trobe University, Bundoora, Australia.
| | - Mandy Stanley
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | | | - Natasha A Lannin
- School of Allied Health (Occupational Therapy), La Trobe University, Bundoora, Australia
- Department of Occupational Therapy, Alfred Health, Melbourne, Australia
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Ajtahed SS, Rezapour T, Etemadi S, Moradi H, Habibi Asgarabad M, Ekhtiari H. Efficacy of Neurocognitive Rehabilitation After Coronary Artery Bypass Graft Surgery in Improving Quality of Life: An Interventional Trial. Front Psychol 2019; 10:1759. [PMID: 31440180 PMCID: PMC6694840 DOI: 10.3389/fpsyg.2019.01759] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 07/15/2019] [Indexed: 12/22/2022] Open
Abstract
Introduction Cognitive deficits are frequent after coronary artery bypass graft (CABG) surgery and consequently could lead to a decrease in quality of life. This is the first study that has been conducted with the aim of examining the efficacy of a computerized cognitive rehabilitation therapy (CCRT) in improving quality of life in patients after CABG surgery. Methods In this study, an interventional trial with pre-, post-, and follow-up assessments in active (CCRT), active control and control groups was conducted. Seventy-five patients after CABG surgery were selected and assigned to the groups (n = 25 for each group). CCRT consists of four modules of attention, working memory, response inhibition and processing speed training with graded schedule in 20-min sessions three times per week within 8 weeks. Cognitive functions (attention and working memory) were assessed by the tests of continuous performance, Flanker, useful field of view and digit span at three time points: pre- and post-intervention (T0 and T1) and 6-month follow-up (T2). Quality of life was assessed by the SF-36 questionnaire at the same time points. The CCRT group received the cognitive rehabilitation for 2 months, active control group received a sham version of CCRT in an equal time duration and control group did not receive any cognitive intervention. Results Repeated measures analysis of variance (ANOVA) revealed a time by group interaction on cognitive functions, with CCRT producing a significant improvement at T1 (p < 0.01) and these improvements were maintained at T2. Moreover, in CCRT and active control groups, quality of life (QoL) improved at T1 and these improvements remained stable throughout follow-up (T2). However, improvement of QoL in CCRT group was greater than improvement of QoL in the other two groups at T1. Pearson’s correlation analysis shows a positive correlation between QoL improvement and sustained attention and working memory enhancement (p < 0.05). Conclusion Cognitive rehabilitation can lead to a significant improvement in the cognitive functions that have been trained in patients receiving CABG. Interestingly enough, cognitive rehabilitation can also improve quality of life in patients after CABG surgery and this improvement is maintained for at least 6 months.
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Affiliation(s)
| | - Tara Rezapour
- Department of Psychology, University of Tehran, Tehran, Iran
| | | | - Hadi Moradi
- School of Electrical and Computer Engineering, University of Tehran, Tehran, Iran
| | - Mojtaba Habibi Asgarabad
- Department of Health Psychology, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - Hamed Ekhtiari
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran.,Translational Neuroscience Program, Institute for Cognitive Science Studies, Tehran, Iran.,Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran
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Efficacy of Telerehabilitation for Adults With Traumatic Brain Injury: A Systematic Review. J Head Trauma Rehabil 2019; 33:E33-E46. [PMID: 29084100 DOI: 10.1097/htr.0000000000000350] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify and appraise studies evaluating the efficacy of telerehabilitation for adults with traumatic brain injury (TBI). METHODS A systematic search of Cochrane Library, MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and PsycINFO databases was conducted from January 1980 to April 23, 2017, for studies evaluating the efficacy of telerehabilitation for adults with TBI. Two reviewers independently assessed articles for eligibility and rated methodological quality using 16 criteria related to internal validity, descriptive, and statistical characteristics. RESULTS The review yielded 13 eligible studies, including 10 randomized controlled trials and 3 pre-/postgroup studies (n ≥ 10). These evaluated the feasibility and/or efficacy of telephone-based (10 studies) and Internet-based (3 studies) interventions. Overall, the evidence of efficacy was somewhat mixed. The most common study design evaluated the efficacy of telephone-based interventions relative to usual care, for which 4 of 5 randomized controlled trials reported positive effects at postintervention (d = 0.28-0.51). For these studies, improvements in global functioning, posttraumatic symptoms and sleep quality, and depressive symptoms were reported. The feasibility of Internet-based interventions was generally supported; however, the efficacy could not be determined because of insufficient studies. CONCLUSIONS Structured telephone interventions were found to be effective for improving particular outcomes following TBI. Controlled studies of Internet-based therapy and comparisons of the clinical and cost-effectiveness of in-person and telerehabilitation formats are recommended for future research.
