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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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McShan EE, Juengst S, Douglas ME, Noorbakhsh D, Calhoun S, Bennett M, Suhalka A, Dubiel R, Driver S. Efficacy of a group-based education intervention for people with traumatic brain injury: supplementary results from a 12-month randomized controlled trial. Brain Inj 2023; 37:1205-1214. [PMID: 37355803 DOI: 10.1080/02699052.2023.2225874] [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: 12/29/2022] [Revised: 04/25/2023] [Accepted: 06/12/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVE Our team developed an attention control condition, called the Brain Health Group (BHG), for a randomized controlled trial (RCT; NCT03594734). The focus of the BHG was on brain health education and self-management. The objectives of this supplementary analysis are to (1) Describe compliance with the 12-month BHG; (2) Examine efficacy for improving general self-efficacy (GSE, primary) and secondary outcomes; and (3) Describe findings from the program evaluation. DESIGN English-speaking adults (18-64 years old) who were ≥6 months post a moderate-to-severe TBI were randomized to the BHG (n = 29) or active intervention (n = 28). Data were collected at baseline and 12 months, including GSE, depression, satisfaction with life (SWL), self-rated abilities for health practices (SRAHP), and alcohol use. Program evaluation was conducted at 12 months. RESULTS Attendance was 89%, and goal tracking was 63%. Within group analysis showed a significant increase in SRAHP scores (p = 0.018). Non-significant increases in GSE and SWL were observed, and participants perceived the BHG as helpful. No significant changes in depression or alcohol use were reported. CONCLUSION People with TBI can engage in and benefit from the BHG and perceive the program as helpful for improving knowledge about brain health and awareness of self-management skills.
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Affiliation(s)
- Evan Elizabeth McShan
- Department of Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation; Baylor Scott and White Research Institute; North Texas Traumatic Brain Injury Model System, Dallas, Texas
| | - Shannon Juengst
- Clinical Investigator Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas b
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center; North Texas Traumatic Brain Injury Model System, Dallas, Texas
- Department of Physical Medicine and Rehabilitation, UT Health Sciences Center at Houston, Houston, Texas
| | - Megan E Douglas
- Department of Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation; Baylor Scott and White Research Institute; North Texas Traumatic Brain Injury Model System, Dallas, Texas
| | - Donna Noorbakhsh
- Speech Language Pathologist Certified Brain Injury Specialist Day Neuro Program, Baylor Scott and White Institute for Rehabilitation; North Texas Traumatic Brain Injury Model System, Dallas, Texas
| | - Stephanie Calhoun
- Department of Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation; Baylor Scott and White Research Institute; North Texas Traumatic Brain Injury Model System, Dallas, Texas
| | - Monica Bennett
- Department of Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation; Baylor Scott and White Research Institute; North Texas Traumatic Brain Injury Model System, Dallas, Texas
- Biostatistics Core Baylor Scott and White Research Institute; North Texas Traumatic Brain Injury Model System, Dallas, Texas
| | - Alexandria Suhalka
- Department of Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation; Baylor Scott and White Research Institute; North Texas Traumatic Brain Injury Model System, Dallas, Texas
| | - Rosemary Dubiel
- TBI Services Baylor Scott and White Institute for Rehabilitation; North Texas Traumatic Brain Injury Model System, Dallas, Texas
| | - Simon Driver
- Department of Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation; Baylor Scott and White Research Institute; North Texas Traumatic Brain Injury Model System, Dallas, Texas
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Abstract
OBJECTIVE Disorders of social cognition, such as difficulties with emotion perception, alexithymia, Theory of Mind (ToM), empathy and disorders of emotion regulation, are prevalent and pervasive problems across many neurological, neurodevelopmental and neuropsychiatric conditions. Clinicians are familiar with how these difficulties present but assessment and treatment has lagged behind other traditional cognitive domains, such as memory, language and executive functioning. METHOD In this paper, we review the prevalence and degree of impairment associated with disorders of social cognition and emotion regulation across a range of clinical conditions, with particular emphasis on their relationship to cognitive deficits and also real-world functioning. We reported effects sizes from published meta-analyses for a range of clinical disorders and also review test usage and available tests. RESULTS In general, many clinical conditions are associated with impairments in social cognition and emotion regulation. Effect sizes range from small to very large and are comparable to effect sizes for impairments in nonsocial cognition. Socio-emotional impairments are also associated with social and adaptive functioning. In reviewing prior research, it is apparent that the standardized assessment of social cognition, in particular, is not routine in clinical practice. This is despite the fact that there are a range of tools available and accruing evidence for the efficacy of interventions for social cognitive impairments. CONCLUSION We are using this information to urge and call for clinicians to factor social cognition into their clinical assessments and treatment planning, as to provide rigorous, holistic and comprehensive person-centred care.
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Affiliation(s)
- Skye McDonald
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Travis Wearne
- School of Psychology, University of Western Sydney, Penrith South, Australia
| | - Michelle Kelly
- School of Psychological Sciences, University of Newcastle, Callaghan, Australia
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Hauger SL, Borgen IMH, Løvstad M, Lu J, Forslund MV, Kleffelgård I, Andelic N, Røe C. Community-Based Interventions After Acquired Brain Injury-A Systematic Review of Intervention Types and Their Effectiveness. J Head Trauma Rehabil 2022; 37:E355-E369. [PMID: 35125426 DOI: 10.1097/htr.0000000000000765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Comprehensive review of existing types and effectiveness of community-based interventions delivered to adults (mean age 18-65 years) with long-lasting (≥6 months) difficulties following acquired brain injury (ABI). DESIGN Systematic review of controlled intervention studies published until February 2021. MAIN MEASURES Systematic searches in databases (MEDLINE, PsycINFO, Database of Abstracts of Reviews of Effects [Cochrane Library], and Cochrane Central Register of Controlled Trials [Cochrane Library]) and inclusion of English peer-reviewed full-text articles; randomized or controlled community-based intervention studies; sample size of 20 or more participants; and 3 or more intervention sessions. Two reviewers independently extracted data for the synthesis and assessed the methodological quality. Data extraction included study characteristics, demographics of participants, content and dose of intervention, outcome measures, and findings. RESULT The search returned 7386 publications, of which 49 eligible studies were included, revealing a diverse range of community-based interventions and a myriad of outcome measures applied for assessing functional capacities, participation, and quality of life in the chronic phase of ABI. Intervention types encompassed 14 holistic, 23 physical, and 12 specific interventions. A large heterogeneity regarding intervention frequency and intensity was found. Meta-analyses performed on the holistic, physical, and specific interventions did not indicate any significant pooled effects but showed highly variable effects between individuals, both in persons with traumatic and nontraumatic brain injuries. CONCLUSIONS Because of lack of pooled effects within types of community-based interventions, specific evidence-based recommendations within holistic, physical, and specific interventions designed to mitigate long-lasting ABI problems cannot be made. This review highlights the need for future studies to address methodological issues concerning larger sample size, lack of clear description interventions and comparator, missing reports of effects in change scores, need for consistent use of recommended outcome measures, and investigating the wide variety in intervention responsiveness among participants with ABI. Systematic review registration: PROSPERO (CRD42019124949).
