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Bodien YG, LaRovere K, Kondziella D, Taran S, Estraneo A, Shutter L. Common Data Elements for Disorders of Consciousness: Recommendations from the Working Group on Outcomes and Endpoints. Neurocrit Care 2024; 41:357-368. [PMID: 39143375 DOI: 10.1007/s12028-024-02068-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 07/08/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND Clinical management of persons with disorders of consciousness (DoC) is dedicated largely to optimizing recovery. However, selecting a measure to evaluate the extent of recovery is challenging because few measures are designed to precisely assess the full range of potential outcomes, from prolonged DoC to return of preinjury functioning. Measures that are designed specifically to assess persons with DoC are often performance-based and only validated for in-person use. Moreover, there are no published recommendations addressing which outcome measures should be used to evaluate DoC recovery. The resulting inconsistency in the measures selected by individual investigators to assess outcome prevents comparison of results across DoC studies. The National Institute of Neurological Disorders and Stroke (NINDS) common data elements (CDEs) is an amalgamation of standardized variables and tools that are recommended for use in studies of neurologic diseases and injuries. The Neurocritical Care Society Curing Coma Campaign launched an initiative to develop CDEs specifically for DoC and invited our group to recommend CDE outcomes and endpoints for persons with DoCs. METHODS The Curing Coma Campaign Outcomes and Endpoints CDE Workgroup, consisting of experts in adult and pediatric neurocritical care, neurology, and neuroscience, used a previously established five-step process to identify and select candidate CDEs: (1) review of existing NINDS CDEs, (2) nomination and systematic vetting of new CDEs, (3) CDE classification, (4) iterative review and approval of panel recommendations, and (5) development of case report forms. RESULTS Among hundreds of existing NINDS outcome and endpoint CDE measures, we identified 20 for adults and 18 for children that can be used to assess the full range of recovery from coma. We also proposed 14 new outcome and endpoint CDE measures for adults and 5 for children. CONCLUSIONS The DoC outcome and endpoint CDEs are a starting point in the broader effort to standardize outcome evaluation of persons with DoC. The ultimate goal is to harmonize DoC studies and allow for more precise assessment of outcomes after severe brain injury or illness. An iterative approach is required to modify and adjust these outcome and endpoint CDEs as new evidence emerges.
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Affiliation(s)
- Yelena G Bodien
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA, USA.
| | - Kerri LaRovere
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel Kondziella
- Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Shaurya Taran
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Anna Estraneo
- Department of Neurorehabilitation, IRCCS, Don Carlo Gnocchi Foundation, Florence, Italy
| | - Lori Shutter
- Departments of Critical Care Medicine, Neurology, and Neurosurgery, UPMC Healthcare System, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Gilmore N, Bergquist TF, Bogner J, Corrigan JD, Dams-O'Connor K, Dreer LE, Healy BC, Juengst SB, Kumar RG, O'Neil-Pirozzi TM, Wagner AK, Giacino JT, Edlow BL, Bodien YG. Cognitive Performance is Associated With 1-Year Participation and Life Satisfaction Outcomes: A Traumatic Brain Injury Model Systems Study. J Head Trauma Rehabil 2024:00001199-990000000-00195. [PMID: 39330921 DOI: 10.1097/htr.0000000000000997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2024]
Abstract
OBJECTIVE To determine, in persons with traumatic brain injury (TBI), the association between cognitive change after inpatient rehabilitation discharge and 1-year participation and life satisfaction outcomes. DESIGN Secondary analysis of prospectively collected TBI Model Systems (TBIMS) data. SETTING Inpatient rehabilitation and community. PARTICIPANTS 499 individuals with TBI requiring inpatient rehabilitation who completed the Brief Test of Adult Cognition by Telephone (BTACT) at inpatient rehabilitation discharge (ie, baseline) and 1-year postinjury. MAIN OUTCOME MEASURES Participation Assessment with Recombined Tools-Objective (PART-O) and Satisfaction with Life Scale (SWLS). RESULTS Of 2,840 TBIMS participants with baseline BTACT, 499 met inclusion criteria (mean [standard deviation] age = 45 [19] years; 72% male). Change in BTACT executive function (EF) was not associated with 1-year participation (PART-O; β = 0.087, 95% CI [-0.004, 0.178], P = .061) when it was the sole model predictor. Change in BTACT episodic memory (EM) was associated with 1-year participation (β = 0.096, [0.007, 0.184], P = .035), but not after adjusting for demographic, clinical, and functional status covariates (β = 0.067, 95% CI [-0.010, 0.145], P = .089). Change in BTACT EF was not associated with life satisfaction total scores (SWLS) when it was the sole model predictor (β = 0.091, 95% CI [-0.001, 0.182], P = .0503). Change in BTACT EM was associated with 1-year life satisfaction before (β = 0.114, 95% CI [0.025, 