Outcomes after head injury: level of agreement between subjects and their informants

Children's and teachers' perspectives on adjustments needed in school settings after acquired brain injury

BACKGROUND

Children with acquired brain injury (ABI) often present with functional deficits that influence their societal participation and well-being. Successful reintegration into school calls for individual support to meet each child's adjustment needs. The adjustment needs of children with ABI in school settings have not previously been explored.

AIM

The objectives of the present study were (a) to describe adjustment needs in school settings for children with ABI and (b) to explore differences and similarities between reports from the children and their teachers.

METHODS

In this cross-sectional study, 20 children with ABI (mean age 12.8 ± 3.4 years; class grade 1-10) and their teachers were interviewed individually, using the School Setting Interview (SSI). Data were analyzed with descriptive and with non-parametric statistics.

RESULTS

(a) In the overall group, children rated that 55.6% of the 16 activities in the SSI needed no adjustment. The corresponding percentage for teachers was 48.4%. (b) In the child-teacher pairs, there was a positive relationship between teachers' and children's responses only in 3 out of 16 school activities and agreement varied strongly according to the activity in question.

CONCLUSIONS AND SIGNIFICANCE

It is important for occupational therapists and other professionals to specifically consider adjustment needs relating to school activities from various perspectives when aiming to provide individualized interventions.

Health-related quality of life in children and adolescents following traumatic injury: a review

This paper comprehensively reviews the published literature investigating health-related quality of life (HRQOL) following general traumatic injury in individuals between birth and 18 years. Studies were not considered if they primarily compared medical treatment options, evaluated physical function but not other aspects of HRQOL, or focused on non-traumatic wounds. Specific injury types (e.g., burn injury) were also not included. A total of 16 studies met criteria. Participants were age 1-18 years, with 12 studies considering children 5 years of age or older. Males were overrepresented. Injury severity averaged mostly in the moderate range. HRQOL deficits were noted in injured samples in all studies except the two with the longest time to follow-up (6-11 years). Some improvement was seen 6 months to 2 years after injury. Factors associated with HRQOL deficits were investigated, with acute and posttraumatic stress disorder symptoms showing the strongest relationship. Research to date in this area is impressive, particularly the number of studies using prospective longitudinal investigations and validated measures. Challenges remain regarding methodologic differences, assessment of preinjury status, retention of participants, and management of missing data. Suggested future directions include extension of follow-up duration, utilization of pediatric self-report when possible, inclusion of younger children, and development of intervention programs.

Health-related quality of life in children with moderate-to-severe traumatic brain injury

OBJECTIVE

To investigate health-related quality of life (HRQOL) in a sample of ethnically diverse children with traumatic brain injury (TBI).

METHODS

Twenty children with moderate-severe TBI and their parents were recruited from a TBI clinic at a paediatric rehabilitation hospital. Children's self-reported HRQOL was assessed with the Pediatric Quality of Life Inventory. Parents completed a parallel proxy measure.

RESULTS

Children reported significantly lower Psychosocial HRQOL compared to their Total HRQOL, driven largely by low School HRQOL scores. Compared to other paediatric populations, children with TBI reported lower or equivalent HRQOL. Compared with children's self-reports, parents reported even lower HRQOL for their children across primary domains, with fair-to-moderate convergence between informants.

CONCLUSIONS

Results provide preliminary evidence that children who have suffered moderate-severe TBI experience relatively poor HRQOL, particularly in the School domain. Limited convergence between informants suggests that children and parents perceive HRQOL differently, with parents reporting lower HRQOL.

Medical Record Review Conduction Model for Improving Interrater Reliability of Abstracting Medical-Related Information

Medical record review (MRR) is often used in clinical research and evaluation, yet there is limited literature regarding best practices in conducting a MRR, and there are few studies reporting interrater reliability (IRR) from MRR data. The aim of this research was twofold: (a) to develop a MRR abstraction tool and standardize the MRR process and (b) to examine the IRR from MRR data. This study introduces the MRR-Conduction Model, which was used to implement a MRR, and examines the IRR between two abstractors who collected preinjury medical and psychiatric, incident-related medical and postinjury head symptom information from the medical records of 47 neurologically injured workers. Results showed that the percentage agreement was ≥85% and the unweighted κ statistic was ≥.60 for most variables, indicating substantial IRR. An effective and reliable MRR to abstract medical-related information requires planning and time. The MRR-Conduction Model is proposed to guide the process of creating a MRR.