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Røe C, Tverdal C, Howe EI, Tenovuo O, Azouvi P, Andelic N. Randomized Controlled Trials of Rehabilitation Services in the Post-acute Phase of Moderate and Severe Traumatic Brain Injury - A Systematic Review. Front Neurol 2019; 10:557. [PMID: 31244748 PMCID: PMC6563754 DOI: 10.3389/fneur.2019.00557] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 05/09/2019] [Indexed: 12/21/2022] Open
Abstract
Background and aims: There is a gap in knowledge regarding effective rehabilitation service delivery in the post-acute phase after traumatic brain injury (TBI). Recently, Gutenbrunner et al. proposed a classification system for health-related rehabilitation services (International Classification System for Service Organization in Health-related Rehabilitation, ICSO-R) that could be useful for contrasting and comparing rehabilitation services. The ICSO-R describes the dimensions of Provision (i.e., context of delivered services), Funding (i.e., sources of income and refunding), and Delivery (i.e., mode, structure and intensity) at the meso-level of services. We aim to: -Provide an overview of randomized, controlled trials (RCTs) with rehabilitation service relevance provided to patients with moderate and severe TBI in the post-acute phase using the ICSO-R as a framework; and -Evaluate the extent to which the provision, funding and delivery dimensions of rehabilitation services were addressed and differed between the intervention arms in these studies. Materials and methods: A systematic literature search was performed in OVID MEDLINE, EMBASE, CINHAL, PsychINFO, and CENTRAL, including multidisciplinary rehabilitation interventions with RCT designs and service relevance targeting moderate and severe TBI in the post-acute phase. Results: 23 studies with 4,644 TBI patients were included. More than two-thirds of the studies were conducted in a hospital-based rehabilitation setting. The contrast in Context between the intervention arms often co-varied with Resources. The funding of the services was explicitly described in only one study. Aspects of the Delivery dimension were described in all of the studies, and the Mode of Production, Intensity, Aspects of Time and Peer Support were contrasted in the intervention arms in several of the studies. A wide variety of outcome measures were applied often covering Body function, as well as the Activities and Participation domains of the International Classification of Functioning, Disability, and Health (ICF). Conclusion: Aspects of service organization and resources as well as delivery may clearly influence outcome of rehabilitation. Presently, lack of uniformity of data and collection methods, the heterogeneity of structures and processes of rehabilitation services, and a lack of common outcome measurements make comparisons between the studies difficult. Standardized descriptions of services by ICSO-R, offer the possibility to improve comparability in the future and thus enhance the relevance of rehabilitation studies.
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Affiliation(s)
- Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital Ulleval, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Research Centre for Habilitation and Rehabilitation Models and Services, Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Cathrine Tverdal
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital Ulleval, Oslo, Norway
| | - Emilie Isager Howe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital Ulleval, Oslo, Norway
| | - Olli Tenovuo
- Department of Neurology, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland
| | - Philippe Azouvi
- Service de Médecine Physique et de Réadaptation, Hôpital Raymond-Poincaré, Garches, France.,Université de Versailles Saint-Quentin, Montigny-Le-Bretonneux, France
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital Ulleval, Oslo, Norway.,Research Centre for Habilitation and Rehabilitation Models and Services, Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
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Radford K, Sutton C, Sach T, Holmes J, Watkins C, Forshaw D, Jones T, Hoffman K, O'Connor R, Tyerman R, Merchán-Baeza JA, Morris R, McManus E, Drummond A, Walker M, Duley L, Shakespeare D, Hammond A, Phillips J. Early, specialist vocational rehabilitation to facilitate return to work after traumatic brain injury: the FRESH feasibility RCT. Health Technol Assess 2019; 22:1-124. [PMID: 29863459 DOI: 10.3310/hta22330] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Up to 160,000 people incur traumatic brain injury (TBI) each year in the UK. TBI can have profound effects on many areas of human functioning, including participation in work. There is limited evidence of the clinical effectiveness and cost-effectiveness of vocational rehabilitation (VR) after injury to promote early return to work (RTW) following TBI. OBJECTIVE To assess the feasibility of a definitive, multicentre, randomised controlled trial (RCT) of the clinical effectiveness and cost-effectiveness of early, specialist VR plus usual care (UC) compared with UC alone on work retention 12 months post TBI. DESIGN A multicentre, feasibility, parallel-group RCT with a feasibility economic evaluation and an embedded mixed-methods process evaluation. Randomisation was by remote computer-generated allocation. SETTING Three NHS major trauma centres (MTCs) in England. PARTICIPANTS Adults with TBI admitted for > 48 hours and working or studying prior to injury. INTERVENTIONS Early specialist TBI VR delivered by occupational therapists (OTs) in the community using a case co-ordination model. MAIN OUTCOME MEASURES Self-reported RTW 12 months post randomisation, mood, functional ability, participation, work self-efficacy, quality of life and work ability. Feasibility outcomes included recruitment and retention rates. Follow-up was by postal questionnaires in two centres and face to face in one centre. Those collecting data were blind to treatment allocation. RESULTS Out of 102 target participants, 78 were recruited (39 randomised to each arm), representing 39% of those eligible and 5% of those screened. Approximately 2.2 patients were recruited per site per month. Of those, 56% had mild injuries, 18% had moderate injuries and 26% had severe injuries. A total of 32 out of 45 nominated carers were recruited. A total of 52 out of 78 (67%) TBI participants responded at 12 months (UC, n = 23; intervention, n = 29), completing 90% of the work questions; 21 out of 23 (91%) UC respondents and 20 out of 29 (69%) intervention participants returned to work at 12 months. Two participants disengaged from the intervention. Face-to-face follow-up was no more effective than postal follow-up. RTW was most strongly related to social participation and work self-efficacy. It is feasible to assess the cost-effectiveness of VR. Intervention was delivered as intended and valued by participants. Factors likely to affect a definitive trial include deploying experienced OTs, no clear TBI definition or TBI registers, and repatriation of more severe TBI from MTCs, affecting recruitment of those most likely to benefit/least likely to drop out. LIMITATIONS Target recruitment was not reached, but mechanisms to achieve this in future studies were identified. Retention was lower than expected, particularly in UC, potentially biasing estimates of the 12-month RTW rate. CONCLUSIONS This study met most feasibility objectives. The intervention was delivered with high fidelity. When objectives were not met, strategies to ensure feasibility of a full trial were identified. Future work should test two-stage recruitment and include resources to recruit from 'spokes'. A broader measure covering work ability, self-efficacy and participation may be a more sensitive outcome. TRIAL REGISTRATION Current Controlled Trials ISRCTN38581822. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 33. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kate Radford