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Affiliation(s)
- Solveig Lægreid Hauger
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway (Drs Hauger and Løvstad); Department of Psychology, Faculty of Social Sciences (Drs Hauger and Løvstad and Ms Borgen), Institute of Clinical Medicine, Faculty of Medicine (Dr Røe), and Center for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society (Dr Andelic), University of Oslo, Norway; Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, USA (Dr Lu); and Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Norway (Ms Borgen and Drs Forslund, Kleffelgård, Andelic, and Røe)
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Treatment of Psychiatric Problems After Traumatic Brain Injury. Biol Psychiatry 2022; 91:508-521. [PMID: 34511181 DOI: 10.1016/j.biopsych.2021.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/14/2021] [Accepted: 07/06/2021] [Indexed: 02/07/2023]
Abstract
Psychiatric sequelae of traumatic brain injury (TBI) can cause significant and often chronic impairment in functioning and quality of life; however, their phenomenological and mechanistic complexities continue to present significant treatment challenges. The clinical presentation is often an amalgam of syndromes and co-occurring symptoms that require a highly nuanced and systematic approach to treatment. Although few randomized controlled trials have tested treatments for psychiatric problems after TBI and the synthesis of results continues to be compromised by the heterogeneity of study populations, small samples, and differing inclusion criteria and outcome measures, an increasing body of literature supports evidence-based treatment strategies. We provide a narrative review of pharmacological, psychoeducational/behavioral, and neuromodulation treatments for psychiatric conditions in adults with TBI and discuss known or postulated mechanisms of action for these treatment approaches. Where data are available, we focus on randomized controlled trials and large case series in which a psychiatric condition provides both a selection criterion and a primary or secondary outcome. We conclude by proposing directions for future research, particularly the need for novel neuropharmacological, behavioral, and neurophysiological studies and pragmatic trials of multicomponent and adaptive models that will increase understanding of the mechanisms underlying post-TBI psychiatric disorders and accelerate dissemination and implementation of effective person-centered care.
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Fisher A, Bellon M, Lawn S, Lennon S. Family perspectives on the acceptability and usefulness of the FAB Positive Behaviour Support program: A pilot study. Brain Inj 2021; 35:609-619. [PMID: 33678101 DOI: 10.1080/02699052.2021.1894479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: This pilot feasibility study aimed to gain preliminary insight into the acceptability and usefulness of the FAB-PBS program for providing behavior support to families following acquired brain injury (ABI) in community settings. The FAB-PBS program is based on a Positive Behavior Support (PBS) framework and principles of Family-Centered Care and Family-Directed Intervention. It consists of an education phase followed by individualized sessions during which the family is supported to develop and implement a PBS plan.Methods: A mixed-methods design was utilized, with feedback obtained from family members via short questionnaires and semi-structured interviews post education phase and individualized sessions, and at three-month follow up.Results: Two family members completed the full FAB-PBS program and reported high satisfaction with the program and increased confidence in providing behavior support. Findings also suggested an increase in desired behaviors and a decrease in challenging behaviors presented by family members with ABI.Conclusions: The FAB-PBS program may be an acceptable and feasible approach to increasing the capability of family caregivers in providing behavior support following ABI. Further pilot testing is required to inform the development of a larger feasibility study.
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Affiliation(s)
- Alinka Fisher
- Disability and Community Inclusion, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Michelle Bellon
- Disability and Community Inclusion, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Sharon Lawn
- Department of Psychiatry, School of Health Sciences, Flinders University, Adelaide, Australia
| | - Sheila Lennon
- Discipline of Physiotherapy, Repatriation General Hospital, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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ROMAN-FILIP C, CATANĂ MG. The importance of multidisciplinary team in the treatment of severe traumatic brain injury. BALNEO RESEARCH JOURNAL 2020. [DOI: 10.12680/balneo.2020.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Noticeable advances have occurred in the field of traumatic brain injury in the past ten years. Brain imagery provides a more precise representation of what occurs in the brain, diffuse axonal injury being an important cause of morbidity and mortality in patients with traumatic brain injury. We present 2 cases that were admitted and discharged from our department. Actually we want to emphasize differences and similarities between the two cases and to highlight different sequelae that traumatic brain injury can do in young patients. Both patients were admitted in a critical state – GCS 4 points and were discharged with an improved neurological status after approximately 30 days. We decided to present these cases to issue a warning about the rehabilitation for these patients which most of the times have a prolonged hospitalization. We wanted to highlight that the rehabilitation does not consist only in the motor part, but in the psychiatric and behaviour part too.
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Affiliation(s)
- Corina ROMAN-FILIP
- 1. Emergency Clinical County Hospital of Sibiu, Department of Neurology. 2. "Lucian Blaga" University, Sibiu, Romania
| | - Maria-Gabriela CATANĂ
- 2. "Lucian Blaga" University, Sibiu, Romania. 3. Center for invasive and non-invasive research in the field of cardiac and vascular pathology in adults
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‘We struggle and muddle.’ A qualitative study exploring community ABI therapists’ experiences of using, training in and implementing behaviour interventions. BRAIN IMPAIR 2020. [DOI: 10.1017/brimp.2020.6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AbstractObjectives:Individuals with acquired brain injury (ABI) may present with challenging behaviours (CB) that place themselves and others at risk of harm and impact their community integration. It is crucial for community ABI therapists to successfully train in and implement behaviour interventions. The current study aimed to investigate community ABI therapists’ experiences of using, training in and implementing behaviour interventions. An additional aim was to determine these therapists’ understanding of Positive Behaviour Support (PBS), one approach to addressing CB with a focus on improving quality of life.Methods:Semi-structured interviews were conducted with 24 Australian community ABI therapists about their experiences of using, training in and implementing behaviour interventions and understanding of PBS. Inductive thematic analysis and content analysis were performed on interview transcripts.Findings:The thematic analysis resulted in the generation of six themes which described the difficulties participants faced in training in and delivering behaviour interventions and identified their training and implementation needs. The content analysis resulted in 10 categories that characterised participants’ understanding of PBS, which centred around the absence of consequences, a focus on antecedents, person-centred practice and encouraging prosocial alternatives to CB.Conclusions:The findings highlight a need and desire for more practical and interactive clinician training in behaviour interventions for individuals with ABI. Moreover, the findings suggest a limited understanding of PBS amongst community ABI therapists. Important considerations for the development of clinician training in ABI behaviour interventions and subsequent implementation into community practice are discussed.
