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Norup A, Soendergaard PL, Wolffbrandt MM, Biering-Sørensen F, Arango-Lasprilla JC, Dornonville de la Cour FL. Psychometric properties of the Danish version of the Caregiver Burden Scale: Investigating predictors and severity of burden after stroke, spinal cord injury, or traumatic brain injury. J Rehabil Med 2024; 56:jrm34732. [PMID: 38698655 DOI: 10.2340/jrm.v56.34732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 04/17/2024] [Indexed: 05/05/2024] Open
Abstract
OBJECTIVE To investigate (i) psychometric properties of the Danish version of the Caregiver Burden Scale, (ii) predictors of burden in caregivers of persons with stroke, spinal cord injury, or traumatic brain injury, and (iii) severity of caregiver burden, and compare level of severity of burden in caregivers of persons with stroke, spinal cord injury, or traumatic brain injury. DESIGN Cross-sectional study. PARTICIPANTS Pooled sample of 122 caregivers. METHODS Psychometric properties including internal consistency, floor and ceiling effects, inter-item and item-total correlation were investigated using the Caregiver Burden Scale. Severity of burden was compared using Fisher's exact test and ANOVA, and predictors of burden were investigated using multiple linear regression models. RESULTS The total burden score exhibited good internal consistency (α = 0.93), with no floor or ceiling effects. Longer time as a caregiver was a significant predictor of higher total score. The majority (52.2%) reported a low level of caregiver burden (below cut-off of 2.00). Mean scores on the Caregiver Burden Scale were not significantly different among caregivers across diagnostic groups. Differences were found when comparing spinal cord injury caregivers with brain injury caregivers (traumatic brain injury and stroke, collectively), χ2(2) = 6.38, p = 0.04, as spinal cord injury caregivers were more likely to report low levels of burden. CONCLUSION Good psychometric properties were reported, and most caregivers reported a low level of burden, and longer time as a caregiver was associated with higher burden. Consequently, the Caregiver Burden Scale is a valid measure to use when measuring burden in caregivers of stroke, spinal cord injury, and traumatic brain injury patients.
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Affiliation(s)
- Anne Norup
- Neurorehabilitation Research & Knowledge Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Glostrup, Denmark; Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark.
| | - Pernille Langer Soendergaard
- Neurorehabilitation Research & Knowledge Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Glostrup, Denmark; Neurorehabilitation-CPH, City of Copenhagen, Hellerup, Denmark
| | - Mia Moth Wolffbrandt
- Neurorehabilitation Research & Knowledge Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Glostrup, Denmark; Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Fin Biering-Sørensen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Brain- and Spinal Cord Injuries, Bodil Eskesen Centre, Rigshospitalet, Glostrup, Denmark
| | | | - Frederik Lehman Dornonville de la Cour
- Neurorehabilitation Research & Knowledge Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Glostrup, Denmark; Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark; The Elsass Foundation, Charlottenlund, Denmark
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Young D, Weaver J, Christie L, Genders M, Simpson GK. Building resilience among families supporting relatives with ABI in rural NSW: testing the feasibility of telephone delivery of Strength2Strength program. Brain Inj 2024; 38:84-98. [PMID: 38328973 DOI: 10.1080/02699052.2024.2304877] [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: 07/21/2022] [Accepted: 01/09/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Strength2Strength (S2S) is a group psychoeducational program aiming to build resilience among families supporting relatives after traumatic injury. OBJECTIVE To test the feasibility, acceptability and outcomes of teleconference delivery of a 5 hour S2S program in rural New South Wales. METHODS A mixed methods design investigated the (i) convenience of telephone-based delivery; and (ii) acceptability of the program material (purpose-designed survey and the Narrative Evaluation of Intervention Interview). Program efficacy was measured with the Resilience Scale (RS) and Connor-Davidson Resilience Scale (CD-RISC); the Positive and Negative Affect Scale (PANAS); Depression, Anxiety and Stress Scale - 21 (DASS-21); Carer Assessment of Managing Index (CAMI); and Caregiver Burden Scale (CBS). Participant outcome data were collected at baseline, post program and 3 months follow-up. RESULTS 11 participants supporting adult relatives with severe brain injury completed the program. All participants and facilitators commented positively about the cost, ease of use and quality of the teleconference facility. Statistically significant gains were found between pre-program and follow-up scores on the RS, CD-RISC, PANAS-Positive, and CAMI, with statistically significant reductions found on the DASS-21 Depression Scale and CBS scores. CONCLUSION The study provides preliminary evidence for the efficacy of telephone-based delivery of S2S to family participants.
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Affiliation(s)
- Denise Young
- Mid Western Brain Injury Rehabilitation Program, Bathurst Health Service, Bathurst, Australia
| | - Jerre Weaver
- Inpatient Mental Health Unit, Bathurst Health Service, Bathurst, Australia
| | - Lauren Christie
- Allied Health Research Unit, St Vincent's Health Network, Sydney, Australia
- Nursing Research Institute, St Vincent's Health Network, St Vincent's Hospital Melbourne and Australian Catholic University, Sydney, Australia
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Michelle Genders
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Grahame K Simpson
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, Australia
- John Walsh Centre for Rehabilitation Research, University of Sydney, Sydney, Australia
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Ikin Anderson M, Gopinath B, Fiona Jones K, Morey P, Simpson GK. Testing the stability of a family resilience model at 2 and 5 years after traumatic brain injury or spinal cord injury: A longitudinal study. Ann Phys Rehabil Med 2023; 66:101734. [PMID: 37030248 DOI: 10.1016/j.rehab.2023.101734] [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: 12/14/2021] [Revised: 10/06/2022] [Accepted: 12/10/2022] [Indexed: 04/10/2023]
Abstract
BACKGROUND Recent studies have tested models of resilience and caregiver adjustment in individuals with traumatic brain injury (TBI) or spinal cord injury (SCI). Few studies have examined the role of adaptive variables over time. OBJECTIVE Conduct a longitudinal study to test a model of caregiver resilience with caregiver outcomes at 2- and 5-years post-injury. METHOD Caregivers of relatives with TBI or SCI were surveyed at 2 years (Time 1) and 5 years (Time 2) post-injury. Stability of the resilience model across the 2 time-points was tested using structural equation modeling with multi-group analysis. Measures included resilience related variables (Connor-Davidson Resilience Scale, General Self-Efficacy Scale, Herth Hope Scale, Social Support Survey) and outcome variables (Caregiver Burden Scale, General Health Questionnaire-28, Medical Outcome Study Short Form -36 [SF-36] and Positive and Negative Affect Scale). RESULTS In total, 100 caregivers were surveyed at both 2 and 5 years (TBI =77, SCI =23). Scores for resilience (Time 1, 75.9 SD 10.6; Time 2, 71.5 SD 12.6) and self-efficacy (Time 1, 32.51 SD 3.85; Time 2, 31.66 SD 4.28) showed significant minor declines, with other variables remaining stable. The resilience model for the pooled responses (Time 1+ Time 2) demonstrated a good fit (Goodness of Fit Index [GFI] = 0.971; Incremental Fit Index [IFI] = 0.986; Tucker-Lewis Index [TLI] = 0.971; Comparative Fit Index [CFI] = 0.985 and Root Mean Square Error of Approximation [RMSEA] = 0.051). Multi-group analysis then compared Time 1 to Time 2 responses and found that a variant (compared to invariant) model best fitted the data, with social support having stronger associations with mental health and positive affect at Time 2 than Time 1. Hope reduced from Time 1 to Time 2. CONCLUSIONS The model suggests that resilience-related variables can play an important role in positive caregiver adjustment over time.
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Affiliation(s)
| | - Bamini Gopinath
- Macquarie University Hearing, Macquarie University, North Ryde, NSW, Australia
| | - Kate Fiona Jones
- Institute for Ethics and Society, The University of Notre Dame, Sydney, NSW Australia; Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | - Peter Morey
- School of Nursing and Health, Avondale University, Sydney, NSW, Australia
| | - Grahame Kenneth Simpson
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; John Walsh Centre for Rehabilitation Research, Kolling Institute, Sydney, NSW, Australia
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4
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Carlozzi NE, Choi SW, Wu Z, Sen S, Troost J, Lyden AK, Miner JA, Graves C, Sander AM. The reliability and validity of the TBI-CareQOL system in four diverse caregiver groups. J Patient Rep Outcomes 2023; 7:57. [PMID: 37358716 DOI: 10.1186/s41687-023-00602-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 06/04/2023] [Indexed: 06/27/2023] Open
Abstract
PURPOSE Establishing the psychometric reliability and validity of new measures is an ongoing process. More work is needed in to confirm the clinical utility of the TBI-CareQOL measurement development system in both an independent cohort of caregivers of traumatic brain injury (TBI), as well as in additional caregiver groups. METHODS An independent cohort of caregivers of people with TBI (n = 139), as well as three new diverse caregiver cohorts (n = 19 caregivers of persons with spinal cord injury, n = 21 caregivers for persons with Huntington disease, and n = 30 caregivers for persons with cancer), completed 11 TBI-CareQOL measures (caregiver strain; caregiver-specific anxiety; anxiety; depression; anger; self-efficacy; positive affect and well-being; perceived stress; satisfaction with social roles and activities; fatigue; sleep-related impairment), as well as two additional measures to examine convergent and discriminant validity (PROMIS Global Health; the Caregiver Appraisal Scale). RESULTS Findings support the internal consistency reliability (all alphas > 0.70 with the vast majority being > 0.80 across the different cohorts) of the TBI-CareQOL measures. All measures were free of ceiling effects, and the vast majority were also free of floor effects. Convergent validity was supported by moderate to high correlations between the TBI-CareQOL and related measures, while discriminant validity was supported by low correlations between the TBI-CareQOL measures and unrelated constructs. CONCLUSION Findings indicate that the TBI-CareQOL measures have clinical utility in caregivers of people with TBI, as well as in other caregiver groups. As such, these measures should be considered as important outcome measures for clinical trials aiming to improve caregiver outcomes.
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Affiliation(s)
- Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Building NCRC B14, Room G216, Ann Arbor, MI, 48109-2800, USA.
| | - Sung Won Choi
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Zhenke Wu
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Michigan Institute for Data Science, University of Michigan, Ann Arbor, MI, USA
| | - Srijan Sen
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Jonathan Troost
- Michigan Institute for Data Science, University of Michigan, Ann Arbor, MI, USA
| | - Angela K Lyden
- Clinical Trials Support Office, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer A Miner
- Department of Physical Medicine and Rehabilitation, University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Building NCRC B14, Room G216, Ann Arbor, MI, 48109-2800, USA
| | - Christopher Graves
- Department of Physical Medicine and Rehabilitation, University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Building NCRC B14, Room G216, Ann Arbor, MI, 48109-2800, USA
| | - Angelle M Sander
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine/Harris Health System, Houston, TX, USA
- Brain Injury Research Center, TIRR Memorial Hermann, Houston, TX, USA
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Sanders G, Rapport LJ, Marwitz JH, Novack TA, Walker W, Tefertiller C, Watanabe TK, Kennedy R, Goldin Y, Bergquist T, Dreer LE, Bombardier CH, Zhang Y. Barriers to driving and psychosocial outcomes after traumatic brain injury. Brain Inj 2023; 37:412-421. [PMID: 36717959 DOI: 10.1080/02699052.2023.2172611] [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] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Examine considerations and perceived barriers to return to driving, and their association with psychosocial outcomes among adults with traumatic brain injury (TBI) who were not driving. METHODS 174 adults with moderate-to-severe TBI enrolled in the TBI Model System participated in this cross-sectional study. All participants were drivers prior to their TBI. Outcome measures included the Barriers to Driving Questionnaire, Disability Rating Scale, Patient Health Questionnaire-9, General Anxiety Disorder-7, and Satisfaction With Life Scale. Descriptive analyses examined considerations and barriers to driving, including differences associated with demographic characteristics. Moderation analyses investigated the extent to which disability moderated the relationship between barriers and psychosocial outcomes. RESULTS Social barriers were the most strongly endorsed domain, whereas physical barriers were endorsed least. The profile of endorsements differed for men and women, and for Black and White participants, on both theoretical considerations in returning to drive and experiences of barriers in doing so. Disability level moderated the relationship between barriers to driving and depression and life satisfaction, but not anxiety. CONCLUSION The experience of barriers to driving is differentially associated with psychosocial outcomes among nondriving adults with TBI. Adults with low disability appear to be at risk for distress, even compared to other nondrivers.
