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Omar SA, Zulkefly NS, Mukhtar F. The Effectiveness of Brain Injury Family Intervention in Improving the Psychological Well-Being of Caregivers of Patients With Traumatic Brain Injury: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e53692. [PMID: 38483466 PMCID: PMC10979341 DOI: 10.2196/53692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Globally, traumatic brain injury (TBI) is recognized as one of the most significant contributors to mortality and disability. Most of the patients who have experienced TBI will be discharged home and reunited with their families or primary caregivers. The degree of severity of their reliance on caregivers varies. Therefore, the task of delivering essential care to the patients becomes demanding for the caregivers. A significant proportion of caregivers expressed considerable burden, distress, and discontentment with their lives. Therefore, it is critical to comprehend the dynamic of TBI and caregivers to optimize patient care, rehabilitation, and administration. The effectiveness of the Brain Injury Family Intervention (BIFI) program tailored for caregivers of patients with TBI has been widely proven in Western countries. However, the impact is less clear among caregivers of patients with TBI in Malaysia. OBJECTIVE This study aims to assess the effectiveness of BIFI in reducing emotional distress and burden of care, fulfilling the needs, and increasing the life satisfaction of caregivers of patients with TBI at government hospitals in Malaysia. METHODS This is a 2-arm, single-blinded, randomized controlled trial. It will be conducted at Hospital Rehabilitasi Cheras and Hospital Sungai Buloh. In total, 100 caregivers of patients with TBI attending the neurorehabilitation unit will be randomized equally to the intervention and control groups. The intervention group will undergo the BIFI program, whereas the control group will receive standard treatment. Caregivers aged ≥18 years, caring for patients who have completed >3 months after the injury, are eligible to participate. The BIFI program will be scheduled for 5 sessions as recommended by the developer of the module. Each session will take approximately 90 to 120 minutes. The participants are required to attend all 5 sessions. A total of 5 weeks is needed for each group to complete the program. Self-reported questionnaires (ie, Beck Depression Inventory, Positive and Negative Affect Schedule, Caregiver Strain Index, Satisfaction With Life Scale, and Family Needs Questionnaire) will be collected at baseline, immediately after the intervention program, at 3-month follow-up, and at 6-month follow-up. The primary end point is the caregivers' emotional distress. RESULTS The participant recruitment process began in January 2019 and was completed in December 2020. In total, 100 participants were enrolled in this study, of whom 70 (70%) caregivers are women and 30 (30%) are men. We are currently at the final stage of data analysis. The results of this study are expected to be published in 2024. Ethics approval has been obtained. CONCLUSIONS It is expected that the psychological well-being of the intervention group will be better compared with that of the control group after the intervention at 3-month follow-up and at 6-month follow-up. TRIAL REGISTRATION Iranian Registry of Clinical Trials IRCT20180809040746N1; https://irct.behdasht.gov.ir/trial/33286. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/53692.
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Affiliation(s)
- Siti Aminah Omar
- Department of Psychiatry, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Nor Sheereen Zulkefly
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Firdaus Mukhtar
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
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Muliira JK, Lazarus ER, Jacob D, Roslin H. The needs of families caring for patients with traumatic brain injury: a scoping review. Disabil Rehabil 2023:1-9. [PMID: 37933167 DOI: 10.1080/09638288.2023.2278178] [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: 05/21/2023] [Accepted: 10/28/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE This scoping review was conducted to synthesize existing literature into a map of the common needs of families caring for patients with traumatic brain injury (TBI) at home. MATERIALS AND METHODS A systematic search of studies published between January 2012 and December 2022 was conducted across databases. The selected studies reported the needs or unmet needs of patients with TBI and/or their family caregivers (FCs). RESULTS A total of 12 publications were identified. The results suggest that the common needs of families caring for patients with TBI at home include: information about TBI as a disease; information about the continuum of TBI healthcare services; information about adaptive technologies; education and skilling of FCs; psychological support and counseling; physical and occupational therapy services; follow-up care and transitional care management; respite care; peer support; financial assistance, advocacy, and legal services; emotional support from the family and community; and assistance with physical patient care and instrumental activities of daily living. CONCLUSION The mapped needs provide insight into supportive interventions required to enhance the health outcomes of patients with TBI and their families during and after rehabilitation. The needs also highlight directions for research and healthcare services for patients with TBI.