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Understanding Australian Community ABI Therapists’ Preferences for Training in and Implementing Behaviour Interventions: A Focus on Positive Behaviour Support. BRAIN IMPAIR 2019. [DOI: 10.1017/brimp.2019.32] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:Individuals with acquired brain injury (ABI) may experience persistent and distressing challenging behaviours (CB), and therefore, effective delivery of behaviour interventions is crucial. This study aimed to investigate community ABI therapists’ experiences of using, training in and implementing behaviour interventions with a focus on Positive Behaviour Support (PBS).Methods:A sample of Australian community ABI therapists (n = 136) completed an online survey about their experiences with behaviour interventions, including PBS. Data from open-ended questions were analysed using content analysis. Frequency and descriptive statistics were computed, and a multiple regression was performed to determine factors predicting readiness to learn and implement new behaviour interventions. Rank-based non-parametric tests were conducted to investigate the influence of clinical role on experiences with behaviour interventions and training preferences.Results:Consistent with PBS, participants indicated that the following were important in addressing CB: teamwork and collaboration, person-centred practice, working with antecedents, environmental modification, improving quality of life and skill-building. Despite a high level of desire and readiness, 80% of participants reported facing barriers to learning and implementing new behaviour interventions (e.g., lack of time). Participants’ confidence in using behaviour interventions (β = 0.31; p = 0.002) and the number of barriers faced (β = −0.30; p = 0.002) predicted their readiness to learn and implement new behaviour interventions. Confidence, duration of past training in behaviour interventions and preferred duration of future training did not differ based on clinical role.Conclusion:Implications for the development of training in behaviour interventions such as PBS and implementation into community practice are discussed.
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Fisher A, Bellon M, Lawn S, Lennon S. Brain injury, behaviour support, and family involvement: putting the pieces together and looking forward. Disabil Rehabil 2019; 42:1305-1315. [PMID: 30653928 DOI: 10.1080/09638288.2018.1522551] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: (1) to provide insight into the family's experience and support needs following acquired brain injury (ABI) specific to behavioural changes; (2) to provide an overview of empirically-based behaviour support approaches for individuals with ABI; and (3), to examine family involvement in implementing behavioural interventions.Methods: Review of the literature.Results: Family members experience significant distress resulting from neurobehavioural changes in relatives with ABI, and report unmet informational and practical support needs regarding this issue. The importance of utilising family expertise within the rehabilitation process is widely acknowledged, with the increasing involvement of family members being promoted. There is growing evidence supporting the use of positive behaviour support approaches for individuals with ABI in community settings, and evidence supporting the involvement of family within behavioural interventions.Conclusions: This review suggests the need to develop alternative support models that shift the focus towards building competence in everyday support people rather than dependency on the service system. A bottom-up approach is recommended, with the aim of addressing unmet support needs and increasing the competence of family members in supporting behaviour change in individuals with ABI. Recommendations are provided in informing an optimal community-based neurobehavioural support model. Implications for RehabilitationPositive behaviour support is recommended in supporting behavioural changes following brain injury, with family expertise utilised in this process.Evidence suggests that family members can be effectively trained in developing and implementing behaviour support strategies.Family involvement in behavioural interventions may address unmet support needs and increasing the competence of family members in supporting behavioural changes following brain injury.
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Affiliation(s)
- Alinka Fisher
- Disability and Community Inclusion, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Michelle Bellon
- Disability and Community Inclusion, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Sharon Lawn
- Department of Psychiatry, Flinders University, Adelaide, Australia
| | - Sheila Lennon
- Discipline of Physiotherapy, Flinders University, Adelaide, Australia
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Kreitzer N, Kurowski BG, Bakas T. Systematic Review of Caregiver and Dyad Interventions After Adult Traumatic Brain Injury. Arch Phys Med Rehabil 2018; 99:2342-2354. [PMID: 29752909 PMCID: PMC8730799 DOI: 10.1016/j.apmr.2018.04.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/13/2018] [Accepted: 04/14/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To describe and synthesize the literature on adult traumatic brain injury (TBI) family caregiver and dyad intervention. TBI is a common injury that has a significant long-term impact, and is sometimes even characterized as a chronic condition. Informal (ie, unpaid) family caregivers of adults with TBI experience high rates of burnout, depression, fatigue, anxiety, lower subjective well-being, and poorer levels of physical health compared to noncaregivers. This study addresses the critical gap in the understanding of interventions designed to address the impact of TBI on adult patients and their family caregivers. DATA SOURCES PubMed and MEDLINE. STUDY SELECTION Studies selected for review had to be written in English and be quasi-experimental or experimental in design, report on TBI caregivers, survivors with heavy involvement of caregivers, or caregiver dyads, involve moderate and severe TBI, and describe an intervention implemented during some portion of the TBI care continuum. DATA EXTRACTION The search identified 2171 articles, of which 14 met our criteria for inclusion. Of the identified studies, 10 were randomized clinical trials and 4 were nonrandomized quasi-experimental studies. A secondary search to describe studies that included individuals with other forms of acquired brain injury in addition to TBI resulted in 852 additional titles, of which 5 met our inclusion criteria. DATA SYNTHESIS Interventions that targeted the caregiver primarily were more likely to provide benefit than those that targeted caregiver/survivor dyad or the survivor only. Many of the studies were limited by poor fidelity, low sample sizes, and high risk for bias based on randomization techniques. CONCLUSIONS Future studies of TBI caregivers should enroll a more generalizable number of participants and ensure adequate fidelity to properly compare interventions.