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Chris Sutton
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Tracey Sach
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Jain Holmes
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Caroline Watkins
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Denise Forshaw
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Trevor Jones
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Karen Hoffman
- Centre for Trauma Sciences, Queen Mary University of London, London, UK
| | - Rory O'Connor
- Academic Department of Rehabilitation Medicine, School of Medicine, University of Leeds, Leeds, UK
| | - Ruth Tyerman
- Community Head Injury Service, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
| | | | - Richard Morris
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Emma McManus
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Avril Drummond
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Marion Walker
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Lelia Duley
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Alison Hammond
- Health Sciences Research Centre, University of Salford, Salford, UK
| | - Julie Phillips
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
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TiO 2-Nanowired Delivery of DL-3-n-butylphthalide (DL-NBP) Attenuates Blood-Brain Barrier Disruption, Brain Edema Formation, and Neuronal Damages Following Concussive Head Injury. Mol Neurobiol 2019; 55:350-358. [PMID: 28856586 DOI: 10.1007/s12035-017-0746-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
DL-3-n-butylphthalide (DL-NBP) is one of the constituents of Chinese celery extract that is used to treat stroke, dementia, and ischemic diseases. However, its role in traumatic brain injury is less well known. In this investigation, neuroprotective effects of DL-NBP in concussive head injury (CHI) on brain pathology were explored in a rat model. CHI was inflicted in anesthetized rats by dropping a weight of 114.6 g from a height of 20 cm through a guide tube on the exposed right parietal bone inducing an impact of 0.224 N and allowed them to survive 4 to 24 h after the primary insult. DL-NBP was administered (40 or 60 mg/kg, i.p.) 2 and 4 h after injury in 8-h survival group and 8 and 12 h after trauma in 24-h survival group. In addition, TiO2-nanowired delivery of DL-NBP (20 or 40 mg/kg, i.p.) in 8 and 24 h CHI rats was also examined. Untreated CHI showed a progressive increase in blood-brain barrier (BBB) breakdown to Evans blue albumin (EBA) and radioiodine ([131]-I), edema formation, and neuronal injuries. The magnitude and intensity of these pathological changes were most marked in the left hemisphere. Treatment with DL-NBP significantly reduced brain pathology in CHI following 8 to 12 h at 40-mg dose. However, 60-mg dose is needed to thwart brain pathology at 24 h following CHI. On the other hand, TiO2-DL-NBP was effective in reducing brain damage up to 8 or 12 h using a 20-mg dose and only 40-mg dose was needed for neuroprotection in CHI at 24 h. These observations are the first to suggest that (i) DL-NBP is quite effective in reducing brain pathology and (ii) nanodelivery of DL-NBP has far more superior effects in CHI, not reported earlier.
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Chia AA, Power E, Kenny B, Elbourn E, McDonald S, Tate R, MacWhinney B, Turkstra L, Holland A, Togher L. Patterns of early conversational recovery for people with traumatic brain injury and their communication partners. Brain Inj 2019; 33:690-698. [DOI: 10.1080/02699052.2019.1571632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- An An Chia
- Discipline of Speech Pathology, Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
| | - Emma Power
- Discipline of Speech Pathology, Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
- Discipline of Speech Pathology, UTS Graduate School of Health, University of Technology, Sydney, Australia
| | - Belinda Kenny
- Discipline of Speech Pathology, Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
- NHMRC Centre of Research Excellence in Brain Recovery, Sydney, NSW, Australia
| | - Elise Elbourn
- Discipline of Speech Pathology, Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
- NHMRC Centre of Research Excellence in Brain Recovery, Sydney, NSW, Australia
| | - Skye McDonald
- NHMRC Centre of Research Excellence in Brain Recovery, Sydney, NSW, Australia
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Robyn Tate
- NHMRC Centre of Research Excellence in Brain Recovery, Sydney, NSW, Australia
- Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Brian MacWhinney
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Lyn Turkstra
- Department of Communicative Disorders, University of Wisconsin-Madison, Madison, WI, USA
| | - Audrey Holland
- Department of Speech, Language and Hearing Sciences, University of Arizona, Tucson, AZ, USA
| | - Leanne Togher
- Discipline of Speech Pathology, Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
- NHMRC Centre of Research Excellence in Brain Recovery, Sydney, NSW, Australia
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Cognitive rehabilitation is advantageous in terms of fatigue and independence in pediatric cancer treatment: a randomized-controlled study. Int J Rehabil Res 2019; 42:145-151. [PMID: 30741725 DOI: 10.1097/mrr.0000000000000340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study aimed to investigate the effect of task-oriented inpatient cognitive rehabilitation on fatigue perception and independence in daily activities. Forty (22 males, 18 females) children with pediatric cancer were randomized to either study [n = 22; 10.81 (1.33) years] or control [n = 18; 10.16 (1.24) years] groups. The study group received a cognitive rehabilitation intervention in addition to a routine therapy program, and the control group received a routine therapy program for 15 sessions. Cognitive status, fatigue, and daily life activity outcomes were assessed by blinded assessors in before and after interventions in the hospital setting. The study group showed a significant decrease in fatigue (P values for fatigue before, during, and after activity: P < 0.001) and in the control group (P values for fatigue only in during and post activity: P < 0.05). A statistically significant improvement was found in functional independence for the study group in all activities of daily living areas areas (P < 0.001), whereas no differences were found in the control group. Cognitive rehabilitation appears to provide beneficial effects in decreasing fatigue, improving functional status in activities of daily living, and increasing cognitive skills at the early stages in inpatient rehabilitation of pediatric cancer.