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Affiliation(s)
- Joshua K Muliira
- School of Nursing, College of Health, Ball State University, Muncie, IN, USA
| | - Eilean R Lazarus
- Department of Adult Health and Critical Care, College of Nursing, Sultan Qaboos University, Muscat, Oman
| | - Devakirubai Jacob
- Department of Adult Health and Critical Care, College of Nursing, Sultan Qaboos University, Muscat, Oman
| | - Hema Roslin
- Department of Adult Health and Critical Care, College of Nursing, Sultan Qaboos University, Muscat, Oman
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Witten JA, Coetzer R, Rowlands L, Turnbull OH. "Talk and Chalk": An emotion regulation intervention for anger after acquired brain injury. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-16. [PMID: 37339498 DOI: 10.1080/23279095.2023.2224481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
Uncontrollable anger is a debilitating consequence of acquired brain injury (ABI). This proof-of-concept study investigated the preliminary efficacy of an emotion regulation intervention for managing post-ABI anger. A secondary objective was to determine which participant characteristics were related to intervention gains. With a pre-post intervention design and three-month follow-up, there were five individually administered meetings on Zoom, over a four-month period. 24 adults who had sustained an ABI were enrolled. Participants were mostly males, from 24 to 85 years old. A series of one-way repeated-measures ANOVAs were conducted to determine the intervention's efficacy, and Spearman's rho bivariate correlations for the association between participant characteristics and intervention gains. Significant differences were observed in external anger from baseline to post-treatment; there were no further changes from post-treatment to follow-up. Of the participant characteristics, only readiness to change and anxiety were correlated. The proposed intervention presents a brief, feasible, and preliminary efficacious alternative for regulating post-ABI anger. Intervention gains are associated with readiness to change and anxiety, which has important implications for clinical delivery.
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Affiliation(s)
| | - Rudi Coetzer
- Department of Psychology, Bangor University, Bangor, United Kingdom
- The Disabilities Trust, Wakefield, United Kingdom
- Faculty of Medical, Life and Health Science, Swansea University, Swansea, United Kingdom
| | - Leanne Rowlands
- School of Psychology, Arden University, Coventry, United Kingdom
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Witten JA, Coetzer R, Turnbull OH. Shades of Rage: Applying the Process Model of Emotion Regulation to Managing Anger After Brain Injury. Front Psychol 2022; 13:834314. [PMID: 35369166 PMCID: PMC8971361 DOI: 10.3389/fpsyg.2022.834314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/28/2022] [Indexed: 11/30/2022] Open
Abstract
Uncontrollable anger is common following an acquired brain injury (ABI), with impaired emotion regulation (ER) being one of the main contributors. Existing psychological interventions appear moderately effective, though studies typically include limitations such as small sample sizes, issues of long-term efficacy, and standardization of content. While ER has been a popular research field, the study of ER for anger management after ABI is less well investigated, and contains few interventions based on the widely used Process Model of ER. This review surveys the efficacy of ER strategies in individuals with ABI, and proposes a novel research design for future interventions. Recommendations are made about: strategy number and type, shared decision-making, approaches to data analysis, and mode of delivery.