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Affiliation(s)
- Natalie Kreitzer
- Department of Emergency Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States; Division of Neurocritical Care, College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States.
| | - Brad G Kurowski
- Department of Pediatrics, Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, United States
| | - Tamilyn Bakas
- College of Nursing, University of Cincinnati, Cincinnati, Ohio, United States
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Fisher A, Bellon M, Lawn S, Lennon S. The development of a positive behaviour support programme for families following acquired brain injury. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2018. [DOI: 10.12968/ijtr.2018.25.10.538] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Alinka Fisher
- Associate lecturer, Disability and Community Inclusion Unit, College of Nursing and Health Sciences, Flinders University Adelaide, Australia
| | - Michelle Bellon
- Senior lecturer, Disability and Community Inclusion Unit, College of Nursing and Health Sciences, Flinders University Adelaide, Australia
| | - Sharon Lawn
- Professor, Department of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Sheila Lennon
- Professor, Discipline of Physiotherapy, College of Medicine and Public Health, Flinders University Adelaide, Australia
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Hart T, Driver S, Sander A, Pappadis M, Dams-O'Connor K, Bocage C, Hinkens E, Dahdah MN, Cai X. Traumatic brain injury education for adult patients and families: a scoping review. Brain Inj 2018; 32:1295-1306. [PMID: 30084694 DOI: 10.1080/02699052.2018.1493226] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Traumatic brain injury (TBI) is increasingly viewed as a chronic condition, bringing long-term needs for patient and caregiver knowledge pertaining to symptom and problem management over time. In light of these needs, we performed a scoping review of the literature on brain injury education provided to adult patients and/ or family members affected by TBI. Objectives were to describe the types of educational interventions that have been developed; to review the effects of these interventions; and to determine gaps that might be filled by future research efforts. Of 88 articles meeting search criteria and subjected to data extraction, 34 concerned education about mild TBI and 54, moderate to severe TBI. Most mild TBI articles focused on education in the Emergency Room, while most moderate/ severe TBI education was directed toward family members/ caregivers and was frequently combined with other treatment components, making the effects of education difficult to discern. Only 1 article incorporated elements of self-management training (SMT), a model proved effective in other chronic health conditions. We recommend further exploration of SMT principles in long-term TBI care, as well as more precise definition of treatment components in all patient and family interventions, so that the specific effects of education and other treatment elements may be more readily evaluated.
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Affiliation(s)
- Tessa Hart
- a Moss Rehabilitation Research Institute , Elkins Park , PA , USA
| | - Simon Driver
- b Department of Rehabilitation Research , Baylor Scott and White Institute for Rehabilitation , Dallas , TX , USA
| | - Angelle Sander
- c Department of Physical Medicine and Rehabilitation , Baylor College of Medicine , Houston , TX , USA.,d Brain Injury Research Center , TIRR Memorial Hermann , Houston , TX , USA
| | - Monique Pappadis
- d Brain Injury Research Center , TIRR Memorial Hermann , Houston , TX , USA.,e Division of Rehabilitation Sciences, School of Health Professions , University of Texas Medical Branch at Galveston , TX , USA
| | - Kristen Dams-O'Connor
- f Department of Rehabilitation Medicine, Department of Neurology Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Claire Bocage
- g American Institutes for Research , Washington , DC , USA
| | - Emma Hinkens
- g American Institutes for Research , Washington , DC , USA
| | - Marie N Dahdah
- b Department of Rehabilitation Research , Baylor Scott and White Institute for Rehabilitation , Dallas , TX , USA.,h Department of Medical Psychology , Baylor Scott and White Medical Center , Plano , TX , USA
| | - Xinsheng Cai
- g American Institutes for Research , Washington , DC , USA
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14
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Verberne DPJ, Spauwen PJJ, van Heugten CM. Psychological interventions for treating neuropsychiatric consequences of acquired brain injury: A systematic review. Neuropsychol Rehabil 2018; 29:1509-1542. [DOI: 10.1080/09602011.2018.1433049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Daan P. J. Verberne
- Department of Acquired Brain Injury, GGZ Oost Brabant, Boekel, the Netherlands
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Neuroscience, School of Mental Health and Neurosciences (MHeNS), Maastricht University Medical Centre, Maastricht, the Netherlands
- Limburg Brain Injury Centre, Maastricht, the Netherlands
| | - Peggy J. J. Spauwen
- Department of Acquired Brain Injury, GGZ Oost Brabant, Boekel, the Netherlands
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Neuroscience, School of Mental Health and Neurosciences (MHeNS), Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Caroline M. van Heugten
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Neuroscience, School of Mental Health and Neurosciences (MHeNS), Maastricht University Medical Centre, Maastricht, the Netherlands
- Limburg Brain Injury Centre, Maastricht, the Netherlands
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
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Jones M, Acion L, Jorge RE. What are the complications and emerging strategies for preventing depression following traumatic brain injury? Expert Rev Neurother 2017; 17:631-640. [PMID: 28343407 DOI: 10.1080/14737175.2017.1311788] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Depression is a common and disabling complication of traumatic brain injury (TBI). The high rates of post-TBI depression (PTBID) make this condition an important candidate for selective preventive interventions. Areas covered: The authors recently reported on the efficacy of sertraline, a selective serotonin reuptake inhibitor (SSRI), for the prevention of new cases of depression in the first six months after TBI. The authors review this and other studies on preventive strategies in PTBID as ascertained from a PubMed and citation search. The potential complications and barriers to the implementation of pharmacological prevention in patients with TBI are also discussed. Expert commentary: The prevention of depression in patients with TBI has received little attention relative to other medical conditions. Future studies are needed to confirm the benefit of SSRIs and investigate other pharmacological and non-pharmacological interventions, including in special groups of patients at greater risk of developing PTBID.
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Affiliation(s)
- Melissa Jones
- a VA South Central Mental Illness Research , Education and Clinical Center , Houston , TX , USA.,b Mental Health Care Line , Michael E. DeBakey Veterans Affairs Medical Center , Houston , TX , USA.,c Menninger Department of Psychiatry and Behavioral Sciences , Baylor College of Medicine , Houston , TX , USA.,d Beth K. and Stuart C. Yudofsky Menninger Department of Psychiatry and Behavioral Sciences , Baylor College of Medicine , Houston , TX , USA
| | - Laura Acion
- c Menninger Department of Psychiatry and Behavioral Sciences , Baylor College of Medicine , Houston , TX , USA.,e Iowa Consortium for Substance Abuse Research and Evaluation , University of Iowa , Iowa , IA , USA
| | - Ricardo E Jorge
- b Mental Health Care Line , Michael E. DeBakey Veterans Affairs Medical Center , Houston , TX , USA.,c Menninger Department of Psychiatry and Behavioral Sciences , Baylor College of Medicine , Houston , TX , USA.,d Beth K. and Stuart C. Yudofsky Menninger Department of Psychiatry and Behavioral Sciences , Baylor College of Medicine , Houston , TX , USA
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Identifying Current Practices and Supports in Behaviour Management Following ABI in South Australian Community Settings: A Delphi Study. BRAIN IMPAIR 2017. [DOI: 10.1017/brimp.2016.36] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Objectives: To consider the strategies currently used by family care givers to manage challenging behaviour in the community following ABI, and to identify what supports are available that support family care givers in addressing this issue.Research design: Delphi study.Methods: Service providers (n = 8) and family care givers (n = 3) completed a three-round Delphi process with the aim of reaching consensus (75% agreement) regarding research objectives. Round 1 consisted of an open-ended questionnaire in which items were identified; these items were then rated in Round 2 and 3 using a Likert scale. Statistical aggregation then allowed for quantitative analysis.Results: The findings suggest a number of behaviour management approaches are being used by family care givers, including basic antecedent strategies, agreeing with the person's demands, and medication. Consensus was reached that only two services in SA provide specific support to family care givers regarding behaviour management in the community: Families4Families Inc. (a peer support network) and Private Specialists (e.g., [neuro]psychologists and [neuro]psychiatrists).Conclusions: Findings emphasise the need for more specialised services specific to educating and supporting family care givers in the management of challenging behaviours following ABI. These services should be accessible, centralised, and easy for family care givers to navigate.