0.202], P = .012) and after adjusting for covariates (β = 0.103, [0.014, 0.191], P = .023). In secondary analyses, change in BTACT EF was associated with PART-O Social Relations and Out and About subdomains before (Social Relations: β = 0.127, 95% CI [0.036, 0.217], P = .006; Out and About: β = 0.141, 95% CI [0.051, 0.232], P = .002) and after (Social Relations: β = 0.168, 95% CI [0.072, 0.265], P < .002; Out and About: β = 0.156, 95% CI [0.061, 0.252], P < .002) adjusting for functional status and further adjusting for covariates (Social Relations: β = 0.127, 95% CI [0.040, 0.214], P = .004; Out and About: β = 0.136, 95% CI [0.043, 0.229], P = .004). However, only the models adjusting for functional status remained significant after multiple comparison correction (ie, Bonferroni-adjusted alpha level = 0.002). CONCLUSION EF gains during the first year after TBI were related to 1-year social and community participation. Gains in EM were associated with 1-year life satisfaction. These results highlight the potential benefit of cognitive rehabilitation after inpatient rehabilitation discharge and the need for interventions targeting specific cognitive functions that may contribute to participation and life satisfaction after TBI.
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Affiliation(s)
- Natalie Gilmore
- Author Affiliations: Department of Neurology (Drs Gilmore, Healy, Edlow and Bodien), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Center for Neurotechnology and Neurorecovery (Drs Gilmore, Edlow, and Bodien), Biostatistics Center (Dr Healy), Massachusetts General Hospital, Boston, Massachusetts; Mayo Clinic College of Medicine and Science (Dr Bergquist), Departments of Physical Medicine and Rehabilitation and Psychiatry and Psychology (Dr Bergquist), Mayo Clinic, Rochester, Minnesota; Department of Physical Medicine and Rehabilitation (Drs Bogner and Corrigan), College of Medicine, The Ohio State University, Columbus, Ohio; Department of Rehabilitation and Human Performance (Drs Dams-O'Connor and Kumar), Department of Neurology (Dr Dams-O'Connor), Icahn School of Medicine at Mount Sinai, New York, New York; Department of Ophthalmology and Visual Sciences & Physical Medicine and Rehabilitation (Dr Dreer), Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Brain Injury Research Center (Dr Juengst), TIRR Memorial Hermann, Houston, Texas; Department of Physical Medicine and Rehabilitation (Dr Juengst), UT Health Sciences Center at Houston, Houston, Texas; Department of Physical Medicine and Rehabilitation (Drs O'Neil-Pirozzi, Giacino, and Bodien), Spaulding Rehabilitation Hospital and Harvard Medical School, Charlestown, Massachusetts; Department of Communication Sciences and Disorders (Dr O'Neil-Pirozzi), Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts; Departments of Physical Medicine & Rehabilitation and Neuroscience (Dr Wagner), Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania; and Athinoula A. Martinos Center for Biomedical Imaging (Dr Edlow), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Taiwo Z, Sander AM, Juengst SB, Liu X, Novelo LL, Hammond FM, O'Neil-Pirozzi TM, Perrin PB, Gut N. Association Between Participation and Satisfaction With Life Over Time in Older Adults With Traumatic Brain Injury: A TBI Model Systems Study. J Head Trauma Rehabil 2024; 39:E190-E200. [PMID: 38453629 PMCID: PMC11227408 DOI: 10.1097/htr.0000000000000940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
OBJECTIVE To examine the association between participation and satisfaction with life at 1, 2, 5, and 10 years after traumatic brain injury (TBI) in older adults. SETTING Community. PARTICIPANTS Participants ( N = 2362) who sustained complicated mild to severe TBI, requiring inpatient rehabilitation, at age 60 years or older and had follow-up data on participation and satisfaction with life for at least 1 follow-up time point across 1, 2, 5, and 10 years. Age at each time period was categorized as 60 to 64 years, 65 to 75 years, and 75 years or older. DESIGN Secondary data analysis of a large multicenter database. MAIN MEASURES Three domains (Productivity, Social Relations, Out and About) of the Participation Assessment With Recombined Tools-Objective (PART-O); Satisfaction With Life Scale (SWLS). RESULTS SWLS increased over the 10 years after TBI and was significantly associated with greater frequency of participation across all domains. There was a significant interaction between age and PART-O Social Relations such that there was a weaker relationship between Social Relations and SWLS in the oldest group (75 years or older). There was no interaction between Productivity or Out and About and age, but greater participation in both of these domains was associated with greater life satisfaction across age groups. CONCLUSIONS These findings indicate that greater participation is associated with increased satisfaction with life in older adults, across all participation domains over the first 10 years postinjury, suggesting that rehabilitation should target improving participation even in older adults. The decreased association of social relations with satisfaction with life in the oldest age group suggests that frequency of social relations may not be as important for life satisfaction in the oldest adults, but quality may still be important.