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Affiliation(s)
- Jade Abigail Witten
- School of Human and Behavioral Sciences, Bangor University, Bangor, United Kingdom
| | - Rudi Coetzer
- School of Human and Behavioral Sciences, Bangor University, Bangor, United Kingdom
- The Disabilities Trust, Wakefield, United Kingdom
| | - Oliver H. Turnbull
- School of Human and Behavioral Sciences, Bangor University, Bangor, United Kingdom
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Chhuom TW, Thompson HJ. Older Spousal Dyads and the Experience of Recovery in the Year After Traumatic Brain Injury. J Neurosci Nurs 2021; 53:57-62. [PMID: 33538455 PMCID: PMC7933048 DOI: 10.1097/jnn.0000000000000569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT BACKGROUND: Significant others of older persons with traumatic brain injury (TBI) may be more likely to face increased caregiving responsibilities, leading to increased relationship challenges. Relatively little is known about this cohort. The study aimed to describe the impact of experiencing a mild/moderate TBI on the older adult as well as the significant other in the year post injury. DESIGN AND METHODS: This is a multiple-case study using data from a larger parent study. Qualitative content analysis of interviews conducted at 1, 3, 6, and 12 months post injury with 3 dyads was performed (24 interviews) and included cross-case and cross-time comparisons. RESULTS: Dyads that included persons 65 years and older with a mild-moderate TBI and their significant others were enrolled (N = 3/6 individuals). The identified themes were struggling to accept limitations and acceptance, gratitude, fear and concern, frustration/anger/guilt/resentment, broader social support, emotional coping, and the presence or absence of broader social support. CONCLUSIONS: Feelings of hope, gratitude, and acceptance serve as vital ways for couples to continue toward a path of recovery and healing. Lack of social support was a stressor, creating a barrier to recovery. Significant others tended to focus on others versus self-care needs. Nurses should integrate social support and self-care into the assessment of the spousal dyad after TBI. These findings can also inform the development of support groups and case management models for both patients after TBI and their significant others.
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Hicks AJ, Clay FJ, Hopwood M, James AC, Jayaram M, Perry LA, Batty R, Ponsford JL. The Efficacy and Harms of Pharmacological Interventions for Aggression After Traumatic Brain Injury-Systematic Review. Front Neurol 2019; 10:1169. [PMID: 31849802 PMCID: PMC6895752 DOI: 10.3389/fneur.2019.01169] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 10/18/2019] [Indexed: 11/25/2022] Open
Abstract
Background: Aggression is a commonly reported problem following traumatic brain injury (TBI). It may present as verbal insults or outbursts, physical assaults, and/or property destruction. Aggressive behavior can fracture relationships and impede participation in treatment as well as a broad range of vocational and social activities, thereby reducing the individual's quality of life. Pharmacological intervention is frequently used to control aggression following TBI. The aim of this systematic review was to critically evaluate the evidence regarding efficacy of pharmacological interventions for aggression following TBI in adults. Methods: We reviewed studies in English, available before December 2018. MEDLINE, PubMed, CINAHL, EMBASE, PsycINFO, and CENTRAL databases were searched, with additional searching of key journals, clinical trials registries, and international drug regulators. The primary outcomes of interest were reduction in the severity of aggression and occurrence of harms. The secondary outcomes of interest were changes in quality of life, participation, psychological health (e.g., depression, anxiety), and cognitive function. Evidence quality was assessed using the Cochrane Risk of Bias tool and the Joanna Briggs Institute Critical Appraisal Instruments. Results: Ten studies were identified, including five randomized controlled trials (RCTs) and five case series. There were positive, albeit mixed, findings for the RCTs examining the use of amantadine in reducing irritability (n = 2) and aggression (n = 2). There were some positive findings favoring methylphenidate in reducing anger (n = 1). The evidence for propranolol was weak (n = 1). Individual analysis revealed differential drug response across individuals for both methylphenidate and propranolol. The less rigorous studies administered carbamazepine (n = 2), valproic acid (n = 1), quetiapine (n = 1), and sertraline (n = 1), and all reported reductions in aggression. However, given the lack of a control group, it is difficult to discern treatment effects from natural change over time. Conclusions: This review concludes that a recommendation for use of amantadine to treat aggression and irritability in adults following TBI is appropriate. However, there is a need for further well-designed, adequately powered and controlled studies of pharmacological interventions for aggression following TBI.