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Eastman A, Chang DG. Return to Learn: A review of cognitive rest versus rehabilitation after sports concussion. NeuroRehabilitation 2016; 37:235-44. [PMID: 26484515 DOI: 10.3233/nre-151256] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cognitive rest is the recommendation for all patients with acute sports concussion. OBJECTIVE/METHODS A comprehensive literature search was conducted for the research question "What is the optimal cognitive load for patients with a sports concussion?" RESULTS Seven studies met the inclusion criteria. The optimal cognitive load for patients after sports concussion is yet to be determined. CONCLUSIONS Additional controlled trials of cognitive rehabilitation are needed to establish best clinical practice. The authors suggest memory training, cognitive behavioral therapy, and environmental interventions as areas of future research for sports concussion injuries.
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Affiliation(s)
- Amelia Eastman
- Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Douglas G Chang
- Physical Medicine and Rehabilitation, University of California, San Diego, La Jolla, CA, USA.,Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, CA, USA
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Wiart L, Luauté J, Stefan A, Plantier D, Hamonet J. Non pharmacological treatments for psychological and behavioural disorders following traumatic brain injury (TBI). A systematic literature review and expert opinion leading to recommendations. Ann Phys Rehabil Med 2016; 59:31-41. [PMID: 26776320 DOI: 10.1016/j.rehab.2015.12.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 12/01/2015] [Accepted: 12/01/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The non pharmacological approach is an important issue in the treatment of psychological and behavioural disorders in traumatic brain injury (TBI) patients. It remains nevertheless insufficiently known and defined. The objective of this work was to develop precise recommendations for caregivers and relatives. METHOD The elaboration of these guidelines followed the procedure validated by the French health authority for good practice recommendations, close to the Prisma statement, involving a systematic, critical review of the literature and the expert opinions of the French Society of Physical Medicine and Rehabilitation (SOFMER) group. RESULTS 458 articles were identified, among which 98 were selected for their relevance to the theme of the research. None of the studies reached the highest level of evidence. Fifteen controlled studies reached a relatively high level of evidence (level 2); other studies were case series or expert opinions, and other articles again were reviews of the literature and theoretical points of view. The holistic approach structured into programmes, cognitive-behavioural therapy, and family and systemic therapy, despite the low levels of proof, are recommended in first intention at all stages in the evolution of TBI. Relational and adaptive approaches, rehabilitation and vocational approaches, and psychoanalytical therapies may be useful, provided that therapists are familiar with and trained in traumatic brain injury. CONCLUSION Despite the small number of publications and a low level of proof, a number of recommendations for the non-pharmacological approach to psychological and behavioural disorders in TBI is proposed by the consensus conference of experts. Scientific research in this domain is needed to confirm and complete these first recommendations.
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Affiliation(s)
- Laurent Wiart
- Service de MPR, CHU Pellegrin, 33076 Bordeaux Cedex, France.
| | - Jacques Luauté
- Service de MPR, Hôpital Henri-Gabrielle, 69230 Saint Genis Laval, France
| | | | - David Plantier
- Service de MPR, Hôpital René-Sabran, 83400 Giens, France
| | - Julia Hamonet
- Service de MPR, Hôpital Dupuytren, 87042 Limoges cedex, France
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Luauté J, Hamonet J, Pradat-Diehl P. Behavioral and affective disorders after brain injury: French guidelines for prevention and community supports. Ann Phys Rehabil Med 2015; 59:68-73. [PMID: 26697992 DOI: 10.1016/j.rehab.2015.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 10/30/2015] [Accepted: 10/30/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The purpose of this study was to elaborate practice guidelines for the prevention of behavioral and affective disorders in adult outpatients after traumatic brain injury (TBI); but also to identify the support systems available for family, caregivers of patients with TBI within the community. METHODS The elaboration of these guidelines followed the procedure validated by the French health authority for good practice recommendations, close to the Prisma statement. This involved a systematic and critical review of the literature looking for studies that investigated the impact of programs in community settings directed to behavioral and affective disorders post-TBI. Recommendations were than elaborated by a group of professionals and family representatives. RESULTS Only six articles were found comprising 4 studies with a control group. Two studies showed a beneficial effect of personalized behavior management program delivered within natural community settings for persons with brain injury and their caregivers. Two other studies showed the relevance of scheduled telephone interventions to improve depressive symptoms and one study emphasized the usefulness of physical training. One study investigated the relevance of an outreach program; this study showed an improvement of the patients' independence but did not yield any conclusions regarding anxiety and depression. DISCUSSION AND RECOMMENDATIONS In addition to the application of care pathways already established by the SOFMER, prevention of behavioral and affective disorders for brain-injured outpatients should involve pain management, as well as development of therapeutic partnerships. It is recommended to inform patients, their family and caregivers regarding the local organization and facilities involved in the management of traumatic brain injury. The relevance of therapeutic education for implementing coping strategies, educating caregivers on behavioral disorder management, follow-up telephone interventions, and holistic therapy seems established. The level of evidence is low and preliminary studies should be confirmed with larger controlled trials.