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Affiliation(s)
- Zinat Taiwo
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas (Drs Taiwo and Sander); Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas (Drs Taiwo, Sander, and Juengst); Harris Health System, Houston, Texas (Dr Sander); Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston (Drs Juengst and Gut); Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston (Ms Liu and Dr Novelo); Department of Physical Medicine and Rehabilitation, School of Medicine, Indiana University, Indianapolis (Dr Hammond); Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital Boston, Charlestown, Massachusetts (Dr O'Neil-Pirozzi); Department of Communication Sciences and Disorders, Northeastern University, Boston, Massachusetts (Dr O'Neil-Pirozzi); Department of Psychology, School of Data Science, University of Virginia, Charlottesville (Dr Perrin); and TBI Model Systems, Polytrauma Rehabilitation Center, Central Virginia Veterans Affairs Health Care System, Richmond (Dr Perrin)
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Birch ES, Stark BC, Neumann D. Factors related to social inferencing performance in moderate-severe, chronic TBI. Brain Inj 2024:1-12. [PMID: 38832655 DOI: 10.1080/02699052.2024.2361634] [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: 09/13/2023] [Accepted: 05/27/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVE Following traumatic brain injury (TBI), deficits in social cognition are common. Social inferencing is a crucial component of social cognition that enables an individual to understand the thoughts, feelings, and intentions of a communication partner when this information is not explicitly stated. Existing literature suggests a variety of factors contribute to social inferencing success (e.g. biological sex, executive functioning), yet findings are not conclusive, largely because these factors have been examined in isolation. METHOD In this cross-sectional study, stepwise regression with cross validation was used to examine the extent that several theoretically motivated factors were associated with social inferencing (measured by performance on The Awareness of Social Inference Test [TASIT]) in adult participants with TBI (n = 105). Demographic information, executive functioning, aggression, emotional functioning measures, and participation in society were all examined in relation to social inferencing performance. RESULTS The findings confirm the importance of higher-level cognitive skills (i.e. executive functioning) in social inferencing, and advance the literature by underlining the potential importance of productive participation in social inferencing performance. CONCLUSION This study innovatively highlights factors linked with social inferencing skills and, in doing so, how deficits in social inferencing might manifest in the lives of individuals with TBI.