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Affiliation(s)
- Gavin Sanders
- Department of Psychology, Wayne State University, Detroit, Michigan, USA
| | - Lisa J Rapport
- Department of Psychology, Wayne State University, Detroit, Michigan, USA
| | - Jenny H Marwitz
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Thomas A Novack
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
| | - William Walker
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | - Thomas K Watanabe
- Department of Physical Medicine and Rehabilitation, MossRehab at Elkins Park/Einstein Healthcare Network, Pennsylvania, USA
| | - Richard Kennedy
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, Integrative Center for Aging Research, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yelena Goldin
- Department of Physical Medicine and Rehabilitation, JFK Johnson Rehabilitation Institute, Edison, New Jersey, USA
| | - Thomas Bergquist
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Laura E Dreer
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Charles H Bombardier
- Department of Physical Medicine and Rehabilitation, University of Washington, Seattle, Washington, USA
| | - Yue Zhang
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, Integrative Center for Aging Research, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Avramovic P, Rietdijk R, Attard M, Kenny B, Power E, Togher L. Cognitive and Behavioral Digital Health Interventions for People with Traumatic Brain Injury and Their Caregivers: A Systematic Review. J Neurotrauma 2023; 40:159-194. [PMID: 35819294 DOI: 10.1089/neu.2021.0473] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Traumatic brain injury (TBI) leads to cognitive linguistic deficits that significantly impact on quality of life and well-being. Digital health offers timely access to specialized services; however, there are few synthesized reviews in this field. This review evaluates and synthesizes reports of digital health interventions in TBI rehabilitation and caregiver education. Systematic searches of nine databases (PsycINFO, MEDLINE, CINAHL, Embase, Cochrane Library, Scopus, Web of Science Core Collection, speechBITE, and PsycBITE) were conducted from database inception to February 2022. Studies were included of interventions where the primary treatment focus (> 50%) was on improving communication, social, psychological or cognitive skills of people with TBI and/or communication partners. Data on participants, characteristics of the interventions, outcome measures and findings were collected. Risk of bias was accounted for through methodological quality assessments (PEDro-P and PEDro+, Risk of Bias in N-of-1 Trials) and intervention description. Qualitative data was analyzed using thematic synthesis. Forty-four articles met eligibility criteria: 20 randomized controlled trials, three single-case experimental designs, six non-randomized controlled trials, nine case series studies, and two case studies. Studies comprised 3666 people with TBI and 213 carers. Methodological quality was varied and intervention description was poor. Most interventions were delivered via a single digital modality (e.g., telephone), with few using a combination of modalities. Five interventions used co-design with key stakeholders. Digital health interventions for people with TBI and their caregivers are feasible and all studies reported positive outcomes; however, few included blind assessors. Improved methodological rigor, clearly described intervention characteristics and consistent outcome measurement is recommended. Further research is needed regarding multi-modal digital health interventions.
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Affiliation(s)
- Petra Avramovic
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.,NHMRC Center of Research Excellence in Aphasia Rehabilitation, Australia
| | - Rachael Rietdijk
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.,NHMRC Center of Research Excellence in Aphasia Rehabilitation, Australia
| | - Michelle Attard
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.,NHMRC Center of Research Excellence in Aphasia Rehabilitation, Australia
| | - Belinda Kenny
- School of Health Sciences, University of Western Sydney, Sydney, New South Wales, Australia
| | - Emma Power
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.,NHMRC Center of Research Excellence in Aphasia Rehabilitation, Australia
| | - Leanne Togher
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.,NHMRC Center of Research Excellence in Aphasia Rehabilitation, Australia
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Juengst SB, Wright B, Driver S, Calhoun S, Muir A, Dart G, Goldin Y, Lengenfelder J, Bell K. Multisite randomized feasibility study of Problem-Solving Training for care partners of adults with traumatic brain injury during inpatient rehabilitation. NeuroRehabilitation 2023; 52:109-122. [PMID: 36617760 DOI: 10.3233/nre-220129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Problem-Solving Training (PST) during inpatient rehabilitation could provide care partners the skills needed to manage their life roles after discharge. OBJECTIVE Determine the feasibility of PST+ Education versus Education for care partners of adults with traumatic brain injury (TBI) during inpatient rehabilitation. METHODS We conducted a multisite randomized feasibility trial across three sites. We present recruitment rates, reasons for refusal to participate, and reasons for non-completion of interventions. We measured client satisfaction, participant engagement, and fidelity for both interventions. We compared change in depressive symptoms and caregiver burden between PST and Education groups. RESULTS Though the interventions were generally feasible, recruitment and retention rates were lower than anticipated largely due to the COVID-19 pandemic. Participants who completed >3 sessions were less likely to be employed full-time and more often spouses and co-residing. Length of inpatient rehabilitation stay was correlated with number of sessions completed. We observed potential benefits of PST over Education, specifically for reducing depression symptoms and caregiver burden. CONCLUSION High satisfaction, engagement, and fidelity, overall recruitment and retention, and positive change in outcomes suggest that PST is generally feasible and beneficial for care partners of persons with TBI. Adaptations, such as developing a 3-session version of PST, could improve feasibility.
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Affiliation(s)
| | - Brittany Wright
- Department of Physical Medicine and Rehabilitation, North Texas TBI Model System, UT Southwestern Medical Center, Dallas, TX, USA
| | - Simon Driver
- North Texas TBI Model System, Baylor Scott and White Research Institute, Dallas, TX, USA
| | - Stephanie Calhoun
- North Texas TBI Model System, Baylor Scott and White Research Institute, Dallas, TX, USA
| | - Aimee Muir
- North Texas TBI Model System, Baylor Scott and White Research Institute, Dallas, TX, USA
| | - Georgianna Dart
- Hackensack Meridian JFK Johnson Rehabilitation Institute, Edison, NJ, USA
| | - Yelena Goldin
- Hackensack Meridian JFK Johnson Rehabilitation Institute, Edison, NJ, USA
| | - Jean Lengenfelder
- Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Kathleen Bell
- Department of Physical Medicine and Rehabilitation, North Texas TBI Model System, UT Southwestern Medical Center, Dallas, TX, USA
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Hendryckx C, Nalder E, Drake E, Leclaire É, Pituch E, Gouin-Vallerand C, Wang RH, Poulin V, Paquet V, Bottari C. Managing challenging behaviours in adults with traumatic brain injury: A scoping review of technology-based interventions. J Rehabil Assist Technol Eng 2023; 10:20556683231191975. [PMID: 37614442 PMCID: PMC10443634 DOI: 10.1177/20556683231191975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Abstract
Challenging behaviours are one of the most serious sequelae after a traumatic brain injury (TBI). These chronic behaviours must be managed to reduce the associated burden for caregivers, and people with TBI. Though technology-based interventions have shown potential for managing challenging behaviours, no review has synthesised evidence of technology aided behaviour management in the TBI population. The objective of this scoping review was to explore what technology-based interventions are being used to manage challenging behaviours in people with TBI. Two independent reviewers analysed 3505 studies conducted between 2000 and 2023. Studies were selected from five databases using search strategies developed in collaboration with a university librarian. Sixteen studies were selected. Most studies used biofeedback and mobile applications, primarily targeting emotional dysregulation. These technologies were tested in a variety of settings. Two interventions involved both people with TBI and their family caregivers. This review found that technology-based interventions have the potential to support behavioural management, though research and technology development is at an early stage. Future research is needed to further develop technology-based interventions that target diverse challenging behaviours, and to document their effectiveness and acceptability for use by people with TBI and their families.
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Affiliation(s)
- Charlotte Hendryckx
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut Universitaire sur la Réadaptation en déficience Physique de Montréal, CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montreal, QC, Canada
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Research Center from CIUSSS du Nord-de-l’Île-de-Montréal, Montreal, QC, Canada
- Department Of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Emily Nalder
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Emma Drake
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Éliane Leclaire
- Department Of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Evelina Pituch
- Department of Health and Society, University of Toronto Scarborough, Toronto, ON, Canada
| | - Charles Gouin-Vallerand
- Centre de Recherche Createch sur les Organisations Intelligentes, Université de Sherbrooke, Sherbrooke, QC, Canada
- DOMUS Laboratory, Université de Sherbrooke, Sherbrooke, QC, Canada
- University of Sherbrooke, Sherbrooke, QC, Canada
| | - Rosalie H Wang
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Valérie Poulin
- Department Of Occupational therapy, Université du Québec à Trois-Rivières, Trois-Rivieres, QC, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), CIUSSS de la Capitale-Nationale, QC, Canada
| | - Virginie Paquet
- Bibliothèque Marguerite-D’Youville, Université de Montréal, Montréal, QC, Canada
| | - Carolina Bottari
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut Universitaire sur la Réadaptation en déficience Physique de Montréal, CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montreal, QC, Canada
- Occupational Therapy Program, School of Rehabilitation, Université de Montréal, Montréal, QC, Canada
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Klyce DW, Merced K, Erickson A, Neumann DM, Hammond FM, Sander AM, Bogner JA, Bushnik T, Chung JS, Finn JA. Perceived care partner burden at 1-year post-injury and associations with emotional awareness, functioning, and empathy after TBI: A TBI model systems study. NeuroRehabilitation 2023; 52:59-69. [PMID: 36617759 PMCID: PMC10325691 DOI: 10.3233/nre-220128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND People with traumatic brain injury (TBI) can lack awareness of their own emotions and often have problems with emotion dysregulation, affective disorders, and empathy deficits. These impairments are known to impact psychosocial behaviors and may contribute to the burden experienced by care partners of individuals with TBI. OBJECTIVE To examine the associations of emotional awareness, emotional functioning, and empathy among participants with TBI with care partner burden. METHOD This multisite, cross-sectional, observational study used data from 90 dyads (participants with TBI and their care partner) 1-year post-injury. Participants with TBI completed the Difficulty with Emotional Regulation Scale (DERS; Awareness, Clarity, Goals, Impulse, Nonacceptance, and Strategies subscales); PTSD Checklist-Civilian Version; NIH Toolbox Anger-Affect, Hostility and Aggression Subdomains; PHQ-9; GAD-7; and the Interpersonal Reactivity Index (empathic concern and perspective taking subscales). Care partners completed the Zarit Burden Inventory (ZBI) and provided demographic information. RESULTS Care partners were predominately female (77%), and most were either a spouse/partner (55.2%) or parent (34.4%). In an unadjusted model that included assessments of emotional awareness, emotional functioning, and empathy of the participant with TBI, the DERS-Awareness and NIH-Hostility subscales accounted for a significant amount of variance associated with care partner burden. These findings persisted after adjusting for care partner age, relationship, education, and the functional status of the participant with TBI (β= 0.493 and β= 0.328, respectively). CONCLUSION These findings suggest that high levels of hostility and low emotional self-awareness can significantly affect the burden felt by TBI care partners.