Dizziness after traumatic brain injury: Results from an interview study

BACKGROUND

Dizziness is a commonly reported sequel to traumatic brain injury (TBI).

OBJECTIVE

To better define the nature of the symptomatology and the impact that dizziness has on the TBI survivor.

SETTING

A community brain injury rehabilitation programme and a community access programme for TBI survivors.

METHOD

Focus groups with TBI survivors and individual interviews with TBI survivors and some of their carers.

RESULTS

The data confirmed that dizziness is difficult for TBI survivors to define and describe and it consists of multiple symptoms. Dizziness also appears to be associated with significant functional difficulties. Additionally, many of the participants of this study reported falling. Carers reported a number of observable signs of dizziness and indicated that they believed they were able to tell when the person they cared for was dizzy.

CONCLUSION

The results provide information which will help in the development of more appropriate outcome measurement tools for dizziness after a TBI.

Dizziness after traumatic brain injury: Overview and measurement in the clinical setting

Traumatic brain injury (TBI) may result in a variety of cognitive, behavioural and physical impairments. Dizziness has been reported in up to 80% of cases within the first few days after injury. The literature was reviewed to attempt to delineate prevalence of dizziness as a symptom, impairments causing dizziness, the functional limitations it causes and its measurement. The literature provides widely differing estimates of prevalence and vestibular system dysfunction appears to be the best reported of impairments contributing to this symptom. The variety of results is discussed and other possible causes for dizziness were reviewed. Functional difficulties caused by dizziness were not reported for this population in the literature and review of cognitive impairments suggests that existing measurement tools for dizziness may be problematic in this population. Research on the functional impact of dizziness in the TBI population and measurement of these symptoms appears to be warranted.

The effects of traumatic brain injury during adolescence on career plans and outcomes

Traumatic brain injury (TBI) often occurs during the years when individuals are aiming for vocational goals and acquiring skills needed to achieve vocational success. This exploratory study aimed to describe the perceived long-term impact on career outcomes for individuals who were hospitalized with a TBI during adolescence. This study used a retrospective cohort design. A telephone questionnaire was administered 5 years postinjury to a consecutive series of 51 participants aged 15-19 years at time of injury, as well as 46 informants who knew the participants well. Participants and informants described the impact the injury had on career plans and outcomes. The nature of occupation postinjury was compared with preinjury plans, with results indicating many participants altering preinjury career plans following TBI.

Prediction of long-term occupational performance outcomes for adults after moderate to severe traumatic brain injury

PURPOSE

To examine predictors of long-term occupational performance outcomes for adults after moderate to severe traumatic brain injury (TBI).

METHOD

This study involved analysis of data from a retrospective cohort of adults (N = 306) with moderate to severe TBI discharged from a Pennsylvania rehabilitation treatment facility. Extensive pre-injury sociodemographic, injury-severity, post-injury personal (cognitive, physical, affective), post-injury environmental (social, institutional, physical), and post-injury occupational performance (participation in self-care, productivity, leisure activities) data were gathered from hospital records and using in-person interviews. Interviews occurred at a mean time of 14 (range, 7-24) years post-injury. Hierarchical multiple regression analysis was used to investigate determinants of long-term occupational performance outcomes.

RESULTS

Pre-injury behavioural problems, male gender, post-injury cognitive and physical deficits, and lack of access to transportation were significant independent predictors of worse occupational performance outcomes.

CONCLUSIONS

The study supports the use of a comprehensive model for long-term outcomes after TBI where pre-injury characteristics and post-injury cognitive and physical characteristics account for the greatest proportion of explained variance.