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Affiliation(s)
- Eleanor S Birch
- Department of Speech, Indiana University Bloomington Language and Hearing Sciences
- Program in Neuroscience, Indiana University Bloomington
| | - Brielle C Stark
- Department of Speech, Indiana University Bloomington Language and Hearing Sciences
- Program in Neuroscience, Indiana University Bloomington
| | - Dawn Neumann
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine
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Juengst SB, Agtarap S, Venkatesan UM, Erler KS, Evans E, Sander AM, Klyce D, O'Neil Pirozzi TM, Rabinowitz AR, Kazis LE, Giacino JT, Kumar RG, Bushnik T, Whiteneck GG. Developing multidimensional participation profiles after traumatic brain injury: a TBI model systems study. Disabil Rehabil 2024; 46:2385-2395. [PMID: 37296112 DOI: 10.1080/09638288.2023.2221900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 03/08/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023]
Abstract
Purpose. To characterize societal participation profiles after moderate-severe traumatic brain injury (TBI) along objective (Frequency) and subjective (Satisfaction, Importance, Enfranchisement) dimensions.Materials and Methods. We conducted secondary analyses of a TBI Model Systems sub-study (N = 408). Multiaxial assessment of participation included the Participation Assessment with Recombined Tools-Objective and -Subjective questionnaires (Participation Frequency and Importance/Satisfaction, respectively) and the Enfranchisement Scale. Participants provided responses via telephone interview 1-15 years post-injury. Multidimensional participation profiles (classes) were extracted using latent profile analysis.Results. A 4-class solution was identified as providing maximal statistical separation between profiles and being clinically meaningful based on profile demographic features. One profile group (48.5% of the sample) exhibited the "best" participation profile (High Frequency, Satisfaction, Importance, and Enfranchisement) and was also the most advantaged according to socioeconomic indicators. Other profile groups showed appreciable heterogeneity across participation dimensions. Age, race/ethnicity, education level, ability to drive, and urbanicity were features that varied between profiles.Conclusions. Societal participation is a critical, but inherently complex, TBI outcome that may not be adequately captured by a single index. Our data underscore the importance of a multidimensional approach to participation assessment and interpretation using profiles. The use of participation profiles may promote precision health interventions for community integration.Implications for RehabilitationOur study found unidimensional measures of societal participation in traumatic brain injury (TBI) populations that focus exclusively on frequency indicators may be overly simplistic and miss key subjective components of participationTaking a multidimensional perspective, we documented four meaningfully distinct participation subgroups (including both objective and subjective dimensions of societal participation) within the TBI rehabilitation populationMultidimensional profiles of participation may be used to group individuals with TBI into target groups for intervention (e.g., deeper goal assessment for individuals who do not rate standard participation activities as important, but also do not participate and do not feel enfranchised).
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Affiliation(s)
- Shannon B Juengst
- Brain Injury Research Center, TIRR Memorial Hermann, Houston, TX, USA
- Department of Physical Medicine & Rehabilitation, UT Houston Health Sciences Center, Houston, TX, USA
| | | | - Umesh M Venkatesan
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA
- Department of Physical Medicine & Rehabilitation, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kimberly S Erler
- Department of Occupational Therapy, MGH Institute of Health Professions, Boston, MA, USA
| | - Emily Evans
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Angelle M Sander
- Brain Injury Research Center, TIRR Memorial Hermann, Houston, TX, USA
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Daniel Klyce
- Central VA Veterans Affairs Health Care System, Richmond, VA, USA
- Virginia Commonwealth University Health System, Richmond, VA, USA
- Sheltering Arms Institute, Richmond, VA, USA
| | - Therese M O'Neil Pirozzi
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA, USA
| | - Amanda R Rabinowitz
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA
- Department of Physical Medicine & Rehabilitation, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Lewis E Kazis
- Rehabilitation Outcomes Center (ROC), Spaulding Hospital, Charlestown, MA, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
- Harvard Medical school Boston, MA, USA
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Raj G Kumar
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, NY, NY, USA
| | - Tamara Bushnik
- Rusk Rehabilitation, NYU Langone Health, New York, NY, USA
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Sherer M, Juengst S, Sander AM, Leon-Novelo L, Liu X, Bogaards J, Chua W, Tran K. Mood Tracker: A Randomized Controlled Trial of a Self-Monitoring Intervention for Emotional Distress After Traumatic Brain Injury. J Head Trauma Rehabil 2024:00001199-990000000-00161. [PMID: 38833719 DOI: 10.1097/htr.0000000000000945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
OBJECTIVE Persons with traumatic brain injury (TBI) frequently experience emotional distress (ED) manifested in anxiety and depression. However, they may not access mental health services due to external (eg, access, transportation, and cost) or internal (eg, stigma and discomfort with traditional counseling) barriers. Based on substantial literature indicating that self-monitoring can ameliorate several health conditions, we conducted a randomized, parallel group, wait-list control (WLC) trial of a self-monitoring intervention to decrease ED after TBI. SETTING Community in the southwestern United States. PARTICIPANTS Persons with medically documented complicated mild, moderate, and severe TBI. DESIGN About 127 participants were randomized in blocks of 6 to an active treatment (AT) group, wherein they completed multiple assessments of ED each week over a 6-week period via a smartphone app, or a WLC group in a parallel group, controlled trial. Participants received weekly support calls to promote self-monitoring of ED using ecological momentary assessment. MAIN MEASURES ED (Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7), Satisfaction with Life Scale, and Participation Assessment with Recombined Tools-Objective. RESULTS Analysis of the primary study outcome at 6 weeks after initiation of treatment for the AT group did not demonstrate that self-monitoring was effective in decreasing ED as compared to the WLC group. Brief support calls made weekly to promote compliance with self-monitoring were effective in achieving the target number of self-assessments. About 80% of support calls lasted less than 5 minutes. Greater ED was associated with lower life satisfaction and lower participation indicating the importance of addressing ED in persons with TBI. CONCLUSION Additional work is needed to develop nontraditional interventions to circumvent barriers that prevent persons with TBI from accessing care for ED. Brief support calls may be an effective, low-cost intervention to improve compliance with self-monitoring or self-management interventions.