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Affiliation(s)
- Daniel W. Klyce
- Central Virginia VA Health Care System, Richmond, VA, USA
- Virginia Commonwealth University Health System, Richmond, VA, USA
- Sheltering Arms Institute, Richmond, VA, USA
| | | | - Alexander Erickson
- Central Virginia VA Health Care System, Richmond, VA, USA
- Palo Alto University, Palo Alto, CA, USA
| | - Dawn M. Neumann
- Indiana University School of Medicine, Indianapolis, IN, USA
- Rehabilitation Hospital of Indiana, Indianapolis, IN, USA
| | - Flora M. Hammond
- Indiana University School of Medicine, Indianapolis, IN, USA
- Rehabilitation Hospital of Indiana, Indianapolis, IN, USA
| | - Angelle M. Sander
- Baylor College of Medicine, Houston, TX, USA
- TIRR Memorial Hermann, Houston, TX, USA
| | | | - Tamara Bushnik
- New York University Langone Health, New York, NY, USA
- Rusk Rehabilitation Center, New York, NY, USA
| | | | - Jacob A. Finn
- Minneapolis VA Health Care System, Minneapolis, MN, USA
- University of Minnesota, Minneapolis, MN, USA
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10
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Brown J, Kaelin D, Mattingly E, Mello C, Miller ES, Mitchell G, Picon LM, Waldron-Perine B, Wolf TJ, Frymark T, Bowen R. American Speech-Language-Hearing Association Clinical Practice Guideline: Cognitive Rehabilitation for the Management of Cognitive Dysfunction Associated With Acquired Brain Injury. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:2455-2526. [PMID: 36373898 DOI: 10.1044/2022_ajslp-21-00361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Cognitive-communication impairments following acquired brain injury (ABI) can have devastating effects on a person's ability to participate in community, social, vocational, and academic preinjury roles and responsibilities. Guidelines for evidence-based practices are needed to assist speech-language pathologists (SLPs) and other rehabilitation specialists in the delivery of cognitive rehabilitation for the adult population. PURPOSE The American Speech-Language-Hearing Association, in conjunction with a multidisciplinary panel of subject matter experts, developed this guideline to identify best practice recommendations for the delivery of cognitive rehabilitation to adults with cognitive dysfunction associated with ABI. METHOD A multidisciplinary panel identified 19 critical questions to be addressed in the guideline. Literature published between 1980 and 2020 was identified based on a set of a priori inclusion/exclusion criteria, and main findings were pooled and organized into summary of findings tables. Following the principles of the Grading of Recommendations Assessment, Development and Evaluation Evidence to Decision Framework, the panel drafted recommendations, when appropriate, based on the findings, overall quality of the evidence, balance of benefits and harms, patient preferences, resource implications, and the feasibility and acceptability of cognitive rehabilitation. RECOMMENDATIONS This guideline includes one overarching evidence-based recommendation that addresses the management of cognitive dysfunction following ABI and 11 subsequent recommendations focusing on cognitive rehabilitation treatment approaches, methods, and manner of delivery. In addition, this guideline includes an overarching consensus-based recommendation and seven additional consensus recommendations highlighting the role of the SLP in the screening, assessment, and treatment of adults with cognitive dysfunction associated with ABI. Future research considerations are also discussed.
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Affiliation(s)
| | | | | | | | - E Sam Miller
- Maryland State Department of Education, Baltimore
| | | | | | | | | | - Tobi Frymark
- American Speech-Language-Hearing Association, Rockville, MD
| | - Rebecca Bowen
- American Speech-Language-Hearing Association, Rockville, MD
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11
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Inci FH, Bakan G. Validity, internal consistency, and responsiveness of the Turkish version of The Family Needs Questionnaire-Revised. Brain Inj 2022; 36:100-109. [PMID: 35129414 DOI: 10.1080/02699052.2022.2034951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE The aim of this study is to conduct validity (language, content and confirmatory factor), internal consistency and responsiveness properties for Turkish version of the Family Needs Questionnaire-Revised (FNQ-R). METHODS It was carried out with 185 family members who met study inclusion criteria and provided care for the patients with TBI. Sociodemographic characteristics form and the FNQ-R were used as data collection tools. Validity was assessed by language validity, content validity and confirmatory factor analysis. Internal consistency and item-total correlation were used for reliability analysis. Responsiveness analyses were evaluated with infit and outfit statistics, person-item maps and point biserial correlation. RESULTS The language validity of FNQ-R was provided by translation-back translation. The content validity index values were above 0.80. Fit indices were at an acceptable level in confirmatory factor analysis. Cronbach alpha of subscales was found to be between 0.69 and 0.85 and Spearman-Brown split-half reliability was between 0.68 and 0.85. A positive and significant relationship was found between the subscales. The item fit statistics were at the acceptable level. CONCLUSION It has been determined that the FNQ-R is a valid and reliable measurement tool to identify the needs of the family members who provide care to patient with traumatic brain injury and can be used for Turkish population.
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Affiliation(s)
- Fadime Hatice Inci
- Public Health Nursing Department, Pamukkale University Faculty of Health Sciences, Denizli, Turkey
| | - Gülcan Bakan
- Internal Medicine Nursing Department, Pamukkale University Faculty of Health Sciences, Denizli, Turkey
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12
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Ahn S, Logan JG. Perceived role overload and physical symptom experience among caregivers of older adults: The moderating effect of social support. Geriatr Nurs 2021; 43:197-205. [PMID: 34922280 DOI: 10.1016/j.gerinurse.2021.11.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/25/2021] [Accepted: 11/26/2021] [Indexed: 11/04/2022]
Abstract
We investigated the association between perceived role overload and physical symptom experience, and the potential moderating effect of social support among caregivers of older adults. We analyzed data of 1,471 caregivers obtained from the 2017 National Study of Caregiving. In the survey, participants were assessed for physical symptoms (pain, limited leg strength, and low energy), symptom-related activity limitations, perceived role overload, and informal/formal support sources. We performed multiple logistic regression analyses with interaction terms. Caregivers who perceived higher role overload were more likely to experience the physical symptoms and frequent limited activities due to the symptoms. The associations of perceived role overload with pain and low energy, respectively, were attenuated among caregivers with high informal support. The moderating effect of formal support appeared to be the opposite in relation to pain. Caregivers who perceived high burden may benefit from their informal support to prevent detrimental effects of caregiving on physical health.
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Affiliation(s)
- Soojung Ahn
- Doctoral Student, School of Nursing, University of Virginia, Charlottesville, VA, USA.
| | - Jeongok G Logan
- Associate Professor, School of Nursing, University of Virginia, Charlottesville, VA, USA
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13
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Carlozzi NE, Choi SW, Wu Z, Miner JA, Lyden AK, Graves C, Wang J, Sen S. An App-Based Just-in-Time Adaptive Self-management Intervention for Care Partners (CareQOL): Protocol for a Pilot Trial. JMIR Res Protoc 2021; 10:e32842. [PMID: 34889775 PMCID: PMC8704108 DOI: 10.2196/32842] [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: 08/11/2021] [Revised: 10/07/2021] [Accepted: 10/07/2021] [Indexed: 12/02/2022] Open
Abstract
Background Care partners (ie, informal family caregivers) of individuals with health problems face considerable physical and emotional stress, often with a substantial negative impact on the health-related quality of life (HRQOL) of both care partners and care recipients. Given that these individuals are often overwhelmed by their caregiving responsibilities, low-burden self-management interventions are needed to support care partners to ensure better patient outcomes.
Objective The primary objective of this study is to describe an intensive data collection protocol that involves the delivery of a personalized just-in-time adaptive intervention that incorporates passive mobile sensor data feedback (sleep and activity data from a Fitbit [Fitbit LLC]) and real time self-reporting of HRQOL via a study-specific app called CareQOL (University of Michigan) to provide personalized feedback via app alerts.
Methods Participants from 3 diverse care partner groups will be enrolled (care partners of persons with spinal cord injury, care partners of persons with Huntington disease, and care partners of persons with hematopoietic cell transplantation). Participants will be randomized to either a control group, where they will wear the Fitbit and provide daily reports of HRQOL over a 3-month (ie, 90 days) period (without personalized feedback), or the just-in-time adaptive intervention group, where they will wear the Fitbit, provide daily reports of HRQOL, and receive personalized push notifications for 3 months. At the end of the study, participants will complete a feasibility and acceptability questionnaire, and metrics regarding adherence and attrition will be calculated.
Results This trial opened for recruitment in November 2020. Data collection was completed in June 2021, and the primary results are expected to be published in 2022.
Conclusions This trial will determine the feasibility and acceptability of an intensive app-based intervention in 3 distinct care partner groups: care partners for persons with a chronic condition that was caused by a traumatic event (ie, spinal cord injury); care partners for persons with a progressive, fatal neurodegenerative disease (ie, Huntington disease); and care partners for persons with episodic cancer conditions that require intense, prolonged inpatient and outpatient treatment (persons with hematopoietic cell transplantation).
Trial Registration ClinicalTrials.gov NCT04556591; https://clinicaltrials.gov/ct2/show/NCT04556591
International Registered Report Identifier (IRRID) DERR1-10.2196/32842
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Affiliation(s)
- Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
| | - Sung Won Choi
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
| | - Zhenke Wu
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Jennifer A Miner
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
| | - Angela K Lyden
- Clinical Trials Support Office, University of Michigan, Ann Arbor, MI, United States
| | - Christopher Graves
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
| | - Jitao Wang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Srijan Sen
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
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14
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Jones M, Holley C, Jacobs M, Batchelor R, Mangin A. Effects of Peer Mentoring for Caregivers of Patients With Acquired Brain Injury: A Preliminary Investigation of Efficacy. Arch Rehabil Res Clin Transl 2021; 3:100149. [PMID: 34589699 PMCID: PMC8463468 DOI: 10.1016/j.arrct.2021.100149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objective To evaluate effectiveness of a peer mentor intervention for caregivers of patients with acquired brain injury (ABI) in encouraging caregiver participation in support services to prepare them for the role of caregiving and in reducing caregiver stress and depression. Design Controlled trial with participants randomized to either usual care or 1-to-1 visits with a family caregiver peer mentor during the ABI inpatient rehabilitation stay. Setting Nonprofit rehabilitation hospital specializing in care of persons with brain and spinal cord injury. Participants Caregivers (N=36) of patients with ABI admitted for rehabilitation whose discharge location was home with care provided by family members (caregivers: 93% female; 58% White; mean age, 48±10.4y). Interventions One-to-one peer mentoring visits during the inpatient stay with a trained peer mentor who is also a family caregiver of a survivor of brain injury. Main Outcome Measures Frequency of participation in support services for family caregivers, reported caregiver stress, and reported caregiver depressive symptoms. Results There was no difference between groups in participation in support services for family caregivers. Participants in the peer mentor intervention group reported significantly greater improvement in caregiver stress at discharge and 30 days post discharge than participants in the usual care group. Reported depressive symptoms were also lower for the intervention group, but change scores did not achieve statistical significance at discharge or 30-day follow-up. Conclusions Peer mentoring appears to improve caregivers' ability to handle the stress of caregiving and reduces reported depressive symptoms. There was no between-group difference noted in participation in support services for families; however, participation was adversely affected by restrictions imposed during the coronavirus disease 2019 pandemic, which may have masked any effect.
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Affiliation(s)
- Michael Jones
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA
| | - Claire Holley
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA
| | - Mariellen Jacobs
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA
| | - Ruth Batchelor
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA
| | - Ashley Mangin
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA
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15
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Simpson GK, Anderson MI, Daher M, Jones KF, Morey P. Testing a Model of Resilience in Family Members of Relatives with Traumatic Brain Injury vs Spinal Cord Injury: Multigroup Analysis. Arch Phys Med Rehabil 2021; 102:2325-2334. [PMID: 34358498 DOI: 10.1016/j.apmr.2021.06.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/17/2021] [Accepted: 06/23/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To test a model comprising explanatory (neurologic impairment, coping, personality) and mediating (resilience, self-efficacy, hope, social support) variables on psychological adjustment and burden among family caregivers of individuals with traumatic brain injury (TBI) vs spinal cord injury (SCI). DESIGN Structural equation modeling with multigroup analysis. SETTING Six rehabilitation centers across New South Wales and Queensland, Australia. PARTICIPANTS A total of 181 family members (N=181; 131 TBI, 50 SCI). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Connor-Davidson Resilience Scale, Eysenck Personality Questionnaire, Ways of Coping Questionnaire, General Self-Efficacy Scale, Herth Hope Scale, Medical Outcome Study Social Support Survey; and 4 measures of psychological adjustment including: Caregiver Burden Scale, Medical Outcomes Survey Short Form-36 (SF-36), General Health Questionnaire-28, and Positive and Negative Affect Scale. RESULTS The model for the aggregated sample demonstrated a very good model fit (χ2=47.42, df=39, ρ=0.167, normed fit index=.962, incremental fit index=.993, Tucker-Lewis index=.985, comparative fit index=.993, root-mean-squared error of approximation=.035). Multi-group analysis found significant commonalities in the pattern of relationships among variables across the 2 groups. In the only differences found, neuroticism was significantly more influential on burden in family members supporting individuals with TBI than family members of individuals with SCI. Furthermore, problem-focused coping was statistically more influential on positive affect in family members of individuals with TBI when compared with family members of individuals with SCI. CONCLUSIONS The study found significant similarities in the patterns of resilience and psychological adjustment among family caregivers of individuals with TBI and SCI.