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Affiliation(s)
- J Luauté
- Service de médecine physique et de réadaptation, rééducation neurologique, hôpital Henry-Gabrielle, CHU de Lyon, 69230 Saint-Genis-Laval, France; Équipe IMPACT, Inserm, U1028, CNRS, UMR 5292, centre de recherche en neuroscience de Lyon (CRNL), Lyon, France.
| | - J Hamonet
- Service de médecine physique et réadaptation, CHU de Limoges, 87042 Limoges, France
| | - P Pradat-Diehl
- Service de rééducation, hôpital de la Salpetrière, AP-HP, CHU de Paris, Paris, France
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A Randomized Controlled Trial to Evaluate the Veterans' In-home Program for Military Veterans With Traumatic Brain Injury and Their Families: Report on Impact for Family Members. PM R 2015; 8:495-509. [PMID: 26514790 DOI: 10.1016/j.pmrj.2015.10.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/14/2015] [Accepted: 10/18/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) creates many challenges for families as well as for patients. Few intervention studies have considered both the needs of the person with TBI and his or her family and included both in the intervention process. To address this gap, we designed an innovative intervention for veterans with TBI and families-the Veterans' In-home Program (VIP)-targeting veterans' environment, delivered in veterans' homes, and involving their families. OBJECTIVES To determine whether the VIP is more effective than standard outpatient clinic care in improving family members' well-being in 3 domains (depressive symptoms, burden, and satisfaction) and to assess its acceptability to family members. DESIGN In this randomized controlled trial, 81 dyads (veteran/family member) were randomly assigned to VIP or an enhanced usual care control condition. Randomization occurred after the baseline interview. Follow-up interviews occurred 3-4 months after baseline, and the interviewer was blinded to group assignment. SETTING Interviews and intervention sessions were conducted in veterans' homes or by telephone. PARTICIPANTS A total of 81 veterans with TBI recruited from a Veterans Affairs (VA) polytrauma program and a key family member for each participated. Of the 81 family members, 63 completed the follow-up interview. INTERVENTION The VIP, guided by the person-environment fit model, consisted of 6 home visits and 2 telephone calls delivered by occupational therapists over a 3- to 4-month period. Family members were invited to participate in the 6 home sessions. MAIN OUTCOME MEASURES Family member well-being was operationally defined as depressive symptomatology, caregiver burden, and caregiver satisfaction 3-4 months after baseline. Acceptability was operationally defined through 3 indicators. RESULTS Family members in the VIP showed significantly lower depressive symptom scores and lower burden scores when compared to controls at follow-up. Satisfaction with caregiving did not differ between groups. Family members' acceptance of the intervention was high. CONCLUSIONS VIP represents the first evidence-based intervention that considers both the veteran with TBI and the family. VIP had a significant impact on family member well-being and thus addresses a large gap in previous research and services for families of veterans with TBI.
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Tam S, McKay A, Sloan S, Ponsford J. The experience of challenging behaviours following severe TBI: A family perspective. Brain Inj 2015; 29:813-21. [DOI: 10.3109/02699052.2015.1005134] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Fisher A, Lennon S, Bellon M, Lawn S. Family involvement in behaviour management following acquired brain injury (ABI) in community settings: A systematic review. Brain Inj 2015; 29:661-75. [DOI: 10.3109/02699052.2015.1004751] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | | | | | - Sharon Lawn
- Department of Psychiatry, School of Health Sciences, Flinders University, Adelaide, Australia
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Mansour A, Lajiness-O’Neill R. Call for an Integrative and Multi-Disciplinary Approach to Traumatic Brain Injury (TBI). ACTA ACUST UNITED AC 2015. [DOI: 10.4236/psych.2015.64033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lu J, Gary KW, Copolillo A, Ward J, Niemeier JP, Lapane KL. Randomized controlled trials in adult traumatic brain injury: a review of compliance to CONSORT statement. Arch Phys Med Rehabil 2014; 96:702-14. [PMID: 25497515 DOI: 10.1016/j.apmr.2014.10.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 10/03/2014] [Accepted: 10/31/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the extent to which adherence to Consolidated Standards of Reporting Trials (CONSORT) statement in randomized controlled trials (RCTs) in adult traumatic brain injury (TBI) has improved over time. DATA SOURCES MEDLINE, PsycINFO, and CINAHL databases were searched from inception to September 2013. STUDY SELECTION Primary report of RCTs in adult TBI. The quality of reporting on CONSORT checklist items was examined and compared over time. Study selection was conducted by 2 researchers independently. Any disagreements were solved by discussion. DATA EXTRACTION Two reviewers independently conducted data extraction based on a set of structured data extraction forms. Data regarding the publication years, size, locations, participation centers, intervention types, intervention groups, and CONSORT checklist items were extracted from the including trials. DATA SYNTHESIS Of 105 trials reviewed, 38.1%, 5.7%, and 32.4% investigated drugs, surgical procedures, and rehabilitations as the intervention of interest, respectively. Among reports published between the 2 periods 2002 and 2010 (n=51) and 2011 and September 2013 (n=16), the median sample sizes were 99 and 118; 39.2% and 37.5% of all reports detailed implementation of the randomization process; 60.8% and 43.8% provided information on the method of allocation concealment; 56.9% and 31.3% stated how blinding was achieved; 15.7% and 43.8% reported information regarding trial registration; and only 2.0% and 6.3% stated where the full trial protocol could be accessed, all respectively. CONCLUSIONS Reporting of several important methodological aspects of RCTs conducted in adult TBI populations improved over the years; however, the quality of reporting remains below an acceptable level. The small sample sizes suggest that many RCTs are likely underpowered. Further improvement is recommended in designing and reporting RCTs.
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Affiliation(s)
- Juan Lu
- Department of Family Medicine and Population Health, Division of Epidemiology, Virginia Commonwealth University, Richmond, VA.
| | - Kelli W Gary
- Department of Occupational Therapy, Virginia Commonwealth University, Richmond, VA
| | - Al Copolillo
- Department of Occupational Therapy, Virginia Commonwealth University, Richmond, VA
| | - John Ward
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, VA
| | - Janet P Niemeier
- Department of Physical Medicine and Rehabilitation, Carolinas Rehabilitation, Charlotte, NC
| | - Kate L Lapane
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
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Abstract
OBJECTIVE To explore factors associated with strain in carers of patients with traumatic brain injury. DESIGN Cross-sectional cohort study. PARTICIPANTS Forty-eight carers of patients with traumatic brain injury admitted to a neurosurgical unit over a 9-year period were assessed an average of 9.3 years after injury. MEASURES Caregiver Strain Index (CSI), Neurobehavioral Functioning Inventory (NFI), Glasgow Outcome Scale (GOS), Virginia Prediction Tree Score, and carer and patient demographics. PROCEDURE Carers were assessed via postal survey for levels of strain using the CSI and for their perception of the patients' disabilities using the NFI. RESULTS Elevated levels of strain were found in 42% of carers. Using logistic regression, outcome as rated by the patients' general practitioner on the GOS and all subscales of the NFI (except Somatic) explained 41% to 57% of the variance in strain and predicted group membership correctly in 72.9% of cases. No individual variable contributed significantly to the explained variance in the model. CONCLUSION A number of factors appear to combine to result in feelings of strain, but the GOS could be used as a crude screening tool. Interventions for cognitive, behavioral, and emotional difficulties may be most useful for carers.