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Howe EI, Løvstad M, Langlo KPS, Hellstrøm T, Spjelkavik Ø, Ugelstad H, Twamley EW, Andelic N. Feasibility of a cognitive rehabilitation program for individuals with mild-to-moderate traumatic brain injury: Participants’ engagement and satisfaction. COGENT MEDICINE 2019. [DOI: 10.1080/2331205x.2019.1565614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Emilie Isager Howe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Marianne Løvstad
- Department of Research, Sunnaas Rehabilitation Hospital Trust, Nesoddtangen, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Knut-Petter S. Langlo
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Torgeir Hellstrøm
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | | | - Helene Ugelstad
- Department of Vocational Rehabilitation, Norwegian Labour and Welfare Administration, Oslo, Norway
| | - Elizabeth W. Twamley
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway
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Elbourn E, Kenny B, Power E, Honan C, McDonald S, Tate R, Holland A, MacWhinney B, Togher L. Discourse recovery after severe traumatic brain injury: exploring the first year. Brain Inj 2018; 33:143-159. [DOI: 10.1080/02699052.2018.1539246] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Elise Elbourn
- Faculty of Health Sciences, The University of Sydney, Lidcombe, Australia
| | - Belinda Kenny
- Faculty of Health Sciences, The University of Sydney, Lidcombe, Australia
| | - Emma Power
- Faculty of Health Sciences, The University of Sydney, Lidcombe, Australia
| | - Cynthia Honan
- School of Medicine, The University of Tasmania, Hobart, Australia
| | - Skye McDonald
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Robyn Tate
- Faculty of Health Sciences, The University of Sydney, Lidcombe, Australia
| | - Audrey Holland
- Speech, Language and Hearing Sciences, The University of Arizona, Tucson, USA
| | - Brian MacWhinney
- Department of Psychology, Carnegie Mellon University, Pittsburgh, USA
| | - Leanne Togher
- Faculty of Health Sciences, The University of Sydney, Lidcombe, Australia
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Yue JK, Winkler EA, Puffer RC, Deng H, Phelps RRL, Wagle S, Morrissey MR, Rivera EJ, Runyon SJ, Vassar MJ, Taylor SR, Cnossen MC, Lingsma HF, Yuh EL, Mukherjee P, Schnyer DM, Puccio AM, Valadka AB, Okonkwo DO, Manley GT, The Track-Tbi Investigators. Temporal lobe contusions on computed tomography are associated with impaired 6-month functional recovery after mild traumatic brain injury: a TRACK-TBI study. Neurol Res 2018; 40:972-981. [PMID: 30175944 DOI: 10.1080/01616412.2018.1505416] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Mild traumatic brain injury (MTBI) can cause persistent functional deficits and healthcare burden. Understanding the association between intracranial contusions and outcome may aid in MTBI treatment and prognosis. METHODS MTBI patients with Glasgow Coma Scale 13-15 and 6-month outcomes [Glasgow Outcome Scale-Extended (GOSE)], without polytrauma from the prospective TRACK-TBI Pilot study were analyzed. Intracranial contusions on computed tomography (CT) were coded by location. Multivariable regression evaluated associations between intracranial injury type (temporal contusion [TC], frontal contusion, extraaxial [epidural/subdural/subarachnoid], other-intraaxial [intracerebral/intraventricular hemorrhage, axonal injury]) and GOSE. Odds ratios (OR) are reported. RESULTS Overall, 260 MTBI subjects were aged 44.4 ± 18.1-years; 67.7% were male. Ninety-seven subjects were CT-positive and 46 had contusions (41.3%-frontal, 30.4%-temporal, 21.7%-frontal + temporal, 2.2% each-parietal/occipital/brainstem); 95.7% had concurrent extraaxial hemorrhage. Mortality was 0% at discharge and 2.3% by 6-months. GOSE distribution was 2.3%-death, 1.5%-severe disability, 27.7%-moderate disability, 68.5%-good recovery. Forty-six percent of TC-positive subjects suffered moderate disability or worse (GOSE ≤6) and 41.7% were unable to return to baseline work capacity (RTBWC), compared to 29.1%/20.4% for CT-negative and 26.1%/20.9% for CT-positive subjects without TC. On multivariable regression, TC associated with OR = 3.33 (95% CI [1.16-9.60], p = 0.026) for GOSE ≤6, and OR = 4.48 ([1.49-13.51], p = 0.008) for inability to RTBWC. CONCLUSIONS Parenchymal contusions in MTBI are often accompanied by extraaxial hemorrhage. TCs may be associated with 6-month functional impairment. Their presence on imaging should alert the clinician to the need for heightened surveillance of sequelae complicating RTBWC, with low threshold for referral to services.