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Affiliation(s)
- Grahame K Simpson
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Liverpool, Sydney; Liverpool Brain Injury Rehabilitation Unit, Liverpool Hospital, Sydney.
| | | | - Maysaa Daher
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Liverpool, Sydney; Brain Injury Rehabilitation Directorate, Agency for Clinical Innovation, NSW Health, Sydney
| | - Kate F Jones
- Institute for Ethics and Society, The University of Notre Dame, Sydney, Australia
| | - Peter Morey
- School of Nursing and Health, Avondale University, Sydney
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16
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Sander AM, Boileau NR, Hanks RA, Tulsky DS, Carlozzi NE. Emotional Suppression and Hypervigilance in Military Caregivers: Relationship to Negative and Positive Affect. J Head Trauma Rehabil 2021; 35:E10-E20. [PMID: 31365438 PMCID: PMC7643713 DOI: 10.1097/htr.0000000000000507] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the relationship of 2 health-related quality-of-life (QOL) item banks (Emotional Suppression and Caregiver Vigilance), developed for caregivers of service members/veterans with traumatic brain injury (TBI), to caregivers' positive and negative affect. SETTING Community. PARTICIPANTS One hundred sixty-five caregivers of service members/veterans with TBI. DESIGN Retrospective database analysis. MAIN MEASURES TBI-CareQOL Emotional Suppression; TBI-CareQOL Caregiver Vigilance; measures of negative (Patient-Reported Outcomes Measurement Information System [PROMIS] Depression, PROMIS Anger, TBI-CareQOL Caregiver-Specific Anxiety, National Institutes of Health Toolbox [NIHTB] Perceived Stress, GAD-7) and positive affect (Neuro-QOL Positive Affect and Well-being, NIHTB Self-efficacy, NIHTB General Life Satisfaction, Family Resilience Scale for Veterans, TBI-QOL Resilience). RESULTS When considered separately, linear regression showed that higher levels of Emotional Suppression and greater Caregiver Vigilance were individually associated with more negative affect and less positive affect. When considered together, the pattern of findings was generally consistent for both Emotional Suppression and Caregiver Vigilance with regard to negative affect and for Emotional Suppression with regard to positive affect. However, when considered together, Caregiver Vigilance was no longer related to positive affect. CONCLUSIONS Caregivers with high emotional suppression and/or vigilance are more likely to show emotional distress and less likely to have positive affect than caregivers with lower levels of emotional suppression and vigilance. A combination of education and individual counseling targeting coping with negative emotions and TBI-related problems may be beneficial.
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Affiliation(s)
- Angelle M Sander
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine/Harris Health System and Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas (Dr Sander); Department of Physical Medicine and Rehabilitation, University of Michigan (Mr Boileau and Dr Carlozzi); Department of Physical Medicine and Rehabilitation, School of Medicine, Wayne State University, Detroit, Michigan (Dr Hanks); and Center for Health Assessment Research and Translation, and Departments of Physical Therapy and Psychological and Brain Sciences, University of Delaware, Newark (Dr Tulsky)
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17
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Souesme G, Voyer M, Gagnon É, Terreau P, Fournier-St-Amand G, Lacroix N, Gravel K, Vaillant MC, Gagné MÈ, Ouellet MC. Barriers and facilitators linked to discharge destination following inpatient rehabilitation after traumatic brain injury in older adults: a qualitative study. Disabil Rehabil 2021; 44:4738-4749. [PMID: 34126821 DOI: 10.1080/09638288.2021.1919212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To identify facilitators and barriers associated with returning home for older adults having received inpatient rehabilitation after traumatic brain injury (TBI). METHODS A qualitative design was used. Five older patients with TBI and four family caregivers were interviewed and six healthcare professionals participated in a focus group. RESULTS Main facilitators to returning home highlighted by all participants were: (1) Patient's adequate health condition and functional status, (2) Access to health and other services at home, (3) Availability of help from a family caregiver. Conversely, if one of these factors was not met, it represented a barrier. Other facilitators identified were (4) Attachment to one's home, (5) Feeling of commitment toward a loved one, (6) Having the possibility of going through a transitional phase, (7) United front between the patient and the family caregiver towards a return home. Additional barriers to returning home included: (8) Incongruent perspectives, and (9) Unclear knowledge about available health and other services at home. CONCLUSION The results of this study could be translated into a practical tool to guide patients, families and professionals in the decision about returning home or exploring an alternative option after inpatient rehabilitation for TBI in older adults.IMPLICATIONS FOR REHABILITATIONWhen orienting an older patient home or to an alternative living environment after a traumatic brain injury (TBI), the perspective of rehabilitation professionals can differ from that of patients and caregivers.Professionals tend to emphasize security, whereas patients and caregivers' focus on the well-being associated with home and on the importance of being with their loved one.Integrating the views, values and wishes of older patients with TBI and their caregivers will support a shared decision-making approach for orientation after rehabilitation.
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Affiliation(s)
- Guillaume Souesme
- Interdisciplinary Centre for Research in Rehabilitation and Social Integration, Québec, Canada.,School of Psychology, Laval University, Québec, Canada
| | - Manon Voyer
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale- Site, Institut de réadaptation en déficience physique de Québec, Canada
| | - Éric Gagnon
- Centre de Recherche sur les Soins et les Services de Première Ligne, Québec, Canada.,Sociology Department, Laval University, Québec, Canada
| | - Paule Terreau
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale- Site, Institut de réadaptation en déficience physique de Québec, Canada
| | - Geneviève Fournier-St-Amand
- Interdisciplinary Centre for Research in Rehabilitation and Social Integration, Québec, Canada.,School of Psychology, Laval University, Québec, Canada
| | - Nadine Lacroix
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale- Site, Institut de réadaptation en déficience physique de Québec, Canada
| | - Kristina Gravel
- Interdisciplinary Centre for Research in Rehabilitation and Social Integration, Québec, Canada.,School of Psychology, Laval University, Québec, Canada
| | - Marie-Claude Vaillant
- Interdisciplinary Centre for Research in Rehabilitation and Social Integration, Québec, Canada.,School of Psychology, Laval University, Québec, Canada
| | - Marie-Ève Gagné
- Interdisciplinary Centre for Research in Rehabilitation and Social Integration, Québec, Canada.,School of Psychology, Laval University, Québec, Canada
| | - Marie-Christine Ouellet
- Interdisciplinary Centre for Research in Rehabilitation and Social Integration, Québec, Canada.,School of Psychology, Laval University, Québec, Canada
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18
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Tsur N, Haller CS. Self-Rated Health Among Patients With Severe Traumatic Brain Injury and Their Close Relatives: The Role of Posttraumatic Stress Symptoms. Psychosom Med 2021; 83:449-456. [PMID: 33883538 DOI: 10.1097/psy.0000000000000946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Severe traumatic brain injury (sTBI) is accompanied by significant declines in self-rated health (SRH). Although such deteriorations in SRH are related to various consequences of sTBI, the effect of posttraumatic reactions (i.e., posttraumatic stress [PTS] symptoms) has been tested insufficiently to date, especially among civilians. The present investigation is based on Trajectories of Recovery After Severe Traumatic brain injury-Matters In families (TRAST-MI), a unique study among civilians with sTBI and their families. Previous research revealed that civilian sTBI has effects beyond the injured patient, influencing their close relatives as well. The aim of this study was to assess the association between PTS symptoms and SRH among patients with civilian sTBI and their close relatives. METHODS Patients with sTBI (assessed by an Abbreviated Injury Scale of the head region score >3) and their close relatives participated in TRAST-MI. One hundred twenty-six patient-relative dyads were assessed at 3, 6, and 12 months after the injury. RESULTS Multilevel modeling revealed that patients' PTS symptoms were associated with consequent SRH (slope = 0.42; p < .001), and relatives' PTS symptoms were associated with their respective SRH (slope = 0.2; p = .012). CONCLUSIONS The findings of this study reveal that SRH of both patients with sTBI and their relatives are negatively affected by their own PTS symptoms. These findings underline the understanding that sTBI is not merely a medical trauma but rather a comprehensive psychosocial trauma, which has consequences for the whole family system.
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Affiliation(s)
- Noga Tsur
- From the Bob Shapell School of Social Work (Tsur), Tel Aviv University, Tel Aviv, Israel; Department of Psychology (Haller), Harvard University, Cambridge; Division of Public Psychiatry, Massachusetts Mental Health Center (Haller), Harvard Medical School, Boston; and Cognicreate LLC (Haller), Cambridge, Massachusetts
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19
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Kanmani TR, Raju B, Konar S, Shukla D, Kukkehalli R. Tailor-Made Psychosocial Intervention for the Caregivers in Emergency and Trauma Care Center. J Neurosci Rural Pract 2021; 12:290-294. [PMID: 33927519 PMCID: PMC8064851 DOI: 10.1055/s-0041-1722815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction The caregiver's psychosocial problems are unnoticed in the emergency and trauma care center. Therefore, the study objective was to understand the impact of psychoeducation and psychosocial intervention on traumatic brain injury (TBI) caregivers during hospitalization. Methodology The study adopted a descriptive research design. Sixty-three ( n = 63) consented caregivers were recruited by using a cross-sectional survey method. Two separate checklists were used to collect the psychosocial problems in emergency and trauma care as well as to know the satisfaction levels of caregivers after the intervention. R free 3.0.1 software was used to calculate the frequency and percentage. Results The caregiver's mean age was 39 years (39.46 ± 16.22). The majority of the caregivers were males (45; 71.4%) working as daily wagers (42; 66.7%). Caregivers experienced psychosocial problems, that is, depression, anxiety, stress, unable to handle crisis, grief, lack of coping skills (57; 90.5%), emotional distress (57; 90.5%), financial constraints (45; 71.1%), and need for referral services (45; 71.1%). Tailor-made psychosocial interventions were provided to the caregivers. Conclusion To conclude, there is a greater need to provide psychosocial intervention and train the caregivers to provide care for TBI survivors during hospitalization. There is a need to develop the uniform standard operating procedure for medical and psychiatric social workers in providing psychosocial care in emergency and trauma care setting.
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Affiliation(s)
- T R Kanmani
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Birudu Raju
- Department of Social Work, Kristu Jayanti College, Bengaluru, Karnataka, India
| | - Subhas Konar
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Dhaval Shukla
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Raghavendra Kukkehalli
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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20
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Park SS. Caregivers' Mental Health and Somatic Symptoms During COVID-19. J Gerontol B Psychol Sci Soc Sci 2021; 76:e235-e240. [PMID: 32738144 PMCID: PMC7454918 DOI: 10.1093/geronb/gbaa121] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES This study examines differences in the mental and physical health of the U.S. population during the early stages of the COVID-19 pandemic among 3 groups: noncaregivers, short-term caregivers (1 year or less), and long-term caregivers (greater than 1 year). METHODS Data from the Understanding America Study are used to describe group differences in reports of psychological distress and somatic symptoms. Logistic and negative binomial regression models are used to examine whether these differences persist after adjusting for demographic, socioeconomic, and prepandemic health conditions. To understand within-group differences in caregiving demands, the intensity of care provided by short-term and long-term caregivers, as well as selected patients' health conditions are summarized. RESULTS Adults' mental and physical health varied substantially by caregiver status. Caregivers continued to fare worse than noncaregivers in terms of mental health and fatigue, and long-term caregivers were more likely to report headache, body aches, and abdominal discomfort than both short-term caregivers and noncaregivers, net of controls. The nature of caregiving differed between short-term and long-term caregivers, with the latter more likely to provide greater hours of care, and to be looking after patients with permanent medical conditions. DISCUSSION Efforts to understand and mitigate the impact of the pandemic on population health should include caregivers, whose mental and physical health were already vulnerable before COVID-19.