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Affiliation(s)
- Mark Sherer
- Author Affiliations: Brain Injury Research Center TIRR Memorial Hermann, Houston, Texas (Drs Sherer, Juengst, and Sander and Mss Bogaards, Chua, and Tran); H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas (Drs Sherer and Sander); Department of Physical Medicine and Rehabilitation, McGovern Medical School, UT Health, Houston, Texas (Dr Juengst); and Department of Biostatistics and Data Science, University of Texas Health Science Center at Houston, School of Public Health, Houston, Texas (Dr Leon-Novelo and Ms Liu)
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Juengst SB, Kumar RG, Venkatesan UM, O'Neil-Pirozzi TM, Evans E, Sander AM, Klyce D, Agtarap S, Erler KS, Rabinowitz AR, Bushnik T, Kazis LE, Whiteneck GG. Predictors of Multidimensional Profiles of Participation After Traumatic Brain Injury: A TBI Model Systems Study. J Head Trauma Rehabil 2024:00001199-990000000-00160. [PMID: 38833709 DOI: 10.1097/htr.0000000000000941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
OBJECTIVES To identify personal, clinical, and environmental factors associated with 4 previously identified distinct multidimensional participation profiles of individuals following traumatic brain injury (TBI). SETTING Community. PARTICIPANTS Participants (n = 408) enrolled in the TBI Model Systems (TBIMS) Participation Module, all 1 year or more postinjury. DESIGN Secondary data analysis of cross-sectional data from participants in a multicenter TBIMS module study on participation conducted between May 2006 and September 2007. Participants provided responses to questionnaires via a telephone interview at their study follow-up (1, 2, 5, 10, or 15 years postinjury). MAIN MEASURES Participants provided responses to personal (eg, demographic), clinical (eg, function), environmental (eg, neighborhood type), and participation measures to create multidimensional participation profiles. Data from measures collected at the time of injury (preinjury questionnaire, injury characteristics) were also included. The primary outcome was assignment to one of 4 multidimensional participation profile groups based on participation frequency, importance, satisfaction, and enfranchisement. The measures used to develop the profiles were: Participation Assessment with Recombined Tools-Objective, Importance, and Satisfaction scores, each across 3 domains (Productivity, Social Relationships, Out and About in the Community) and the Enfranchisement Scale (contributing to one's community, feeling valued by the community, choice and control). RESULTS Results of the multinomial regression analysis, with 4 distinct participation profile groups as the outcome, indicated that education, current employment, current illicit drug use, current driving status, community type, and Functional Independence Measure Cognitive at follow-up significantly distinguished participation profile groups. Findings suggest a trend toward differences in participation profile groups by race/Hispanic ethnicity. CONCLUSIONS Understanding personal, clinical, and environmental factors associated with distinct participation outcome profiles following TBI may provide more personalized and nuanced guidance to inform rehabilitation intervention planning and/or ongoing clinical monitoring.