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Affiliation(s)
- John K Yue
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Ethan A Winkler
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Ross C Puffer
- c Department of Neurological Surgery , Mayo Clinic , Rochester , MN , USA.,d Department of Neurological Surgery , University of Pittsburgh Medical Center , Pittsburgh , PA , USA
| | - Hansen Deng
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Ryan R L Phelps
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Sagar Wagle
- e Department of Radiology , Mayo Clinic , Rochester , MN , USA
| | - Molly Rose Morrissey
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Ernesto J Rivera
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Sarah J Runyon
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Mary J Vassar
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Sabrina R Taylor
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Maryse C Cnossen
- f Department of Public Health , Erasmus Medical Center , Rotterdam , The Netherlands
| | - Hester F Lingsma
- f Department of Public Health , Erasmus Medical Center , Rotterdam , The Netherlands
| | - Esther L Yuh
- b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA.,g Department of Radiology , University of California San Francisco , San Francisco , CA , USA
| | - Pratik Mukherjee
- b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA.,g Department of Radiology , University of California San Francisco , San Francisco , CA , USA
| | - David M Schnyer
- h Department of Psychology , University of Texas at Austin , Austin , TX , USA
| | - Ava M Puccio
- d Department of Neurological Surgery , University of Pittsburgh Medical Center , Pittsburgh , PA , USA
| | - Alex B Valadka
- i Department of Neurological Surgery , Virginia Commonwealth University , Richmond , VA , USA
| | - David O Okonkwo
- d Department of Neurological Surgery , University of Pittsburgh Medical Center , Pittsburgh , PA , USA
| | - Geoffrey T Manley
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
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Defense and Veterans Brain Injury Center: The First 25 Years. J Head Trauma Rehabil 2018. [DOI: 10.1097/htr.0000000000000389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hassett L, Moseley AM, Harmer AR. Fitness training for cardiorespiratory conditioning after traumatic brain injury. Cochrane Database Syst Rev 2017; 12:CD006123. [PMID: 29286534 PMCID: PMC6486048 DOI: 10.1002/14651858.cd006123.pub3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Reduced cardiorespiratory fitness (cardiorespiratory deconditioning) is a common consequence of traumatic brain injury (TBI). Fitness training may be implemented to address this impairment. OBJECTIVES The primary objective of this updated review was to evaluate whether fitness training improves cardiorespiratory fitness in people who have sustained a TBI. The secondary objectives were to evaluate whether fitness training improves body function and structure (physical and cognitive impairments, psychological responses resulting from the injury), activity limitations and participation restrictions in people who have sustained a TBI as well as to evaluate its safety, acceptance, feasibility and suitability. SEARCH METHODS We searched 10 electronic databases (the Cochrane Injuries Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Embase; PubMed (MEDLINE); CINAHL; AMED; SPORTDiscus; PsycINFO; PEDro and PsycBITE) and the International Clinical Trials Registry Platform for relevant trials. In addition we screened reference lists from systematic reviews related to the topic that we identified from our search, and from the included studies, and contacted trialists to identify further studies. The search was run in August 2017. SELECTION CRITERIA Randomised controlled studies with TBI participants were eligible if they compared an exercise programme incorporating cardiorespiratory fitness training to usual care, a non-exercise intervention, or no intervention. DATA COLLECTION AND ANALYSIS Two authors independently screened the search results, extracted data and assessed bias. We contacted all trialists for additional information. We calculated mean difference (MD) or standardised mean difference (SMD) and 95% confidence intervals (CI) for continuous data, and odds ratio with 95% CI for dichotomous data. We pooled data when there were sufficient studies with homogeneity. MAIN RESULTS Two new studies incorporating 96 participants were identified in this update and were added to the six previously included studies. A total of eight studies incorporating 399 participants are included in the updated review. The participants were primarily men aged in their mid-thirties who had sustained a severe TBI. No studies included children. The studies were clinically diverse with regard to the interventions, time postinjury and the outcome measures used. At the end of intervention, the mean difference in peak power output was 35.47 watts (W) in favour of fitness training (MD 35.47 W, 95% CI 2.53 to 68.41 W; 3 studies, 67 participants; low-quality evidence). The CIs include both a possible clinically important effect and a possible negligible effect, and there was moderate heterogeneity among the studies.Five of the secondary outcomes had sufficient data at the end of intervention to enable meta-analysis: body composition (SMD 0.29 standard deviations (favouring control), 95% CI -0.22 to 0.79; 2 studies, 61 participants; low-quality evidence), strength (SMD -0.02 (favouring control), 95% CI -0.86 to 0.83; 2 studies, 23 participants; very low-quality evidence), fatigue (SMD -0.32 (favouring fitness training), 95% CI -0.90 to 0.26; 3 studies, 130 participants; very low-quality evidence), depression (SMD -0.43 (favouring fitness training), 95% CI -0.92 to 0.06; 4 studies, 220 participants; very low-quality evidence), and neuromotor function (MD 0.01 m (favouring fitness training), 95% CI -0.25 to 0.27; 2 studies, 109 participants; moderate-quality evidence). It was uncertain whether fitness training was more or less effective at improving these secondary outcomes compared to the control interventions. Quality of life was assessed in three trials, but we did not pool the data because of substantial heterogeneity. Five of the eight included studies had no dropouts from their intervention group and no adverse events were reported in any study. AUTHORS' CONCLUSIONS There is low-quality evidence that fitness training is effective at improving cardiorespiratory deconditioning after TBI; there is insufficient evidence to draw any definitive conclusions about the other outcomes. Whilst the intervention appears to be accepted by people with TBI, and there is no evidence of harm, more adequately powered and well-designed studies are required to determine a more precise estimate of the effect on cardiorespiratory fitness, as well as the effects across a range of important outcome measures and in people with different characteristics (e.g. children). In the absence of high quality evidence, clinicians may be guided by pre-exercise screening checklists to ensure the person with traumatic brain injury is safe to exercise, and set training parameters using guidelines established by the American College of Sports Medicine for people who have suffered a brain injury.