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Affiliation(s)
- Sung S Park
- Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts
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21
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Knowlton AR, Nguyen TQ, Isenberg S, Tseng TY, Catanzarite Z, Mitchell MM, Cruz-Oliver D. Quality of Life Among Caregivers of a Vulnerable Population Living with HIV: Caregiving and Relationship Factors. AIDS Behav 2021; 25:360-376. [PMID: 32715410 PMCID: PMC10696639 DOI: 10.1007/s10461-020-02975-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Literature on health-related quality of life (HRQOL) has focused on people living with chronic conditions, with less attention given to HRQOL among informal caregivers. We used cross-sectional dyadic data from both care recipients (CR) living with HIV and the person they identified as their primary informal (unpaid) caregiver (CG) to identify psychosocial and caregiving relationship factors (including, CG role ambivalence and caregiving-related stress) associated with CG HRQOL. We conducted confirmatory factor analysis and structural equation modeling testing. The results highlight interdependent effects of the CG-CR relationship and reveal pathways whereby relationship interactions positively and negatively impact CGs' HRQOL. Affiliative stigma, CG-CR communication, CRs' reciprocity of support and other psychosocial factors indirectly and differentially affected physical and mental HRQOL through effects on secondary stress and role ambivalence. Dyad-focused intervention on interpersonal communication and support exchange may improve HRQOL and resilience of CGs of vulnerable people living with HIV.
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Affiliation(s)
- Amy R Knowlton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Trang Q Nguyen
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sarina Isenberg
- Temmy Latner Centre for Palliative Care, Sinai Health System, Department of Family and Community Medicine, University of Toronto, Toronto, USA
| | - Tuo-Yen Tseng
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Zachary Catanzarite
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mary M Mitchell
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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22
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Ohayagha C, Perrin PB, Cariello AN, Arango-Lasprilla JC. Is Helping Really Helping? Health-Related Quality of Life after TBI Predicting Caregiver Depression Symptom Trajectories in Latin America. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031247. [PMID: 33573228 PMCID: PMC7908361 DOI: 10.3390/ijerph18031247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 12/23/2022]
Abstract
Previous research connecting health-related quality of life (HRQoL) in people with traumatic brain injury (TBI) and caregiver mental health has primarily been conducted cross-sectionally in the U.S. and Western Europe. This study, therefore, examined how HRQoL in individuals immediately after their TBI predicts longitudinal caregiver depression symptom trajectories in Latin America. A sample of 109 patients with an acute TBI and 109 caregivers (total n = 218) was recruited from three hospitals in Mexico City, Mexico, and in Cali and Neiva, Colombia. TBI patients reported their HRQoL while they were still in hospital, and caregivers reported their depression symptoms at the same time and at 2 and 4 months later. Hierarchal linear models (HLM) found that caregiver depression symptom scores decreased over time, and lower patient mental health and pain-related quality of life at baseline (higher pain) predicted higher overall caregiver depression symptom trajectories across the three time points. These findings suggest that in Latin America, there is an identifiable relationship between psychological and pain-related symptoms after TBI and caregiver depression symptom outcomes. The results highlight the importance of early detection of caregiver mental health needs based in part upon patient HRQoL and a culturally informed approach to rehabilitation services for Latin American TBI caregivers.
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Affiliation(s)
- Chimdindu Ohayagha
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA; (C.O.); (P.B.P.); (A.N.C.)
| | - Paul B. Perrin
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA; (C.O.); (P.B.P.); (A.N.C.)
| | - Annahir N. Cariello
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA; (C.O.); (P.B.P.); (A.N.C.)
| | - Juan Carlos Arango-Lasprilla
- BioCruces Bizkaia Health Research Institute, 40903 Barakaldo, Spain
- IKERBASQUE, Basque Foundation for Science, 48009 Bilbao, Spain
- Department of Cell Biology and Histology, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain
- Correspondence:
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Sutter-Leve R, Passint E, Ness D, Rindflesch A. The Caregiver Experience After Stroke in a COVID-19 Environment: A Qualitative Study in Inpatient Rehabilitation. J Neurol Phys Ther 2021; 45:14-20. [PMID: 33086240 PMCID: PMC7737698 DOI: 10.1097/npt.0000000000000336] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Stroke is the leading cause of disability in the United States. Two-thirds of stroke survivors will require caregiver assistance. Evidence suggests the mental health of caregivers is closely related to patients' health outcomes. The timing of this study intersected with the beginning of the coronavirus disease-2019 (COVID-19) pandemic that required strict social distancing and hospital visitor policy changes. This study aims to answer the primary research question: What is the level and nature of stress experienced by caregivers of persons with newly-acquired stroke in the inpatient rehabilitation setting and how has the COVID-19 pandemic impacted the caregiver experience? METHODS Recruitment occurred from a single inpatient rehabilitation facility. Participants were administered the Perceived Stress Scale and then completed qualitative semistructured interviews. The investigators used a phenomenological, iterative approach to collect and analyze qualitative data. The data were independently coded and categorized before consolidated into primary themes and subthemes. RESULTS Eleven informal caregivers' perspectives generated 13 subthemes across 4 primary thematic categories: COVID-19 impact, concerns of the caregiver, coping strategies, and important aspects of the caregiver experience. COVID-19 social distancing necessitated new visitor policies, which presented additional challenges for caregivers. DISCUSSION AND CONCLUSIONS Caregiver attendance at therapy sessions and frequent, direct communication between staff and caregivers improved caregiver readiness for family member discharge following inpatient rehabilitation. This study shared perspectives from a distinctive time during the COVID-19 pandemic. If visitation for multiple therapy sessions is prohibited, we recommend taking alternative measures to keep the caregiver involved in the plan of care.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A326).
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Bivona U, Villalobos D, De Luca M, Zilli F, Ferri G, Lucatello S, Iannetti M, Cellupica L, Mungiello F, Lo Sterzo P, Marchegiani V, Puccitti A, Lombardi G, Moretti G, Donvito T, Penza F, Formisano R. Psychological status and role of caregivers in the neuro-rehabilitation of patients with severe Acquired Brain Injury (ABI). Brain Inj 2020; 34:1714-1722. [PMID: 33190555 DOI: 10.1080/02699052.2020.1812002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate the relationships between (a) the psychological status of the caregiver, (b) the specific features of caregiving as perceived by the cognitive therapist in neuro-rehabilitation, (c) the caregivers' subjective approach to neuro-rehabilitation, and (d) the functional outcome of the patient. METHODS Twenty-four patients with severe acquired brain injury and their 24 caregivers participated in this observational study. Caregivers underwent a psychological assessment examining emotional distress, burden and family strain; their subjective approach to neuro-rehabilitation has been evaluated by two specific answers. The patients' cognitive therapists responded to an ad-hoc questionnaire, namely the "Caregiving Impact on Neuro-Rehabilitation Scale" (CINRS), evaluating the features (i.e., amount and quality) of caregiving. Finally, the functional outcome of the patient was assessed through standardized scales of disability and cognitive functioning. RESULTS The caregivers' psychological well-being was associated to the features of caregiving, to the subjective approach to neuro-rehabilitation, and to the functional recovery of their loved ones. A better caregivers' approach to neuro-rehabilitation was also associated to an overall positive impact of caregiving in neuro-rehabilitation and to a better functional outcome of the patients. CONCLUSIONS We posited a virtuous circle involving caregivers within the neuro-rehabilitation process, according to which the caregivers' psychological well-being could be strictly associated to a better level of caregiving and to a better functional outcome of the patients that, in turn, could positively influence the caregivers' psychological well-being. Although preliminary, these results suggest a specific psycho-educational intervention, aimed at improving the caregivers' psychological well-being and at facilitating their caring of the loved one.
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Affiliation(s)
- U Bivona
- Post-Coma Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - D Villalobos
- Laboratory of Cognitive and Computational Neuroscience. Center for Biomedical Technology (Technical University of Madrid and Complutense University of Madrid), Madrid, Spain
| | - M De Luca
- Neuropsychology Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - F Zilli
- Post-Coma Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - G Ferri
- Post-Coma Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - S Lucatello
- Post-Coma Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - M Iannetti
- Post-Coma Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - L Cellupica
- Post-Coma Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - F Mungiello
- Post-Coma Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - P Lo Sterzo
- Post-Coma Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - V Marchegiani
- Post-Coma Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - A Puccitti
- Post-Coma Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - G Lombardi
- Post-Coma Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - G Moretti
- Post-Coma Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - T Donvito
- Post-Coma Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - F Penza
- Post-Coma Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - R Formisano
- Post-Coma Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
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25
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Hanks RA, Boileau NR, Norman AL, Nakase-Richardson R, Mariouw KH, Carlozzi NE. Spirituality and outcomes in caregivers of persons with traumatic brain injury (TBI). Rehabil Psychol 2020; 65:347-359. [PMID: 31916806 PMCID: PMC7643714 DOI: 10.1037/rep0000304] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE/OBJECTIVE Spiritual well-being has been associated with better quality of life outcomes in caregivers, but the associations among the care recipient's functional status, the caregiver's spiritual well-being, and the caregiver's health-related quality of life (HRQOL) is unknown. Research Method/Design: The study examined the Spiritual Well-Being Scale in caregivers of persons with traumatic brain injury (TBI; n = 335). Participants completed measures from the Patient-Reported Outcomes Measurement Information System, the Quality of Life in Caregivers of TBI, and the Caregiver Appraisal Scale. The Mayo-Portland Adaptability Inventory-4 (MPAI-4) measured care recipient's functional status. The association between religious well-being and existential well-being and HRQOL were examined with Pearson correlation coefficients. Multiple linear regressions examined the interaction between caregiver well-being and care recipient functional status on HRQOL outcomes accounting for demographic variables. RESULTS Less favorable caregiver HRQOL was associated with military affiliation, male status, spousal caregiver relationship, and White race. MPAI-4 was moderately associated with all HRQOL subdomains. For spiritual well-being, existential well-being was moderately correlated with 9 of 16 HRQOL subdomains in comparison to religious well-being that demonstrated small correlations with 3 of 16 subdomains. MPAI-4 had negative effects on HRQOL regardless of spiritual well-being with higher existential well-being reducing the negative impact of the care recipient's functional impairment on HRQOL for significant HRQOL interactions. CONCLUSIONS/IMPLICATIONS Interventions that encourage development and maintenance of life purpose and meaning in caregivers of persons with TBI, and less so, spirituality, might have beneficial effects on HRQOL when the person with injury has more functional limitations. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Robin A Hanks
- Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine
| | - Nicholas R Boileau
- Department of Physical Medicine and Rehabilitation, University of Michigan
| | - Andria L Norman
- Department of Rehabilitation Psychology and Neuropsychology, Rehabilitation Institute of Michigan
| | - Risa Nakase-Richardson
- Mental Health and Behavioral Sciences, Polytrauma Division, Defense and Veterans Brain Injury Center, James A. Haley Veterans Hospital
| | - Kyr Hudson Mariouw
- Department of Rehabilitation Psychology and Neuropsychology, Rehabilitation Institute of Michigan
| | - Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan
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26
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Walker J, Schlebusch L, Gaede B. The impact of stress on depression, ill health and coping in family members caring for patients with acquired brain injury. S Afr Fam Pract (2004) 2020; 62:e1-e6. [PMID: 33054250 PMCID: PMC8377968 DOI: 10.4102/safp.v62i1.5149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 11/15/2022] Open
Abstract
Background This study investigated the impact of stress on levels of depression and ill health as an indication of psychological coping. The research sample consisted of 80 family caregivers (who are members of Headway Gauteng, located in Johannesburg, South Africa) of patients with acquired brain injury. Methods A mixed method design of data collection was utilised that included self-report procedures (structured questionnaires and interviews) and post-interview content analyses. In addition, two individually administered measures that have been widely used in clinical practice and research were administered (a stress symptom checklist and the Beck Depression Inventory). Results The majority of the research participants experienced high levels of stress along with an inordinate physical and mental health impact indicating that they were not able to cope up with the ongoing chronic stress of caregiving. Conclusion Findings provide compelling evidence of the value of psychological screening for elevated stress and poor coping in family members caring for a patient with acquired brain injury in a resource-limited healthcare society. We recommend a collaborative effort between medical and psychological health practitioners in order to ensure a holistic and inclusive approach towards treatment procedures and interventions to improve coping skills in family members caring for a patient with acquired brain injury.
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Affiliation(s)
- Janet Walker
- Department of Family Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban.