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Trivedi RB, Szarka JG, Beaver K, Brousseau K, Nevins E, Yancy WS, Slade A, Voils CI. Recruitment and retention rates in behavioral trials involving patients and a support person: a systematic review. Contemp Clin Trials 2013; 36:307-18. [PMID: 23916918 DOI: 10.1016/j.cct.2013.07.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 07/23/2013] [Accepted: 07/26/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recruitment and retention challenges impede the study of behavioral interventions among patient-support person dyads. PURPOSE The aim of the study was to characterize recruitment and retention rates of behavioral interventions involving dyads. METHODS Using PRISMA guidelines and with the guidance of a medical librarian, we searched Medline, EMBASE, Cochrane Controlled Trials, PsycInfo, and CINAHL from inception until July 2011. Eligible articles involved RCTs of behavioral interventions targeting adult patients with a non-psychiatric illness and a support person. Sample and study characteristics, recruitment and retention strategies, and recruitment and retention rates were abstracted in duplicate. Quality of reporting was determined on a 5-point scale. Due to the heterogeneity in data reporting and missing data, a narrative synthesis was undertaken. RESULTS 53 unique studies involving 8081 dyads were included. 9 studies were ascertained to have a "high quality" of reporting. A majority of the studies did not report target sample size, time to complete recruitment, and sample sizes at each follow-up time point. Strategies employed to recruit support persons were rarely reported. 16 studies did not report the number of dyads screened. The mean recruitment rate was 51.2% (range: 4.3%-95.4%), and mean retention rate was 77.5% (range: 36%-100%). CONCLUSIONS Details regarding recruitment and retention methodology were sparse in these interventions. Where available, data suggests that resources need to be devoted towards recruitment of sample but that retention rates are generally adequate.
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Affiliation(s)
- Ranak B Trivedi
- Department of Health Services, University of Washington, Seattle, WA 98195, USA.
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Lu J, Gary KW, Neimeier JP, Ward J, Lapane KL. Randomized controlled trials in adult traumatic brain injury. Brain Inj 2013; 26:1523-48. [PMID: 23163248 DOI: 10.3109/02699052.2012.722257] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND To optimize strategies for achieving the effectiveness of interdisciplinary interventions, this study conducted a comprehensive literature review of all Randomized Controlled Trials (RCT) in adults with traumatic brain injury (TBI) over the past 30 years. METHOD Three major databases including Medline, PsycINFO and CINAHL were searched, yielding 1176 peer reviewed publications. One hundred RCTs were included, encompassing 55 pharmacologic and non-pharmacologic acute phase trials and 45 rehabilitation and pharmacologic post-acute trials. RESULTS The majority of acute phase pharmacologic or non-pharmacologic trials (40/55) showed either no effect or adverse effect on TBI outcomes. Several trials involving early nutritional therapy or pre-hospital rapid intubation demonstrated significant treatment effects. The effect of decompressive craniectomy, therapeutic hypothermia and osmotic therapy remained controversial. The majority of post-acute phase trials (36/45), consisting of cognitive rehabilitation, physical rehabilitation and pharmacotherapy, produced various beneficial treatment effects. CONCLUSION The data indicate that several active interventions during the acute phase of TBI are likely to be more effective than pharmacotherapy, whereas a comprehensive rehabilitation approach is preferred in post-acute phase TBI management. Great progress has been made in understanding the heterogeneous injury mechanisms as well as the complexity of medical management and rehabilitation following the recovery course of TBI.
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Affiliation(s)
- Juan Lu
- Department of Epidemiology and Community Health, Virginia Commonwealth University, Richmond, VA 23298-0212, USA.
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Psychotherapeutic follow up of out patients with traumatic brain injury: Preliminary results of an individual neurosystemic approach. Ann Phys Rehabil Med 2012; 55:375-87. [DOI: 10.1016/j.rehab.2012.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 04/13/2012] [Accepted: 04/25/2012] [Indexed: 11/23/2022]
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Kelly G, Parry A. Managing Challenging Behaviour of People With Acquired Brain Injury in Community Settings: The First 7 Years of a Specialist Clinical Service. BRAIN IMPAIR 2012. [DOI: 10.1375/brim.9.3.293] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThis article provides a review of the development and clinical practice of the ABI Behaviour Consultancy (the ‘Consultancy’), a specialist clinical service that provides outreach behaviour management support across the state of Victoria, Australia, to people with acquired brain injury (ABI) and their social network (i.e., family members, friends, support workers, and therapists). The Consultancy is a small, unique service that has developed ways of providing behaviour management strategies in community settings, despite the difficulties presented by changing and uncontrolled environments. The aim of this article is to provide a detailed account of this service. Information from the first 7 years of full operation, 1998 to 2004, is presented, during which a small number of psychologists saw more than 800 clients. A detailed description is given of behaviours referred and associated risks, assessment procedures, intervention approaches, and research activity. A variety of key service aspects are detailed, including the qualifications required of specialised staff, the service funding levels, and funding and service issues. These detailed accounts of service delivery are placed in the context of several major themes: specialist versus generalist services, the deployment of targeted interventions throughout the lifespan of a brain-injured individual, the role of specialist behaviour management services in the continuum of brain-injury support services, and broader equity issues.
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Shields CG, Finley MA, Chawla N, Meadors WP. Couple and family interventions in health problems. JOURNAL OF MARITAL AND FAMILY THERAPY 2012; 38:265-80. [PMID: 22283390 DOI: 10.1111/j.1752-0606.2011.00269.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Intervention research for couples and families managing chronic health problems is in an early developmental stage. We reviewed randomized clinical trials of family interventions for common neurological diseases, cardiovascular diseases, cancer, and diabetes, which is similar to the content of previous reviews discussed later. One overriding theme of these studies is that patients with chronic illnesses and their families face a variety of challenges to which researchers have responded with an array of treatment modalities. Very few of the interventions reviewed, with the exception of treatment for adolescents with diabetes, tested family psychotherapy models. Most interventions were time-limited therapeutic interventions that trained families to improve their communication and problem-solving skills, individual and family coping skills, and medical management. Researchers more clearly described mechanisms of change in intervention studies with cancer and diabetes than with other diseases, and not surprisingly, they found greater empirical support for their interventions. Family interventions show promise to help patients and family members manage chronic illnesses. To develop an empirical base for family approaches to managing chronic illnesses, interventions must be based on theories that delineate mechanisms of change in family processes and skills in medical management necessary to maintain patients' and family members' health.
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Affiliation(s)
- Cleveland G Shields
- Purdue University, Human Development and Family Studies Department, Marriage and Family Therapy Program.