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Affiliation(s)
- Leanne Hassett
- The University of SydneyDiscipline of Physiotherapy, Faculty of Health Sciences and Musculoskeletal Health Sydney, School of Public HealthSydneyAustralia
| | - Anne M Moseley
- School of Public Health, The University of SydneyMusculoskeletal Health SydneyPO Box M179Missenden RdSydneyNSWAustralia2050
| | - Alison R Harmer
- The University of SydneyFaculty of Health SciencesC42 ‐ Cumberland CampusRoom 208, O BlockSydneyNew South WalesAustraliaNSW 1825
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Howe EI, Langlo KPS, Terjesen HCA, Røe C, Schanke AK, Søberg HL, Sveen U, Aas E, Enehaug H, Alves DE, Klethagen P, Sagstad K, Moen CM, Torsteinsbrend K, Linnestad AM, Nordenmark TH, Rismyhr BS, Wangen G, Lu J, Ponsford J, Twamley EW, Ugelstad H, Spjelkavik Ø, Løvstad M, Andelic N. Combined cognitive and vocational interventions after mild to moderate traumatic brain injury: study protocol for a randomized controlled trial. Trials 2017; 18:483. [PMID: 29041954 PMCID: PMC5645893 DOI: 10.1186/s13063-017-2218-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/27/2017] [Indexed: 11/25/2022] Open
Abstract
Background A considerable proportion of patients with mild to moderate traumatic brain injury (TBI) experience long-lasting somatic, cognitive, and emotional symptoms that may hamper their capacity to return to work (RTW). Although several studies have described medical, psychological, and work-related factors that predict RTW after TBI, well-controlled intervention studies regarding RTW are scarce. Furthermore, there has traditionally been weak collaboration among health-related rehabilitation services, the labor and welfare sector, and workplaces. Methods/design This study protocol describes an innovative randomized controlled trial in which we will explore the effect of combining manualized cognitive rehabilitation (Compensatory Cognitive Training [CCT]) and supported employment (SE) on RTW and related outcomes for patients with mild to moderate TBI in real-life competitive work settings. The study will be carried out in the southeastern region of Norway and thereby be performed within the Norwegian welfare system. Patients aged 18–60 years with mild to moderate TBI who are employed in a minimum 50% position at the time of injury and sick-listed 50% or more for postconcussive symptoms 2 months postinjury will be included in the study. A comprehensive assessment of neurocognitive function, self-reported symptoms, emotional distress, coping style, and quality of life will be performed at baseline, immediately after CCT (3 months after inclusion), following the end of SE (6 months after inclusion), and 12 months following study inclusion. The primary outcome measures are the proportion of participants who have returned to work at 12-month follow-up and length of time until RTW, in addition to work stability as well as work productivity over the first year following the intervention. Secondary outcomes include changes in self-reported symptoms, emotional and cognitive function, and quality of life. Additionally, a qualitative RTW process evaluation focused on organizational challenges at the workplace will be performed. Discussion The proposed study will combine cognitive and vocational rehabilitation and explore the efficacy of increased cross-sectoral collaboration between specialized health care services and the labor and welfare system. If the intervention proves effective, the project will describe the cost-effectiveness and utility of the program and thereby provide important information for policy makers. In addition, knowledge about the RTW process for persons with TBI and their workplaces will be provided. Trial registration ClinicalTrials.gov, NCT03092713. Registered on 10 March 2017. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2218-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emilie I Howe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway. .,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Knut-Petter S Langlo
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | | | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anne-Kristine Schanke
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.,Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Helene L Søberg
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Faculty of Health Sciences, Oslo and Akershus University College of Applied Science, Oslo, Norway
| | - Unni Sveen
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Faculty of Health Sciences, Oslo and Akershus University College of Applied Science, Oslo, Norway
| | - Eline Aas
- Department of Health Economics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Heidi Enehaug
- The Work Research Institute, Oslo and Akershus University College of Applied Science, Oslo, Norway
| | - Daniele E Alves
- The Work Research Institute, Oslo and Akershus University College of Applied Science, Oslo, Norway
| | - Pål Klethagen
- The Work Research Institute, Oslo and Akershus University College of Applied Science, Oslo, Norway
| | - Kjersti Sagstad
- Department of Vocational Rehabilitation, Norwegian Labor and Welfare Administration, Oslo, Norway
| | - Christine M Moen
- Department of Vocational Rehabilitation, Norwegian Labor and Welfare Administration, Oslo, Norway
| | - Karin Torsteinsbrend
- Department of Vocational Rehabilitation, Norwegian Labor and Welfare Administration, Oslo, Norway
| | | | - Tonje Haug Nordenmark