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Mental Health and Family Functioning in Patients and Their Family Members after Traumatic Brain Injury: A Cross-Sectional Study. Brain Sci 2020; 10:brainsci10100670. [PMID: 32992808 PMCID: PMC7600942 DOI: 10.3390/brainsci10100670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/23/2020] [Accepted: 09/23/2020] [Indexed: 11/17/2022] Open
Abstract
Traumatic brain injury (TBI) affects the family as a whole. This study aimed to describe and compare mental health and family functioning in TBI patients and their family members, and to identify individual and family-related factors that were associated with mental health. It was conducted at an urban, specialized, TBI outpatient clinic and included 61 patients with mild to severe TBI and 63 family members. Baseline demographics and injury-related data were collected, and the participants answered standardized, self-reported questionnaires 6-18 months post-injury that assessed mental health; general health; family functioning, communication, and satisfaction; depression and anxiety; self-efficacy; resilience; and condition-specific quality of life. The patients reported significantly worse mental health, depression, resilience, self-efficacy, and general health compared with the family members. Patients and family members had similar perceptions, showing balanced family functioning, high family communication levels, and moderate family satisfaction. Factors significantly associated with mental health in patients and family members were depression, anxiety, and resilience, explaining 56% of the variance (p < 0.001). Family-related factors were not associated with mental health. The disease burden was mainly on the patients; however, the family members also reported emotional distress. Family-targeted interventions across the TBI continuum should be considered.
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28
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McClure J, Leah C. Is independence enough? Rehabilitation should include autonomy and social engagement to achieve quality of life. Clin Rehabil 2020; 35:3-12. [PMID: 32959679 DOI: 10.1177/0269215520954344] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This discussion paper argues that holding independence as the central goal for rehabilitation has limitations that hinder successful outcomes. It shows why autonomy and social engagement should also serve as goals of rehabilitation, in order to achieve quality of life and effective functioning. METHODS The paper reviews problems arising from the over-emphasis on independence in rehabilitation. Although independence is a valuable goal on some tasks, it is sometimes not possible or desirable and is best complimented by autonomy and social engagement. Autonomy recognises that enacting some goals requires the support of other people. Autonomy is thus linked to social engagement (connectivity) in the workplace and personal relationships. The paper applies this framework to motor and cognitive disabilities. RESULTS The inclusion of autonomy and social engagement as goals for rehabilitation addresses the limitations of independence and can serve the unifying aim of enhancing the person's quality of life. These goals apply equally to motor disabilities and the cognitive and behavioural effects of injuries which affect personal and work relationships. CONCLUSIONS Rehabilitation is likely to be more effective if it aims at a combination of independence, autonomy and social engagement, in service of the goal of a good quality of life.
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Affiliation(s)
- John McClure
- School of Psychology, Victoria University of Wellington, New Zealand
| | - Caspian Leah
- School of Psychology, Victoria University of Wellington, New Zealand
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29
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Røe C, Anke A, Arango-Lasprilla JC, Andelic N, Caracuel A, Rivera D, Norup A. The Family Needs Questionnaire-Revised: a Rasch analysis of measurement properties in the chronic phase after traumatic brain injury. Brain Inj 2020; 34:1375-1383. [PMID: 32758024 DOI: 10.1080/02699052.2020.1802664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE The main aim was to evaluate the measurement properties of the Family Needs Questionnaire-Revised (FNQ-R) in family members of individuals living with severe traumatic brain injury (TBI). METHODS A total of 309 family members of individuals with severe TBI from Colombia, Denmark, Mexico, Norway and Spain participated. Rasch analysis of the FNQ-R and its 6 subscales was conducted. RESULTS The Rasch analysis indicated a lack of fit of the 37-item FNQ-R to one single underlying construct of needs, and less than half of the items were invariant across the countries. Misfit of single items was revealed in the Need for Health Information, Need for Emotional Support, Need for Instrumental Support, Need for Professional Support and Need for Community Support Network subscales. Fit to the Rasch model was obtained after removal of misfitting items. The Involvement in Care subscale had too few items to be adequately assessed by the Rasch approach. CONCLUSION The FNQ-R is a well-targeted instrument for assessing the unmet needs of caregivers regarding the need for health information, emotional support, professional support and a community support network after some scoring adjustment and the removal of misfitting items. Caution should be taken when comparing responses across countries.
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Affiliation(s)
- Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital , Oslo, Norway.,Institute of Clinical Medicine, University of Oslo , Oslo, Norway.,Center for Habilitation and Rehabilitation Research Models and Services, Institute of Health and Society, University of Oslo , Oslo, Norway
| | - Audny Anke
- Center for Habilitation and Rehabilitation Research Models and Services, Institute of Health and Society, University of Oslo , Oslo, Norway.,Department of Rehabilitation, University Hospital of North Norway , Tromso, Norway.,Faculty of Health Sciences, Department of Clinical Medicine, The Arctic University of Norway , Tromso, Norway
| | - Juan Carlos Arango-Lasprilla
- Biocruces Bizkaia Health Research Institute , Barakaldo, Spain.,IKERBASQUE. Basque Foundation for Science , Bilbao, Spain.,Department of Cell Biology and Histology, University of the Basque Country UPV/EHU , Leioa, Spain
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital , Oslo, Norway.,Center for Habilitation and Rehabilitation Research Models and Services, Institute of Health and Society, University of Oslo , Oslo, Norway
| | | | - Diego Rivera
- Department of Health Sciences, Public University of Navarre , Pamplona, Spain
| | - Anne Norup
- Department of Neurorehabilitation, TBI Unit , Copenhagen, Denmark.,Department of Psychology, University of Southern Denmark , Odense, Denmark
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30
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Tsur N, Haller CS. Physical and Mental Health and Functioning Among Traumatic Brain Injury Close Relatives: The Role of Posttraumatic Stress Symptoms. FAMILY PROCESS 2020; 59:666-680. [PMID: 31013369 DOI: 10.1111/famp.12454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Severe Traumatic brain injury (sTBI) often instigates widespread long-lasting disability and is accompanied by extensive rehabilitation. Unsurprisingly, sTBI also holds malignant consequences for patients' close relatives. The burden caused by the injury and its severity explains some of the ramifications for the relatives. Additionally, some findings demonstrate that patients with sTBI and their relatives develop posttraumatic stress (PTS) symptoms. However, although the link between PTS symptoms and physical and mental health is well-documented in literature, the effect of PTS symptoms on relatives of patients with sTBI has barely been examined. This study examines the influence of PTS symptoms of patients with sTBI and their relatives on the physical and mental health and functioning of the relatives. Patients who sustained a severe sTBI (Abbreviated Injury Scale of the head region > 3) and close relatives were included in a multi-center, prospective cohort study (TRAST-MI). One-hundred patients and their relatives were assessed at 2, 6, and 12 months post injury. Outcome variables included health-related quality of life (SF-12) as well as emotional, cognitive, interpersonal, and total functioning (PCRS). Relatives' physical health was predicted by relatives' PTS symptoms (Slope=-1.76; p = .043), and mental health was predicted by both patients' (Slope=-2.77; p = .034) and relatives' (Slope=-6.59; p < .001) PTS symptoms. Functioning level was only predicted by patients' PTS symptoms (Slope=-.25; p< .001). The findings emphasize that TBI should be considered a comprehensive traumatic experience reaching further than mere physical damage to the brain and its direct consequences, affecting the injured individual and close relatives.
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Affiliation(s)
- Noga Tsur
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Chiara S Haller
- Department of Psychology, Harvard University, Cambridge, MA
- Division of Public Psychiatry, Massachusetts Mental Health Center, Harvard Medical School, Boston, MA
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31
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Kratz AL, Boileau NR, Sander AM, Nakase-Richardson R, Hanks RA, Massengale JP, Miner JA, Carlozzi NE. Do emotional distress and functional problems in persons with traumatic brain injury contribute to perceived sleep-related impairment in caregivers? Rehabil Psychol 2020; 65:2020-31793-001. [PMID: 32406737 PMCID: PMC7665992 DOI: 10.1037/rep0000327] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The goal of this study was to examine the association between characteristics of persons with traumatic brain injury (PwTBI) and perceived sleep-related impairment of the caregivers. METHOD Fifty-two dyads (n = 23 civilians, n = 29 service members/veterans [SMVs]) were enrolled. Caregivers completed the Patient-Reported Outcomes Measurement Information System Sleep-Related Impairment computer adaptive test, and PwTBI completed Quality of Life in Neurological Disorders measures of depression, anxiety, anger, cognitive functioning, and upper and lower extremity functioning. Hierarchical linear regression models, stratified by civilian/SMV group, were employed to assess prediction of caregiver-perceived sleep-related impairment from emotional distress of the PwTBI (anxiety, depressed mood, and anger) and perceived functional status of the PwTBI (cognitive, upper extremity, lower extremity functioning). RESULTS Compared with caregivers of civilians, caregivers of SMVs reported higher perceived sleep-related impairment. Regression results showed that characteristics of the PwTBI accounted for moderate amounts of variance in the sleep-related impairment of caregivers of both civilians and SMVs. Within-group analyses showed that the strongest predictor of sleep-related impairment of caregivers of civilians was self-reported cognitive function of the PwTBI (β = -0.82, p = .08); the strongest predictor of sleep-related impairment of caregivers of SMVs was self-reported anger of the PwTBI (β = 0.54, p = .07). CONCLUSIONS In both caregivers of civilians and SMVs with TBI, characteristics of the PwTBI were related to perceived caregiver sleep-related impairment. These preliminary data can inform future research with larger samples that examine the impact of multiple characteristics of the caregiver and care recipient on caregiver sleep. Findings highlight the potential importance of considering the dynamics of the dyad in rehabilitation programming not only for the PwTBI but for caregivers as well. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Anna L Kratz
- Department of Physical Medicine and Rehabilitation
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32
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Azman A, Jali NA, Jamir Singh PS, Abdullah JM, Ibrahim H. Family roles, challenges and needs in caring for traumatic brain injury (TBI) family members: a systematic review. JOURNAL OF HEALTH RESEARCH 2020. [DOI: 10.1108/jhr-07-2019-0138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PurposeAdvanced medical technology has reduced the mortality rate among traumatic brain injury (TBI) patients. This, however, has led to an increasing number of surviving patients with a major disability. As a consequence, these patients need attentive care which becomes an important issue for the society, particularly family members. Thus, this paper aims to review some of the salient roles, challenges and needs of the family caregivers in caring or nursing for their family members diagnosed with TBI.Design/methodology/approachAn inclusive search of the literature was undertaken to identify the family roles, challenges and needs in supporting and nursing TBI patients.FindingsPrevious studies have shown that the family needs to address two important aspects of taking care of TBI patients, which involve emotional and physical affairs. Hence, it is essential for the family members to have adequate information on healing treatment, nursing and care methods, financial support, support groups, managing self-care and, more importantly, emotional and social support.Originality/valueThis paper is not currently under consideration, in press or published elsewhere. In Malaysian culture, nursing disabled patients have always been a family responsibility. The role of nursing the patients has been done domestically and is considered a private affair. In order to execute the role, some put the patient needs as their priority and leave aside their needs and matters.