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Legg LA, Quinn TJ, Mahmood F, Weir CJ, Tierney J, Stott DJ, Smith LN, Langhorne P. Non-pharmacological interventions for caregivers of stroke survivors. Cochrane Database Syst Rev 2011:CD008179. [PMID: 21975778 DOI: 10.1002/14651858.cd008179.pub2] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND A substantial component of care is provided to stroke survivors by informal caregivers. However, providing such care is often a new and challenging experience and has been linked to a number of adverse outcomes. A range of interventions targeted towards stroke survivors and their family or other informal caregivers have been tested in randomised controlled trials (RCTs). OBJECTIVES To evaluate the effect of interventions targeted towards informal caregivers of stroke survivors or targeted towards informal caregivers and the care recipient (the stroke survivor). SEARCH STRATEGY We searched the Cochrane Stroke Group Trials Register (March 2011), CENTRAL (The Cochrane Library Issue 2010, Issue 4), MEDLINE (1950 to August 2010), EMBASE (1980 to December 2010), CINAHL (1982 to August 2010), AMED (1985 to August 2010), PsycINFO (1967 to August 2010) and 11 additional databases. In an effort to identify further published, unpublished and ongoing studies, we searched conference proceedings and trials registers, scanned reference lists of relevant articles and contacted authors and researchers. There were no language restrictions. SELECTION CRITERIA We included RCTs if they evaluated the effect of non-pharmacological interventions (compared with no care or routine care) on informal caregivers of stroke survivors. We included trials of interventions delivered to stroke survivors and informal caregivers only if the stroke survivor and informal caregiver were randomised as a dyad. We excluded studies which included stroke survivors and caregivers if the stroke survivors were the primary target of the intervention. DATA COLLECTION AND ANALYSIS Two review authors selected studies for inclusion, independently extracted data and assessed methodological quality. We sought original data from trialists. We categorised interventions into three groups: support and information, teaching procedural knowledge/vocational training type interventions, and psycho-educational type interventions. The primary outcome was caregivers' stress or strain. We resolved disagreements by consensus. MAIN RESULTS Eight studies, including a total of 1007 participants, met our inclusion criteria. We did not pool the results of all the studies because of substantial methodological, statistical and clinical heterogeneity. For caregivers' stress or strain we found no significant results within categories of intervention, with the exception of one single-centre study examining the effects of a 'vocational training' type intervention which found a mean difference between the intervention and comparator group at the end of scheduled follow-up of -8.67 (95% confidence interval -11.30 to -6.04, P < 0.001) in favour of the 'teaching procedural knowledge' type intervention group. AUTHORS' CONCLUSIONS It was not possible to carry out a meta-analysis of the evidence from RCTs because of methodological, clinical and statistical heterogeneity. One limitation across all studies was the lack of a description of important characteristics that define the informal caregiver population. However, 'vocational educational' type interventions delivered to caregivers prior to the stroke survivor's discharge from hospital appear to be the most promising intervention. However, this is based on the results from one, small, single-centre study.
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Affiliation(s)
- Lynn A Legg
- Academic Section of Geriatric Medicine, Division of Cardiovascular & Medical Sciences, Faculty of Medicine, University of Glasgow, Room 5, 4th Floor, Walton Building, Royal Infirmary, Glasgow, UK, G4 0SF
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Tu LV, Togher L, Power E. The impact of communication partner and discourse task on a person with traumatic brain injury: The use of multiple perspectives. Brain Inj 2011; 25:560-80. [DOI: 10.3109/02699052.2011.571655] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Long-term psychiatric outcomes following traumatic brain injury: a review of the literature. J Head Trauma Rehabil 2010; 24:452-9. [PMID: 19940678 DOI: 10.1097/htr.0b013e3181c133fd] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the relationship between traumatic brain injury (TBI) and long-term psychiatric health outcomes, occurring 6 months or more after TBI. PARTICIPANTS Not applicable. DESIGN Systematic review of the published, peer-reviewed literature. PRIMARY MEASURES Not applicable. RESULTS We identified studies that examined psychiatric disorders following TBI. There was sufficient evidence of an association between TBI and depression and similarly compelling evidence of an association between TBI and aggression. There was limited/suggestive evidence of an association between TBI and subsequent completed suicide, decreased alcohol and drug use compared to preinjury levels, and psychosis. While there was also limited/suggestive evidence for posttraumatic stress disorder (PTSD) in military populations with TBI, there was inadequate evidence to reach a conclusion about whether TBI was associated with PTSD in civilian populations. CONCLUSION TBI is associated with a wide range of psychiatric disorders among individuals surviving at least 6 months. The association between mild TBI and PTSD seems to differ in military and civilian populations.
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Cattelani R, Zettin M, Zoccolotti P. Rehabilitation Treatments for Adults with Behavioral and Psychosocial Disorders Following Acquired Brain Injury: A Systematic Review. Neuropsychol Rev 2010; 20:52-85. [DOI: 10.1007/s11065-009-9125-y] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Accepted: 12/21/2009] [Indexed: 12/19/2022]
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Fraas M, Bellerose A. Mentoring programme for adolescent survivors of acquired brain injury. Brain Inj 2009; 24:50-61. [DOI: 10.3109/02699050903446781] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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A web-based videoconferencing approach to training caregivers in rural areas to compensate for problems related to traumatic brain injury. J Head Trauma Rehabil 2009; 24:248-61. [PMID: 19625864 DOI: 10.1097/htr.0b013e3181ad593a] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the development and the implementation of a Web-based, videoconferencing training program for caregivers of adults with traumatic brain injury in rural areas to manage cognitive and behavioral changes in the person with the injury. DESIGN Feasibility study, with satisfaction and perceived utility assessed. INTERVENTION Six Web-based videoconference sessions, combining didactic education and interactive problem-solving. PARTICIPANTS Fifteen caregivers of persons with complicated mild, moderate, or severe traumatic brain injury, who were admitted to a level III trauma center in a rural area of Texas. MEASURES Satisfaction survey and perceived utility questions conducted immediately following training and at an average of 18 months after training. RESULTS Participants' overall satisfaction and comfort with the training was high. They perceived that they gained knowledge that was applicable to the everyday problems being experienced. At follow-up, all participants reported having used the knowledge gained to help cope with problems and all had referred to the written materials at least once since the training. CONCLUSIONS Web-based videoconferencing can be used to provide training to caregivers to manage cognitive and behavioral problems resulting from traumatic brain injury. However, there are obstacles related to willingness to seek help among persons in rural areas that must be overcome.
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Evans L, Brewis C. The efficacy of community-based rehabilitation programmes for adults with TBI. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2008. [DOI: 10.12968/ijtr.2008.15.10.31213] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Lizzie Evans
- Neuropsychiatry, Whitchurch Hospital. Cardiff and Vale NHS Trust
| | - Claire Brewis
- Occupational Therapy at the University of Teesside, Middlesbrough, UK
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