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Affiliation(s)
- Amelia J Hicks
- Monash-Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Fiona J Clay
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia.,Department of Forensic Medicine, Monash University, Southbank, VIC, Australia.,Professorial Psychiatry Unit Albert Road Clinic, Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia.,Professorial Psychiatry Unit Albert Road Clinic, Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Amelia C James
- Monash-Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Mahesh Jayaram
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Luke A Perry
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Rachel Batty
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Jennie L Ponsford
- Monash-Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
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Mollayeva T, Bordignon C, Ishtiaq M, Colquhoun H, D'Souza A, Archambault P, Lewko J, Quilico E, Colantonio A. Knowledge of sex and gender and related information needs in patients with traumatic brain injury: in-depth interview study. Disabil Rehabil 2019; 43:1872-1882. [PMID: 31702962 DOI: 10.1080/09638288.2019.1683235] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIM This research aimed to gain an understanding of biological sex and social gender phenomena experienced by patients with traumatic brain injury in recovery, and to understand the educational needs of this group. METHODS We conducted semi-structured interviews of 40 adult patients (22 men, 18 women) of different ages, education levels, and ethnicities, with diagnoses of mild and moderate-severe traumatic brain injury at the acute and chronic stages post-injury. RESULTS Applying classic content analysis with inductive coding, three overarching themes that limited patients' knowledge and subsequent efforts to obtain information on the topic emerged: (1) the complexity of sex and gender subject matters, (2) patients' dependence on others, and (3) uncertainty about the course of recovery. The first diminished the patient's desire to seek further information. Dependence on others and trust that others were in a better position to use the information, compelled patients to redirect the need for education to clinicians, significant others, and the public on the unique post-injury experiences of men and women. Uncertainty about what to expect in the acute phases, and a feeling of identity loss in the chronic phases, established patients' desire to seek out only the information they believed to be necessary for them to carry on with life. CONCLUSIONS In developing recommendations for patient education, variations in patients' knowledge and desire for information, and the reasons behind these variations, should be considered. Improving injury prognosis requires taking into account the gendered context of injury and recovery from it.IMPLICATIONS FOR REHABILITATIONSex/gender issues in traumatic brain injury are complex; the challenge is identifying which information is most relevant for patients; this research assessed patients' knowledge of and interest in sex/gender-related topics in traumatic brain injury.Evidence shows most patients unable to differentiate between sex and gender, but when asked about living as a man or woman with traumatic brain injury, disturbed gender roles and identities became evident.Gender shapes the health status trajectory and outcomes of patients with traumatic brain injury which becomes evident when attention is paid to patients' personal life stories.To improve traumatic brain injury prognosis, clinicians should tailor management plans taking into account gender, an amalgamation of biological, behavioural, cultural, and social characteristics of their patients.In research, explicit and consistent consideration of the interrelated constructs of sex and gender would produce a better understanding of the different mechanisms that shape the course of traumatic brain injury.
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Affiliation(s)
- Tatyana Mollayeva
- KITE-Toronto Rehabilitation Research Institute, University Health Network, Toronto, ON, Canada.,Acquired Brain Injury Research Lab, University of Toronto, Toronto, ON, Canada
| | - Caterina Bordignon
- KITE-Toronto Rehabilitation Research Institute, University Health Network, Toronto, ON, Canada.,Biology Department, University of Toronto Mississauga, Mississauga, ON, Canada
| | - Maryam Ishtiaq
- KITE-Toronto Rehabilitation Research Institute, University Health Network, Toronto, ON, Canada.,Biology Department, University of Toronto Mississauga, Mississauga, ON, Canada
| | - Heather Colquhoun
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Andrea D'Souza
- KITE-Toronto Rehabilitation Research Institute, University Health Network, Toronto, ON, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Patrick Archambault
- Department of Family and Emergency Medicine, Université Laval, Québec, QC, Canada.,Centre de recherche sur les soins et les services de premi ère ligne de l'Université Laval (CERSSPL-UL), Quebec, QC, Canada
| | - John Lewko
- School of Rural and Northern Health, Laurentian University, Sudbury, ON, Canada
| | - Enrico Quilico
- Acquired Brain Injury Research Lab, University of Toronto, Toronto, ON, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Angela Colantonio
- KITE-Toronto Rehabilitation Research Institute, University Health Network, Toronto, ON, Canada.,Acquired Brain Injury Research Lab, University of Toronto, Toronto, ON, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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8
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Biological Sex/Gender and Biopsychosocial Determinants of Traumatic Brain Injury Recovery Trajectories. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2019. [DOI: 10.1007/s40141-019-00238-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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9
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Brickell TA, French LM, Lippa SM, Lange RT. The impact of deployment and traumatic brain injury on the health and behavior of children of US military service members and veterans. Clin Child Psychol Psychiatry 2018; 23:425-441. [PMID: 29139308 DOI: 10.1177/1359104517740405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examined the impact of service member/veteran (SMV) combat deployment and traumatic brain injury (TBI) on the health and behavior of his or her children. Participants were 104 female spouse caregivers of US SMVs who had sustained a mild, severe, or penetrating TBI. Participants completed the Children's Health and Behavior Questionnaire (CHBQ; r = .758 to .881) that evaluates school grades, behavior, medical health, emotional health, and social participation: (a) prior to the first combat deployment, (b) in the month prior to the TBI, (c) within 2 years after the TBI, and (d) 2 or more years after the TBI. A substantial number of children experienced a decline in health and behavior following the TBI (41.7%-79.1%). Of those who declined (a) 68.8%-75.5% declined within the first 2 years post-injury, followed by improvement or stabilization; (b) 6.7%-15.6% declined only after 2 or more years post-injury; (c) 15.6%-25.0% declined within the first 2 years post-injury and then again 2 or more years post-injury; and (d) 16.9%-26.5% experienced a decline as a result of deployment, followed by an additional decline after the SMV's TBI. Services are required for children of SMVs following TBI and deployment, particularly children at risk for poor outcome.