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Simpson GK, Anderson MI, Jones KF, Genders M, Gopinath B. Do spirituality, resilience and hope mediate outcomes among family caregivers after traumatic brain injury or spinal cord injury? A structural equation modelling approach. NeuroRehabilitation 2020; 46:3-15. [DOI: 10.3233/nre-192945] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Grahame Kenneth Simpson
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney NSW, Australia
- John Walsh Centre of Rehabilitation Research, Kolling Institute, Sydney University, Sydney NSW, Australia
| | | | - Kate Fiona Jones
- Royal Rehab, Ryde NSW, Australia
- Menzies Health Institute, Griffith University, Gold Coast QLD, Australia
| | - Michelle Genders
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney NSW, Australia
- John Walsh Centre of Rehabilitation Research, Kolling Institute, Sydney University, Sydney NSW, Australia
| | - Bamini Gopinath
- John Walsh Centre of Rehabilitation Research, Kolling Institute, Sydney University, Sydney NSW, Australia
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King G, Nalder E, Stacey L, Hartman LR. Investigating the adaptation of caregivers of people with traumatic brain injury: a journey told in evolving research traditions. Disabil Rehabil 2020; 43:3102-3116. [PMID: 32078400 DOI: 10.1080/09638288.2020.1725158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To examine how conceptualizations of caregiver adaptation to traumatic brain injury have changed over time. The objectives were to identify research traditions, adaptive outcomes assessed in these traditions, and psychosocial variables associated with adaptive outcomes. METHODS A meta-narrative review was conducted on 29 identified articles published over a 25-year period (1990-2015). RESULTS Four traditions were identified with varying storylines. Burden/Strain (1990-1999) focused on adjustment as the absence of a negative state. Appraisal/Coping (2000-2005) recognized that caregiving experiences could be both positive and negative. In Quality of Life (2006-2011), there was increasing recognition that both personal and contextual factors influence adaptation. Resiliency (2012-2015) used the term "resiliency" as an organizing framework for a broad group of variables and assessed resilience, quality of life, community re-integration, and life/marital satisfaction. CONCLUSIONS These storylines reflect an evolution from problem-based to strengths-based conceptualizations, from interest in crisis to considering adaptation as a process unfolding over time, from quantitative to qualitative methods, and towards more holistic views of adaptive outcomes. Variables significantly associated with outcomes across the traditions included social support, reframing and positive appraisal, and behavior strategies. Implications concern the need for longitudinal studies, measurement of environmental factors, and the development of best practices.IMPLICATIONS FOR REHABILITATIONResearch studies on the adaptation of caregivers for people with TBI have evolved from a focus on burden, to coping and quality of life, and most recently to resiliency.It is important to assist caregivers of people with TBI to obtain social support, find positive ways of viewing their experiences, and take part in respite and enjoyed activities.Service providers can help caregivers by adopting a strengths-based perspective to help them recognize available resources, supports, and opportunities.Since caregiver adaptation changes over time, service providers should pay attention to changes in family circumstances and the mental health of caregivers.
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Affiliation(s)
- Gillian King
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Emily Nalder
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Lauren Stacey
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Laura R Hartman
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada.,Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
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35
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Caregiver Issues and Concerns Following TBI: A Review of the Literature and Future Directions. PSYCHOLOGICAL INJURY & LAW 2020. [DOI: 10.1007/s12207-019-09369-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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36
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McDonald S, Trimmer E, Newby J, Grant S, Gertler P, Simpson GK. Providing on-line support to families of people with brain injury and challenging behaviour: A feasibility study. Neuropsychol Rehabil 2019; 31:392-413. [PMID: 31778091 DOI: 10.1080/09602011.2019.1696846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Challenging behaviour following traumatic brain injury (TBI) is a major source of stress for families. Providing support can be limited by availability of clinicians and geographic location. A solution is to provide support on-line. This study aimed to evaluate the feasibility of an on-line treatment programme "Carer's Way Ahead" that provides families and carers with psychoeducation about TBI and challenging behaviours, specific approaches to managing apathy, irritability/aggression, acting without thinking and social difficulties and also self-care for the family member. Each module was supplemented with detailed notes and summaries of the sessions. Six family carers, five caring for a person with TBI and one caring for a person with stroke, worked through the programme, providing feedback on wording, content, structure and useability. They also completed measures of family functioning, social problem solving, carer strain, mood and the nature and severity of challenging behaviours. In general, the families were positive about the programme with most finding it useful, practical and logically structured although not all believed it was helpful. There was little change in self-reported challenging behaviour, mood, carer strain and family function over the few months of the programme. Longer-term effects were not examined but this requires further research.
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Affiliation(s)
- Skye McDonald
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Emily Trimmer
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Jill Newby
- School of Psychology, University of New South Wales, Sydney, Australia
| | | | - Paul Gertler
- Gertler Psychological Services, Sydney, Australia
| | - Grahame K Simpson
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, Australia
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Anke A, Røe C, Sigurdardottir S, Norup A, Soberg HL, Arango-Lasprilla JC, Manskow US. Family needs at one and two years after severe traumatic brain injury: a prospective study of changes and predictors. Brain Inj 2019; 34:89-97. [DOI: 10.1080/02699052.2019.1682191] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Audny Anke
- Department of Rehabilitation, University Hospital of North Norway, Tromso, Norway
- Faculty of Health Sciences, Department of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Cecilie Røe
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | | | - Anne Norup
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Helene L. Soberg
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Juan Carlos Arango-Lasprilla
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- IKERBASQUE, Basque Foundation For Science, Bilbao, Spain
- Department of Cell Biology and Histology, University of the Basque Country UPV/EHU, Leioa, Spain
| | - Unn Sollid Manskow
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
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Thirty Years of National Institute on Disability, Independent Living, and Rehabilitation Research Traumatic Brain Injury Model Systems Center Research-An Update. J Head Trauma Rehabil 2019; 33:363-374. [PMID: 30395041 DOI: 10.1097/htr.0000000000000454] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Traumatic Brain Injury Model Systems Center (TBIMSC) program was established by the National Institute on Disability, Independent Living, and Rehabilitation Research in 1987, with the goal of conducting research to improve the care and outcomes for individuals with moderate-to-severe traumatic brain injury (TBI). This article provides an update on TBIMSC research program activities since 2010 when a similar article was published. It includes (1) discussion of TBIMSC program management and infrastructure; (2) detail on the management, data quality, access, use, and knowledge translation of the TBIMSC National Database, with more than 16 000 participants with follow-up out to 25 years postinjury to date; (3) an overview of the TBIMSC site-specific studies and collaborative module research; (4) highlights of several collaborative initiatives between the TBIMSCs and other federal, advocacy, and research stakeholders; (5) an overview of the vast knowledge translation occurring through the TBIMSC program; and (6) discussion of issues that impact on the data collection methods for and contents of the TBIMSC National Database. On the occasion of the 30th anniversary of the TBIMSC program, this article highlights many of the accomplishments of this well-established, multicenter TBI research consortium.
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Abstract
AbstractObjective:The impact of traumatic brain injury (TBI) extends beyond the person who was injured. Family caregivers of adults with moderate to severe TBI frequently report increased burden, stress and depression. Few studies have examined the well-being of family members in the mild TBI population despite the latter representing up to 95% of all TBIs.Methods:Five areas of well-being were examined in 99 family members (including parents, partners, siblings, other relatives, adult children, friends or neighbours) of adults (aged ≥16 years) with mild TBI. At 6- and 12-month post-injury, family members completed the Bakas Caregiver Outcomes Scale, Short Form-36 Health Survey, EQ-5D-3L, Hospital Anxiety and Depression Scale and the Pittsburgh Sleep Quality Index. Outcomes and change over time and associated factors were examined.Results:At 6 months, group mean scores for health-related quality of life for mental and physical components and overall health status were similar to the New Zealand (NZ) population. Mean scores for sleep, anxiety and depression were below clinically significant thresholds. From 6 to 12 months, there were significant improvements in Bakas Caregiver Outcomes Scale scores by 2.61 (95% confidence interval: 0.72–4.49), health-related quality of life (mental component) and EQ-5D-3L overall health (P= 0.01). Minimally clinically important differences were observed in overall health, anxiety, health-related quality of life and depression at 12 months. Female family members reported significant improvements in physical health over time, and more positive life changes were reported by those caring for males with TBI.Conclusions:The findings suggest diminished burden over time for family members of adults with mild TBI.
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Carlozzi NE, Kallen MA, Brickell TA, Lange RT, Boileau NR, Tulsky D, Hanks RA, Massengale JP, Nakase-Richardson R, Ianni PA, Miner JA, French LM, Sander AM. Measuring emotional suppression in caregivers of adults with traumatic brain injury. Rehabil Psychol 2019; 65:455-470. [PMID: 31580109 DOI: 10.1037/rep0000291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Caregivers of individuals with traumatic brain injury (TBI) often feel pressure to maintain the appearance that they are emotionally well adjusted, despite feelings to the contrary. Because there are currently no measures examining this construct, this article focuses on the development of a new measure that is specific to caregivers of people with TBI. DESIGN A total of 533 caregivers of civilians with TBI (n = 218) or service members/veterans (SMVs) with TBI (n = 315) completed 43 emotional suppression items, as well as other patient-reported outcomes and an estimate of the functional ability of the person with TBI. RESULTS Exploratory and confirmatory factor analyses supported the retention of 25 items. Graded response model (GRM) analyses and differential item functioning (DIF) studies supported the retention of 21 items in the final measure. Expert review and GRM calibration data were used to develop a 6-item static short form (SF) and program a computer adaptive test (CAT). Internal consistency was excellent for both the CAT and SF (reliabilities ≥ 0.91); 3-week test-retest stability was good (all intraclass correlations ≥ 0.89). Convergent validity was supported by moderate associations between TBI-CareQOL Emotional Suppression and related measures (rs from 0.47 to 0.59); discriminant validity was supported by small correlations between Emotional Suppression and positive aspects of caregiving and physical health (rs from 0.14 to 0.28). Known-groups validity was also supported. CONCLUSIONS The new TBI-CareQOL Emotional Suppression CAT and 6-item short form is the first self-report measure of this construct in this population. Our findings suggest this new measure has strong psychometric properties. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | - David Tulsky
- Center for Health Assessment Research and Translation
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Evaluation of a Brief, Skill-Building, Supportive, and Educational Intervention for Couples After Brain Injury. J Head Trauma Rehabil 2019; 35:175-186. [PMID: 31479075 DOI: 10.1097/htr.0000000000000519] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the effectiveness of an intervention (Therapeutic Couples Intervention, TCI) designed to improve relationship quality for couples after acquired brain injury. SETTING Outpatient brain injury rehabilitation center. PARTICIPANTS Persons with brain injury (n = 75) and their intimate partners (n = 75). DESIGN Two-arm parallel, randomized, controlled trial with wait-listed control. METHODS Composed of 5 to 6 2-hour sessions, the TCI is a manualized, treatment program designed to enhance relationship quality by addressing issues and concerns most often identified by persons with brain injury and their partners. MAIN MEASURE Revised Dyadic Adjustment Scale completed by the persons with brain injury and their partners. RESULTS Persons with brain injury and their partners in the treatment group showed an improvement in relationship quality, both compared with their own baseline values and the control group. CONCLUSIONS Investigation provided evidence that a curriculum-based education, skill-building, and supportive intervention can benefit couples for up to 3 months after treatment. Additional research is needed to ascertain the long-term benefits of intervention and the efficacy of alternative delivery methods (eg, Internet, telephone, and group).
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Driver S, Juengst S, Reynolds M, McShan E, Kew CL, Vega M, Bell K, Dubiel R. Healthy lifestyle after traumatic brain injury: a brief narrative. Brain Inj 2019; 33:1299-1307. [DOI: 10.1080/02699052.2019.1641623] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Simon Driver
- North Texas TBI Model System, Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA
| | - Shannon Juengst
- North Texas TBI Model System, University of Texas at Southwestern, Dallas, TX, USA
| | - Megan Reynolds
- North Texas TBI Model System, Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA
| | - Evan McShan
- North Texas TBI Model System, Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA
| | - Chung Lin Kew
- North Texas TBI Model System, University of Texas at Southwestern, Dallas, TX, USA
| | - Marlene Vega
- North Texas TBI Model System, University of Texas at Southwestern, Dallas, TX, USA
| | - Kathleen Bell
- North Texas TBI Model System, University of Texas at Southwestern, Dallas, TX, USA
| | - Randi Dubiel
- North Texas TBI Model System, Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA
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Anderson MI, Daher M, Simpson GK. A predictive model of resilience among family caregivers supporting relatives with traumatic brain injury (TBI): A structural equation modelling approach. Neuropsychol Rehabil 2019; 30:1925-1946. [PMID: 31132931 DOI: 10.1080/09602011.2019.1620787] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Constructs from positive psychology were employed to create an explicit model of caregiver resilience. Predictive and mediating relationships among resilience and related variables (personality, coping, self-efficacy, hope, social support) were then tested for their association with burden and psychological adjustment among family members caring for relatives with severe TBI. Family participants (n = 131) from six rehabilitation units from New South Wales and Queensland completed assessments which elicited explanatory (Eysenck Personality Questionnaire, Ways of Coping Questionnaire), mediating (Connor-Davidson Resilience Scale, General Self-Efficacy Scale, Herth Hope Scale, Medical Outcome Study Social Support Survey), and caregiver outcome (Caregiver Burden Scale, Mental Health sub-Scale-SF36, General Health Questionnaire, and Positive and Negative Affect Scale) variables. Structural Equation Modeling (SEM) showed that resilience had a direct effect on positive affect in caregivers. Resilience also played a protective role in relation to two variables associated with caregiver vulnerability: an indirect association with caregiver burden mediated through social support; a direct effect on hope, which, in turn, was associated with positive mental health. Positive mental health then played a buffering role in relation to psychological distress and negative affect. Resilience, in combination with other psychological attributes, was associated with reduced morbidity among family caregivers after severe TBI.