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Birte Sand Rismyhr
- The Norwegian User Organization (Personskadeforbundet LTN), Oslo, Norway
| | - Grete Wangen
- Faculty of Health Sciences, Oslo and Akershus University College of Applied Science, Oslo, Norway
| | - Juan Lu
- Department of Family Medicine and Population Health, Division of Epidemiology, Virginia Commonwealth University, Richmond, VA, USA
| | - Jennie Ponsford
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Faculty of Medicine, Nursing and Health Sciences , Clayton, Victoria, Australia
| | - Elizabeth W Twamley
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Helene Ugelstad
- Department of Vocational Rehabilitation, Norwegian Labor and Welfare Administration, Oslo, Norway
| | - Øystein Spjelkavik
- The Work Research Institute, Oslo and Akershus University College of Applied Science, Oslo, Norway
| | - Marianne Løvstad
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.,Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Center for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Hoeffding LK, Nielsen MH, Rasmussen MA, Norup A, Arango-Lasprilla JC, Kjær UK, Burgdorf KS, Quas KJ, Schow T. A manual-based vocational rehabilitation program for patients with an acquired brain injury: study protocol of a pragmatic randomized controlled trial (RCT). Trials 2017; 18:371. [PMID: 28793916 PMCID: PMC5550982 DOI: 10.1186/s13063-017-2115-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 07/23/2017] [Indexed: 12/02/2022] Open
Abstract
Background An acquired brain injury (ABI) is a complex injury often followed by a broad range of cognitive, physical, emotional, and behavioral disabilities. Because of these disabilities, vocational rehabilitation (VR) is a challenging task, however, of great importance, since approximately 75% of the patients with ABI are of working age. Thus, standardized clinically effective and cost-effective methodologies regarding VR for patients with ABI are highly needed. Therefore, the aim of this study is to evaluate the effect of an individually targeted manual-based VR for patient with ABI compared to conventional VR (usual care). Methods This study is an interventional, two-arm, six-month follow-up, cluster randomized controlled trial involving four municipalities in the Zealand Region and the Capital Region of Denmark. A total of 84 patients with ABI evenly distributed across four municipalities will be included in the study. The patients will randomly be allocated in a 1:1 ratio to the VR intervention provided by a specialized Brain Injury Centre or the conventional VR provided by the municipalities (usual care). The six- to nine-month intervention will consist of individual and group therapies as well as a work placement program including supported employment. Furthermore, the intervention will include a family intervention program followed up by support to one individual family caregiver. The primary outcomes are increased work or study rate at six-month follow-up. Moreover, a budget impact analysis and possibly a cost-utility analysis of the intervention will be performed. Discussion This study consists of a comprehensive multidiciplinary VR intervention involving several parties such as the municipalities, a specialized rehabilitation team, and patients’ own family caregivers. If this intervention is proven successful when compared to the conventional VR, it will provide evidence for a manual-based individualized holistic approach in returning to work after an ABI. Furthermore, the study will contribute with novel knowledge regarding feasibility and clinical effectiveness of the VR intervention relevant to clinicians, researchers, and policymakers. Trial registration ClinicalTrials.gov, NCT03086031. Registered on 21 March 2017. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2115-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Louise K Hoeffding
- Research and development, Brain Injury Center BOMI, Maglegaardsvej 15, 4000, Roskilde, Denmark.,Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Roskilde, Denmark.,Department of Clinical Immunology, the Blood Bank, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Maria Haahr Nielsen
- Research and development, Brain Injury Center BOMI, Maglegaardsvej 15, 4000, Roskilde, Denmark.,Department of Clinical Immunology, the Blood Bank, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Morten A Rasmussen
- Faculty of Science, Chemometrics and Analytical Technology, University of Copenhagen, Copenhagen, Denmark.,Copenhagen Prospective Studies on Asthma in Childhood, Faculty of Health and Medical Sciences, University of Copenhagen & Danish Pediatric Asthma Center, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Anne Norup
- National Study on Young Brain Injury Survivors, Department of Neurology, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark
| | - Juan Carlos Arango-Lasprilla
- BioCruces Health Research Institute, Cruces University Hospital, Barakaldo, Spain.,IKERBASQUE. Basque Foundation for Science, Bilbao, Spain
| | | | - Kristoffer Sølvsten Burgdorf
- Research and development, Brain Injury Center BOMI, Maglegaardsvej 15, 4000, Roskilde, Denmark.,Department of Clinical Immunology, the Blood Bank, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Kirsten Jensen Quas
- Neuropsychologist, Head of Research and Development at Brain Injury Center BOMI, Roskilde, Denmark
| | - Trine Schow
- Research and development, Brain Injury Center BOMI, Maglegaardsvej 15, 4000, Roskilde, Denmark.