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Affiliation(s)
- Tracey A Brickell
- 1 Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, USA.,2 National Intrepid Center of Excellence, Walter Reed National Military Medical Center, USA.,3 Uniformed Services University of the Health Sciences, USA
| | - Louis M French
- 1 Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, USA.,2 National Intrepid Center of Excellence, Walter Reed National Military Medical Center, USA.,3 Uniformed Services University of the Health Sciences, USA
| | - Sara M Lippa
- 1 Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, USA.,2 National Intrepid Center of Excellence, Walter Reed National Military Medical Center, USA
| | - Rael T Lange
- 1 Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, USA.,2 National Intrepid Center of Excellence, Walter Reed National Military Medical Center, USA.,4 University of British Columbia, Canada
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Saban KL, Griffin JM, Urban A, Janusek MA, Pape TLB, Collins E. Perceived health, caregiver burden, and quality of life in women partners providing care to Veterans with traumatic brain injury. ACTA ACUST UNITED AC 2018; 53:681-692. [PMID: 27997670 DOI: 10.1682/jrrd.2015.07.0143] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 12/17/2015] [Indexed: 11/05/2022]
Abstract
Families of Veterans with traumatic brain injury (TBI) are often faced with providing long-term informal care to their loved one. However, little is known about how their perceived health and caregiving burden contribute to their quality of life (QOL). The purpose of this descriptive study was to describe perceived health, somatic symptoms, caregiver burden, and perceived QOL and to identify the extent to which these variables are associated with QOL in female partners/spouses of Veterans with TBI. Participants completed a written questionnaire including the Patient Health Questionnaire-15, Caregiver Reaction Assessment, Quality of Life Index, and the general health subscale of the 12-Item Short Form Survey version 2. Caregivers reported moderate levels of QOL, and over a quarter of the sample reported high levels of somatic symptoms, particularly fatigue and sleep disturbance. Age, perceived general health, somatic symptoms, the five subscales of caregiver burden (self-esteem, disrupted schedule, effect on finances, lack of family support, and effect on health) predicted QOL and explained 64% of its variance (adjusted r2 = 0.64, F(8,31) = 9.59). However, only somatic symptoms and the caregiver burden subscales of self-esteem and effect on finances were significant predictors in the model. These findings have implications for development of family-centered interventions to enhance the QOL of informal caregivers of Veterans with TBI.