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Affiliation(s)
| | - Maysaa Daher
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Liverpool, Sydney, Australia.,Brain Injury Rehabilitation Directorate, Agency for Clinical Innovation, NSW Health, Sydney, Australia
| | - Grahame K Simpson
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Liverpool, Sydney, Australia.,John Walsh Centre for Rehabilitation Research, University of Sydney, Sydney, Australia
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Care partner problem solving training (CP-PST) for care partners of adults with traumatic brain injury during inpatient rehabilitation: Study protocol for a multisite, randomized, single-blind clinical feasibility trial. Contemp Clin Trials 2019; 80:9-15. [DOI: 10.1016/j.cct.2019.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/02/2019] [Accepted: 03/14/2019] [Indexed: 11/19/2022]
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Keatley E, Hanks R, Sander AM, Kratz AL, Tulsky DS, Ianni P, Miner J, Carlozzi NE. Group Differences Among Caregivers of Civilians and Service Members or Veterans With Traumatic Brain Injury. Arch Phys Med Rehabil 2019; 100:S52-S57. [PMID: 30537488 PMCID: PMC6528672 DOI: 10.1016/j.apmr.2018.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/26/2018] [Accepted: 11/28/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To examine group differences among caregivers of service members or veterans (SMVs) and civilians with traumatic brain injury (TBI). DESIGN An observational research study examining the group differences between caregivers of SMVs and civilians with TBI. The data presented was collected as part of a larger study that calibrated and validated the Traumatic Brain Injury-Care Quality of Life (TBI-CareQOL) item banks. SETTING Participants in this multicenter study completed an online survey via a study-specific website. Surveys were completed at the study site, at home, or via phone interview. Civilian caregivers were recruited from 4 rehabilitation hospitals and caregivers of SMVs were recruited through community outreach and collaboration with the Hearts of Valor. PARTICIPANTS Participants (N=473) consisted of 344 caregivers of civilians with TBI and 129 caregivers of SMVs with TBI. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Zarit Burden Interview Scale, TBI-CareQOL, and Mayo Portland Adaptability Inventory, 4th revision (MPAI-4). RESULTS Of the independent variables included in the logistic regression model that classified military-affiliated vs civilian caregivers, 5 were statistically significant: age, spousal status, time since injury, MPAI-4 Adjustment, and TBI-CareQOL Feeling Trapped. CONCLUSIONS The results indicate that caregivers of SMVs were more likely to report worse emotional and social adjustment among the individuals with TBI and caregivers of SMVs were more likely to report greater levels of feeling trapped by their caregiving duties.
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Affiliation(s)
- Eva Keatley
- Department of Psychology, University of Windsor, Windsor, ON; Department of Psychology and Neuropsychology, Rehabilitation Institute of Michigan, Detroit, MI.
| | - Robin Hanks
- Department of Psychology and Neuropsychology, Rehabilitation Institute of Michigan, Detroit, MI; Wayne State University School of Medicine, Detroit, MI
| | - Angelle M Sander
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine and Harris Health System, Houston, TX; Brain Injury Research Center, TIRR Memorial Hermann, Houston, TX
| | - Anna L Kratz
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI
| | - David S Tulsky
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Phillip Ianni
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI
| | - Jennifer Miner
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI
| | - Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI
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Carlozzi NE, Kallen MA, Hanks R, Kratz AL, Hahn EA, Brickell TA, Lange RT, French LM, Ianni PA, Miner JA, Sander AM. The Development of a New Computer Adaptive Test to Evaluate Feelings of Being Trapped in Caregivers of Individuals With Traumatic Brain Injury: TBI-CareQOL Feeling Trapped Item Bank. Arch Phys Med Rehabil 2019; 100:S43-S51. [PMID: 30075146 PMCID: PMC6422745 DOI: 10.1016/j.apmr.2018.06.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/25/2018] [Accepted: 06/23/2018] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To develop a new patient-reported outcome measure that captures feelings of being trapped that are commonly experienced by caregivers of individuals with traumatic brain injury (TBI). DESIGN Cross-sectional. SETTING Three TBI Model Systems rehabilitation hospitals, an academic medical center, and a military medical treatment facility. PARTICIPANTS Caregivers (N=560) of civilians with TBI (n=344) and caregivers of service members/veterans with TBI (n=216). INTERVENTIONS Not applicable. OUTCOME MEASURES Traumatic Brain Injury Caregiver Quality of Life (TBI-CareQOL) Feeling Trapped item bank. RESULTS From an initial item pool of 28 items, exploratory and confirmatory factor analyses supported the retention of 16 items. After graded response model (GRM) and differential item functioning analyses were conducted, 15 items were retained in the final measure. GRM calibration data, along with clinical expert input, were used to choose a 6-item, static short form (SF), and the calibration data were used for programming of the TBI-CareQOL Feeling Trapped computer adaptive test (CAT). CAT simulation analyses produced an r=0.99 correlation between CAT scores and the full item bank. Three-week short-form test-retest reliability was very good (r=0.84). CONCLUSIONS The new TBI-CareQOL Feeling Trapped item bank was developed to provide a sensitive and efficient examination of the effect that feelings of being trapped, due to the caregiver role, have on health-related quality of life for caregivers of individuals with TBI. Both the CAT and corresponding 6-item SF demonstrate excellent psychometric properties. Future work is needed to establish the responsiveness of this measure to clinical interventions for these caregivers.
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Affiliation(s)
- Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI.
| | - Michael A Kallen
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Robin Hanks
- Rehabilitation Institute of Michigan, Department of Psychology and Neuropsychology, Detroit, MI; Department of Physical Medicine and Rehabilitation, Wayne State University, Detroit, MI
| | - Anna L Kratz
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Elizabeth A Hahn
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Tracey A Brickell
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD; National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD; Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Rael T Lange
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD; National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD; University of British Columbia, Vancouver, British Columbia, Canada
| | - Louis M French
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD; National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD; Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Phillip A Ianni
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Jennifer A Miner
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Angelle M Sander
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine and Harris Health System, Houston, TX; Brain Injury Research Center, TIRR Memorial Hermann, Houston, TX
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Carlozzi NE, Kallen MA, Ianni PA, Hahn EA, French LM, Lange RT, Brickell TA, Hanks R, Sander AM. The Development of a New Computer-Adaptive Test to Evaluate Strain in Caregivers of Individuals With TBI: TBI-CareQOL Caregiver Strain. Arch Phys Med Rehabil 2019; 100:S13-S21. [PMID: 29966647 PMCID: PMC6389439 DOI: 10.1016/j.apmr.2018.05.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/25/2018] [Accepted: 05/31/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To develop a new measure of caregiver strain for use in caregivers of individuals with traumatic brain injury (TBI), Traumatic Brain Injury Caregiver Quality of Life (TBI-CareQOL) Caregiver Strain. DESIGN Qualitative data, literature reviews, and cross-sectional survey study. SETTING Three TBI Model Systems rehabilitation hospitals, an academic medical center, and a military medical treatment facility. PARTICIPANTS Caregivers (N=560) of civilians (n=344) or service members/veterans (SMVs) with TBI (n=216). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE TBI-CareQOL Caregiver Strain Item Bank. RESULTS Exploratory and confirmatory factor analyses, a graded response model (GRM) and differential item functioning supported the retention of 33 items in the final measure. GRM calibration data was used to inform the selection of a 6-item static short form, and to program the TBI-CareQOL Caregiver Strain computer-adaptive test (CAT). CAT simulation analyses indicated a 0.97 correlation between the CAT scores and the full item-bank. Three-week test-retest reliability was strong (r=0.83). CONCLUSIONS The new TBI-CareQOL Caregiver Strain CAT and corresponding 6-item short form were developed using established rigorous measurement development standards; this is the first self-reported measure developed to evaluate caregiver strain in caregivers of individuals with TBI.
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Affiliation(s)
- Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI.
| | - Michael A Kallen
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Phillip A Ianni
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Elizabeth A Hahn
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Louis M French
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD; National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD; Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Rael T Lange
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD; National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD; University of British Columbia, Vancouver, British Columbia, Canada
| | - Tracey A Brickell
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD; National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD; Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Robin Hanks
- Rehabilitation Institute of Michigan, Department of Psychology and Neuropsychology, Detroit, MI; Department of Physical Medicine and Rehabilitation, Wayne State University, Detroit, MI
| | - Angelle M Sander
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine & Harris Health System, Houston, TX; Brain Injury Research Center, TIRR Memorial Hermann, Houston, TX
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Abstract
Telerehabilitation refers to the virtual delivery of rehabilitation services into the patient's home. This methodology has shown to be advantageous when used to enhance or replace conventional therapy to overcome geographic, physical, and cognitive barriers. The exponential growth of technology has led to the development of new applications that enable health care providers to monitor, educate, treat, and support patients in their own environment. Best practices and well-designed Telerehabilitation studies are needed to build and sustain a strong Telerehabilitation system that is integrated in the current health care structure and is cost-effective.
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Manskow US, Arntzen C, Damsgård E, Braine M, Sigurdardottir S, Andelic N, Røe C, Anke A. Family members' experience with in-hospital health care after severe traumatic brain injury: a national multicentre study. BMC Health Serv Res 2018; 18:951. [PMID: 30526574 PMCID: PMC6286568 DOI: 10.1186/s12913-018-3773-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 11/27/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Family member's experience and satisfaction of health care in the acute care and in-patient rehabilitation are important indicators of the quality of health care services provided to patients with severe traumatic brain injury (TBI). The objective was to assess family members' experience of the health care provided in-hospital to patients with severe TBI, to relate experiences to family member and patient demographics, patients' function and rehabilitation pathways. METHODS Prospective national multicentre study of 122 family members of patients with severe TBI. The family experience of care questionnaire in severe traumatic brain injury (FECQ-TBI) was applied. Independent sample t-tests or analysis of variance (ANOVA) were used to compare the means between 2 or more groups. Paired samples t-tests were used to investigate differences between experience in the acute and rehabilitation phases. RESULTS Best family members` experience were found regarding information during the acute phase, poorest scores were related to discharge. A significantly better care experience was reported in the acute phase compared with the rehabilitation phase (p < 0.05). Worst family members` experience was related to information about consequences of the injury. Patient's dependency level (p < 0.05) and transferral to non-specialized rehabilitation were related to a worse family members` experience (p < 0.01). CONCLUSIONS This study underscores the need of better information to family members of patients with severe TBI in the rehabilitation as well as the discharge phase. The results may be important to improve the services provided to family members and individuals with severe TBI.
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Affiliation(s)
- Unn Sollid Manskow
- Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway.
- Faculty of Health Sciences, Department of Health and Care Sciences, UiT, The Arctic University of Norway, Tromsø, Norway.
| | - Cathrine Arntzen
- Faculty of Health Sciences, Department of Health and Care Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Elin Damsgård
- Faculty of Health Sciences, Department of Health and Care Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Mary Braine
- School of Health and Society, University of Salford, Salford, UK
| | | | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Audny Anke
- Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway
- Faculty of Health Sciences, Department of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
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Migliorini C, Callaway L, Moore S, Simpson GK. Family and TBI: an investigation using the Family Outcome Measure – FOM-40. Brain Inj 2018; 33:282-290. [DOI: 10.1080/02699052.2018.1553307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Libby Callaway
- Department of Occupational Therapy, Monash University, Melbourne, Australia
- Neuroskills Pty Ltd, Sandringham, Australia
| | - Sophie Moore
- Department of Occupational Therapy, Monash University, Melbourne, Australia
| | - Grahame K Simpson
- Brain Injury Rehabilitation Research Group, Ingham Institute of Applied Medical Research, Sydney, Australia
- John Walsh Centre for Rehabilitation Research, Kolling Institute, University of Sydney, Sydney, Australia
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