Appraising evidence on community integration following brain injury: a systematic review

A systematic review of the community integration (CI) literature for persons with traumatic brain injury was undertaken to evaluate: (1) How do we best measure CI? (2) Can we predict CI following rehabilitation? (3) Does social and activity participation have an effect on CI? (4) Does CI have an effect on quality of life/life satisfaction? Seventy-two articles were analysed. The results demonstrated: (1) strong evidence supporting the use of the Community Integration Questionnaire (CIQ), (2) mixed evidence supporting the ability to predict CI, with the prominent predictive variables being severity of injury, age, gender, education, prior work, living environment, cognition, emotional status, functional performance and disability. The literature search was restricted to articles published in English and the heterogeneity in the outcomes, methods, participants and other characteristics not reported. Further research is needed to examine the complex relationship of person, environment and CI.

Community Integration Status 4 Years After Traumatic Brain Injury

OBJECTIVES

To measure the level of agreement on community integration outcomes 4 years after traumatic brain injury (TBI) in relation to injury severity, proxy-participant relationship, and type of question.

PARTICIPANTS

Thirty-one survivors of TBI (14 with mild TBI and 17 with moderate-severe TBI) and 31 significant other proxies.

MEASURES

General and leisure activity scales of the Katz Adjustment Scale (KAS).

RESULTS

Agreement was highest between proxies and participants with mild versus moderate-severe TBIs, between spouse proxies and TBI participants compared to nonspouse proxies and on the more objective subscales (frequency of participation) compared to the expectation and satisfaction scales regardless of injury severity or proxy-participant relationship.

CONCLUSIONS

For research purposes, proxy data are acceptable but clinicians should assess outcomes and set goals with input from both persons with TBIs and their proxies.

Patients with cancer and next-of-kin response comparability on physical and psychological symptom well-being: trends and measurement issues

Next of kin (NOK) play an integral role in fostering optimal quality of life in symptomatic patients who are coping with cancer in the home setting. Often when patients in advanced stages of cancer are no longer able to meaningfully communicate their illness and symptom needs, healthcare professionals turn to NOK to provide sound estimates of patients' symptom experiences. This overview is based on 37 research studies written between 1987 and 2002 and updates an earlier overview of 13 studies on patient-NOK response comparability. The purpose is to, first, promote a better comprehension of methodologies and statistical techniques commonly employed to measure patterns of response comparability (or levels of agreement) between patient self-reports and NOK estimates on patient quality-of-life experiences of physical or symptom and emotional or psychological well-being. The second aim is to identify conditions where NOK may pose as reasonably accurate judges of patients' health-related quality of life, particularly symptom experiences arising from various diagnoses, including cancer. Third, subsequent to identifying the gaps in current research knowledge and limitations in study designs, recommendations for statistical and methodological techniques are outlined.

Mild traumatic brain injury from motor vehicle accidents: factors associated with return to work

OBJECTIVES

To describe return to work (RTW) for motor vehicle accident (MVA) survivors with mild traumatic brain injury (MTBI) and to examine relationships between RTW and injury severity, cognitive impairment, social interaction, discharge disposition, and sociodemographics.

DESIGN

Inception cohort assessed within 1 month of injury and at follow-up 6 to 9 months (mean = 7.4) after injury, for comparisons on outcome of RTW.

SETTING

Tertiary care center in Toronto (time 1); at home for follow-up.

PARTICIPANTS

Fifty patients with MTBI resulting from MVA who were consecutively admitted during a 20-month period ending April 1994. Thirteen of 63 eligible patients refused consent or were lost to follow-up. Mean age was 31; 62% were men.

ELIGIBILITY CRITERIA

(1) patients had been working; (2) they had no history of head injury, neurologic disease, or psychiatric illness requiring hospitalization; and (3) they had no catastrophic impairment from accident.

MAIN OUTCOME MEASURE

Return to work (at premorbid or modified level).

RESULTS

Of the 42% who returned to work, 12% resumed their premorbid level of employment and 30% returned to modified work. There were significant differences (p<.05) between the groups in level of social interaction, premorbid occupation, and discharge disposition. On one test of cognitive functioning the difference was at p = .06.

CONCLUSION

Social interaction, jobs with greater decision-making latitude, and discharge home were positively related to RTW for this population. Cognitive impairment within the first month was not a reliable indicator of RTW potential.