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Affiliation(s)
- Karen L Saban
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Department of Veterans Affairs (VA) Hospital, Hines, IL.,Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, IL
| | - Joan M Griffin
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic College of Medicine, Rochester, MN.,Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN
| | | | | | - Theresa Louise-Bender Pape
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Department of Veterans Affairs (VA) Hospital, Hines, IL.,Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Eileen Collins
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Department of Veterans Affairs (VA) Hospital, Hines, IL.,Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, IL
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Kivunja S, River J, Gullick J. Experiences of giving and receiving care in traumatic brain injury: An integrative review. J Clin Nurs 2018; 27:1304-1328. [PMID: 29396883 DOI: 10.1111/jocn.14283] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2018] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To synthesise the literature on the experiences of giving or receiving care for traumatic brain injury for people with traumatic brain injury, their family members and nurses in hospital and rehabilitation settings. BACKGROUND Traumatic brain injury represents a major source of physical, social and economic burden. In the hospital setting, people with traumatic brain injury feel excluded from decision-making processes and perceive impatient care. Families describe inadequate information and support for psychological distress. Nurses find the care of people with traumatic brain injury challenging particularly when experiencing heavy workloads. To date, a contemporary synthesis of the literature on people with traumatic brain injury, family and nurse experiences of traumatic brain injury care has not been conducted. DESIGN Integrative literature review. METHODS A systematic search strategy guided by the PRISMA statement was conducted in CINAHL, PubMed, Proquest, EMBASE and Google Scholar. Whittemore and Knafl's (Journal of Advanced Nursing, 52, 2005, 546) integrative review framework guided data reduction, data display, data comparison and conclusion verification. RESULTS Across the three participant categories (people with traumatic brain injury/family members/nurses) and sixteen subcategories, six cross-cutting themes emerged: seeking personhood, navigating challenging behaviour, valuing skills and competence, struggling with changed family responsibilities, maintaining productive partnerships and reflecting on workplace culture. CONCLUSIONS Traumatic brain injury creates changes in physical, cognitive and emotional function that challenge known ways of being in the world for people. This alters relationship dynamics within families and requires a specific skill set among nurses. RELEVANCE TO CLINICAL PRACTICE Recommendations include the following: (i) formal inclusion of people with traumatic brain injury and families in care planning, (ii) routine risk screening for falls and challenging behaviour to ensure that controls are based on accurate assessment, (iii) formal orientation and training for novice nurses in the management of challenging behaviour, (iv) professional case management to guide access to services and funding and (v) personal skill development to optimise family functioning.
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Affiliation(s)
- Stephen Kivunja
- Susan Wakil School of Nursing & Midwifery (Sydney Nursing School), The University of Sydney, Camperdown, NSW, Australia
| | - Jo River
- Susan Wakil School of Nursing & Midwifery (Sydney Nursing School), The University of Sydney, Camperdown, NSW, Australia
| | - Janice Gullick
- Susan Wakil School of Nursing & Midwifery (Sydney Nursing School), The University of Sydney, Camperdown, NSW, Australia
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Do Mild Traumatic Brain Injury Severity Sub-classification Systems Help to Identify People Who Go on to Experience Long-Term Symptoms? BRAIN IMPAIR 2017. [DOI: 10.1017/brimp.2017.11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objective: To identify the systems available to sub-classify mild traumatic brain injury (TBI) and to determine their utility in predicting 1-year outcome.Methods: A systematic review to identify mild-TBI sub-classification systems was conducted until March 2016. The identified systems were applied to a cohort ofN= 290 adults who had experienced a mild-TBI, and who had been assessed for post-concussion symptoms 1-year post injury. ANOVAs and regression models were used to determine whether each sub-classification system could distinguish between outcomes and to explore their contribution to explaining variance in post-concussion symptoms 1-year post injury.Results: Nineteen sub-classification systems for mild-TBI met the inclusion criteria for this review. The Saal (1991) classification system significantly differentiated the experience of post-concussion symptoms in our cohort 1-year post injury (F= 2.39,p= 0.05). However, the findings did not remain significant following correction for multiple comparisons and inclusion of socio-demographic and contextual factors in the regression model.Conclusions: Current sub-classification systems fail to explain much of the variance in post-concussion symptoms 1 year following mild-TBI. Further research is needed to identify the factors (including socio-demographic and contextual factors) to determine, who may be at risk of developing persistent post-concussion symptoms.