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Budnick HC, Tyroch AH, Milan SA. Ethnic disparities in traumatic brain injury care referral in a Hispanic-majority population. J Surg Res 2017; 215:231-238. [DOI: 10.1016/j.jss.2017.03.062] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 03/10/2017] [Accepted: 03/30/2017] [Indexed: 10/19/2022]
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Kumar KS, Samuelkamaleshkumar S, Viswanathan A, Macaden AS. Cognitive rehabilitation for adults with traumatic brain injury to improve occupational outcomes. Cochrane Database Syst Rev 2017; 6:CD007935. [PMID: 28631816 PMCID: PMC6481568 DOI: 10.1002/14651858.cd007935.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cognitive impairment in people with traumatic brain injury (TBI) could affect multiple facets of their daily functioning. Cognitive rehabilitation brings about clinically significant improvement in certain cognitive skills. However, it is uncertain if these improved cognitive skills lead to betterments in other key aspects of daily living. We evaluated whether cognitive rehabilitation for people with TBI improves return to work, independence in daily activities, community integration and quality of life. OBJECTIVES To evaluate the effects of cognitive rehabilitation on return to work, independence in daily activities, community integration (occupational outcomes) and quality of life in people with traumatic brain injury, and to determine which cognitive rehabilitation strategy better achieves these outcomes. SEARCH METHODS We searched CENTRAL (the Cochrane Library; 2017, Issue 3), MEDLINE (OvidSP), Embase (OvidSP), PsycINFO (OvidSP), and clinical trials registries up to 30 March 2017. SELECTION CRITERIA We identified all available randomized controlled trials of cognitive rehabilitation compared with any other non-pharmacological intervention for people with TBI. We included studies that reported at least one outcome related to : return to work, independence in activities of daily living (ADL), community integration and quality of life. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials. We used standard methodological procedures expected by Cochrane. We evaluated heterogeneity among the included studies and performed meta-analysis only when we could include more than one study in a comparison. We used the online computer programme GRADEpro to assess the quality of evidence, and generate 'Summary of findings' tables. MAIN RESULTS We included nine studies with 790 participants. Three trials (160 participants) compared cognitive rehabilitation versus no treatment, four trials (144 participants) compared cognitive rehabilitation versus conventional treatment, one trial (120 participants) compared hospital-based cognitive rehabilitation versus home programme and one trial (366 participants) compared one cognitive strategy versus another. Among the included studies, we judged three to be of low risk of bias.There was no difference between cognitive rehabilitation and no intervention in return to work (risk ratio (RR) 1.80, 95% confidence interval (CI) 0.74 to 4.39, 1 study; very low-quality evidence). There was no difference between biweekly cognitive rehabilitation for eight weeks and no treatment in community integration (Sydney Psychosocial Reintegration Scale): mean difference (MD) -2.90, 95% CI -12.57 to 6.77, 1 study; low-quality evidence). There was no difference in quality of life between cognitive rehabilitation and no intervention immediately following the 12-week intervention(MD 0.30, 95% CI -0.18 to 0.78, 1 study; low-quality evidence). No study reported effects on independence in ADL.There was no difference between cognitive rehabilitation and conventional treatment in return to work status at six months' follow-up in one study (RR 1.43, 95% CI 0.87 to 2.33; low-quality evidence); independence in ADL at three to four weeks' follow-up in two studies (standardized mean difference (SMD) -0.01, 95% CI -0.62 to 0.61; very low-quality evidence); community integration at three weeks' to six months' follow-up in three studies (Community Integration Questionnaire: MD 0.05, 95% CI -1.51 to 1.62; low-quality evidence) and quality of life at six months' follow-up in one study (Perceived Quality of Life scale: MD 6.50, 95% CI -2.57 to 15.57; moderate-quality evidence).For active duty military personnel with moderate-to-severe closed head injury, there was no difference between eight weeks of cognitive rehabilitation administered as a home programme and hospital-based cognitive rehabilitation in achieving return to work at one year' follow-up in one study (RR 0.95, 95% CI 0.85 to 1.05; moderate-quality evidence). The study did not report effects on independence in ADL, community integration or quality of life.There was no difference between one cognitive rehabilitation strategy (cognitive didactic) and another (functional experiential) for adult veterans or active duty military service personnel with moderate-to-severe TBI (one study with 366 participants and one year' follow-up) on return to work (RR 1.10, 95% CI 0.83 to 1.46; moderate-quality evidence), or on independence in ADL (RR 0.90, 95% CI 0.75 to 1.08; low-quality evidence). The study did not report effects on community integration or quality of life.None of the studies reported adverse effects of cognitive rehabilitation. AUTHORS' CONCLUSIONS There is insufficient good-quality evidence to support the role of cognitive rehabilitation when compared to no intervention or conventional rehabilitation in improving return to work, independence in ADL, community integration or quality of life in adults with TBI. There is moderate-quality evidence that cognitive rehabilitation provided as a home programme is similar to hospital-based cognitive rehabilitation in improving return to work status among active duty military personnel with moderate-to-severe TBI. Moderate-quality evidence suggests that one cognitive rehabilitation strategy (cognitive didactic) is no better than another (functional experiential) in achieving return to work in veterans or military personnel with TBI.
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Affiliation(s)
- K Suresh Kumar
- London School of Hygiene and Tropical MedicineClinical Research DepartmentKeppel StreetLondonUKWC1E 7HT
| | | | - Anand Viswanathan
- Christian Medical CollegeCochrane South Asia, Prof. BV Moses Center for Evidence‐Informed Health Care and Health PolicyBagayamVelloreTamil NaduIndia632002
| | - Ashish S Macaden
- Raigmore Hospital (NHS Highland)Stroke and Rehabilitation MedicineInvernessUKIV2 3UJ
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Brunner M, Hemsley B, Togher L, Palmer S. Technology and its role in rehabilitation for people with cognitive-communication disability following a traumatic brain injury (TBI). Brain Inj 2017; 31:1028-1043. [DOI: 10.1080/02699052.2017.1292429] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Melissa Brunner
- Speech Pathology, Faculty of Education and Arts, University of Newcastle, Newcastle, Australia
| | - Bronwyn Hemsley
- Speech Pathology, Faculty of Education and Arts, University of Newcastle, Newcastle, Australia
| | - Leanne Togher
- Speech Pathology, Faculty of Health Sciences, University of Sydney, Sydney, Australia
- NHMRC Centre of Research Excellence in Brain Recovery, Sydney, Australia
| | - Stuart Palmer
- Faculty of Science, Engineering & Built Environment, Deakin University, Geelong, Australia
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