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13
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Coffey NT, Cassese J, Cai X, Garfinkel S, Patel D, Jones R, Shaewitz D, Weinstein AA. Identifying and Understanding the Health Information Experiences and Preferences of Caregivers of Individuals With Either Traumatic Brain Injury, Spinal Cord Injury, or Burn Injury: A Qualitative Investigation. J Med Internet Res 2017; 19:e159. [PMID: 28490418 PMCID: PMC5443912 DOI: 10.2196/jmir.7027] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 02/20/2017] [Accepted: 03/08/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In order to meet the challenges of caring for an injured person, caregivers need access to health information. However, caregivers often feel that they lack adequate information. Previous studies of caregivers have primarily focused on either their time and emotional burdens or their health outcomes, but the information needs of caregivers have not been thoroughly investigated. OBJECTIVE The purpose of this investigation was to identify the preferred sources of health information for caregivers supporting individuals with injuries and to explore how access to this information could be improved. METHODS A total of 32 caregivers participated in semistructured interviews, which were used in order to develop a more in-depth understanding of these caregivers' information needs. Digital audio recordings of the interviews were used for analysis purposes. These audio recordings were analyzed using a thematic analysis or qualitative content analysis. All of participant's interviews were then coded using the qualitative analysis program, Nvivo 10 for Mac (QSR International). RESULTS The caregivers endorsed similar behaviors and preferences when seeking and accessing health information. Medical professionals were the preferred source of information, while ease of access made the Internet the most common avenue to obtain information. The challenges faced by participants were frequently a result of limited support. In describing an ideal health system, participants expressed interest in a comprehensive care website offering support network resources, instructive services about the injury and caregiving, and injury-specific materials. CONCLUSIONS According to the participants, an ideal health information system would include a comprehensive care website that offered supportive network resources, instructive services about the injury and caregiving, and materials specific to the type of patient injury.
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Affiliation(s)
- Nathan T Coffey
- Center for the Study of Chronic Illness and Disability, George Mason University, Fairfax, VA, United States
| | - James Cassese
- Center for the Study of Chronic Illness and Disability, George Mason University, Fairfax, VA, United States
| | - Xinsheng Cai
- American Institutes for Research, Washington, DC, United States
| | | | - Drasti Patel
- Center for the Study of Chronic Illness and Disability, George Mason University, Fairfax, VA, United States
| | - Rebecca Jones
- American Institutes for Research, Washington, DC, United States
| | - Dahlia Shaewitz
- American Institutes for Research, Washington, DC, United States
| | - Ali A Weinstein
- Center for the Study of Chronic Illness and Disability, George Mason University, Fairfax, VA, United States
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Winter L, Moriarty HJ. Quality of relationship between veterans with traumatic brain injury and their family members. Brain Inj 2017; 31:493-501. [PMID: 28340316 DOI: 10.1080/02699052.2017.1283534] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The quality of the relationship between patients with many illnesses and their family members has been shown to affect the well-being of both. Yet, relationship quality has not been studied in traumatic brain injury (TBI), and giving and receiving aspects have not been distinguished. The present study of veterans with TBI examined associations between relationship quality and caregiver burden, satisfaction with caregiving, and veterans' competence in interpersonal functioning, rated by veterans and family members. METHOD In this cross-sectional study, 83 veterans and their family members were interviewed at home. Measures of quality of relationship, veterans' interpersonal competence and sociodemographics were collected for both, caregiver burden and satisfaction for family members only. RESULTS As predicted, veteran-rated Qrel/Giving was associated with family-rated Qrel/Receiving, and veteran-rated Qrel/Receiving with family-rated Qrel/Giving. Lower caregiver burden and higher caregiving satisfaction were associated with higher Qrel/Receiving scores but not with Qrel/Giving scores. Veterans' interpersonal competence was associated with total Qrel as rated by either veterans or family members. CONCLUSIONS Relationship quality should be included in family research in TBI, and giving and receiving aspects should be differentiated. Findings suggest that lower caregiver burden and greater satisfaction should be more achievable by increasing caregivers' sense of benefits received from the relationship.
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Affiliation(s)
- Laraine Winter
- a Nursing Service, Corporal Michael J. Crescenz Veterans Affairs Medical Center , Philadelphia , PA , USA.,b Philadelphia Research and Education Foundation, Corporal Michael J. Crescenz Veterans Affairs Medical Center , Philadelphia , PA , USA
| | - Helene J Moriarty
- a Nursing Service, Corporal Michael J. Crescenz Veterans Affairs Medical Center , Philadelphia , PA , USA.,c Villanova University, College of Nursing , Villanova , PA , USA
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Chipidza F, Wallwork RS, Adams TN, Stern TA. Evaluation and Treatment of the Angry Patient. Prim Care Companion CNS Disord 2016; 18:16f01951. [PMID: 27733956 DOI: 10.4088/pcc.16f01951] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 04/28/2016] [Indexed: 12/30/2022] Open
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