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Affiliation(s)
- Shannon B Juengst
- Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas (Drs Juengst and Sander); Department of Physical Medicine & Rehabilitation, UT Health Science Center at Houston, Houston (Dr Juengst); Department of Physical Medicine & Rehabilitation, UT Southwestern Medical Center, Dallas (Dr Juengst); Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York City, New York (Dr Kumar); Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania (Drs Venkatesan and Rabinowitz); Department of Rehabilitation Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania (Drs Venkatesan and Rabinowitz); Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts (Dr O'Neil-Pirozzi); Department of Communication Sciences and Disorders, Northeastern University, Boston, Massachusetts (Dr O'Neil-Pirozzi); Department of Physical Therapy, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts (Dr Evans); H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas (Dr Sander); Richmond Veterans Affairs Medical Center, Richmond, Virginia (Dr Klyce); Virginia Commonwealth University Health System, Richmond (Dr Klyce); Sheltering Arms Institute, Richmond, Virginia (Dr Klyce); Research Department, Craig Hospital, Englewood, Colorado (Drs Agtarap and Whiteneck); Department of Occupational Therapy, MGH Institute of Health Professions, Boston, Massachusetts (Dr Erler); Rusk Rehabilitation, NYU Langone Health, New York City, New York (Dr Bushnik); Rehabilitation Outcomes Center (ROC), Spaulding Hospital, Charlestown, Massachusetts (Dr Kazis); Department of Health Law, Policy & Management, School of Public Health, Boston University, Boston, Massachusetts (Dr Kazis); and Harvard Medical School, Boston, Massachusetts (Dr Kazis)
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8
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West SJ, Klyce DW, Perrin PB, Juengst SB, Dams-O'Connor K, Vargas TA, Grover R, Finn JA, Eagye CB, Agtarap SD, Chung JS, Campbell TA. A Network Analysis of the PART-O at 1 and 2 Years After TBI: A Veterans Affairs Model Systems Study. J Head Trauma Rehabil 2023; 38:401-409. [PMID: 36730958 PMCID: PMC10119324 DOI: 10.1097/htr.0000000000000820] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The construct of participation after traumatic brain injury (TBI) can be difficult to operationalize. Psychometric network analysis offers an empirical approach to visualizing and quantifying the associations between activities that comprise participation, elucidating the relations among the construct's components without assuming the presence of a latent common cause and generating a model to inform future measurement methods. The current research applied psychometric network analysis to the Participation Assessment with Recombined Tools-Objective (PART-O) within a sample of service members and veterans (SM/Vs) with a history of TBI at 1 and 2 years ( T1 and T2 ) postinjury. PARTICIPANTS Participants ( N = 663) were SM/Vs with a history of TBI who completed comprehensive inpatient rehabilitation services at a Department of Veterans Affairs (VA) Polytrauma Rehabilitation Center (PRC). SETTING Five VA PRCs. DESIGN Cross-sectional, retrospective analysis of data from the VA TBI Model Systems study. MAIN MEASURES PART-O. RESULTS Network analysis demonstrated that the PART-O structure was generally consistent over time, but some differences emerged. The greatest difference observed was the association between "spending time with friends" and "giving emotional support" to others. This association was more than twice as strong at T2 as at T1 . The "out of the house" item was most central, as demonstrated by dense connections within its own subscale (Out and About) and items in other subscales (ie, Social Relations and Productivity). When examining items connecting the 3 subscales, the items related to giving emotional support, internet use, and getting out of the house emerged as the strongest connectors at T1 , and the internet was the strongest connector at T2 . CONCLUSION Providing emotional support to others is associated with greater participation across multiple domains and is an important indicator of recovery. Being out and about, internet use, and engagement in productive activities such as school and work shared strong associations with Social Relations. Network analysis permits visual conceptualization of the dynamic constructs that comprise participation and has the potential to inform approaches to measurement and treatment.
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Affiliation(s)
- Samuel J West
- Departments of Surgery (Dr West), Psychology (Dr Perrin), and Physical Medicine and Rehabilitation (Dr Perrin), Virginia Commonwealth University (Ms Grover), Richmond; Central Virginia Veterans Affairs Health Care System, Richmond (Drs Klyce, Perrin, and Campbell and Ms Vargas); Virginia Commonwealth University Health System, Richmond (Dr Klyce); Sheltering Arms Institute, Richmond, Virginia (Dr Klyce); The Institute for Rehabilitation Research, Memorial Hermann, Houston, Texas (Dr Juengst); Departments of Rehabilitation and Human Performance (Dr Dams-O'Connor) and Neurology (Dr Dams-O'Connor), Icahn School of Medicine at Mount Sinai, New York City, New York; Rehabilitation & Extended Care Patient Service Line, Minneapolis VA Health Care System, Minneapolis, Minnesota (Dr Finn); Psychiatry and Behavioral Sciences, University of Minnesota-Twin Cities, Minneapolis (Dr Finn); Department of Research, Craig Hospital, Englewood, Colorado (Ms Eagye and Dr Agtarap); and VA Palo Alto Health Care System, Polytrauma System of Care, Palo Alto, California (Dr Chung)
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9
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Hauger SL, Borgen IMH, Forslund MV, Kleffelgård I, Andelic N, Løvstad M, Perrin PB, Røe C, Fure SCR. Participation in the Chronic Phase after Traumatic Brain Injury: Variations and Key Predictors. J Clin Med 2023; 12:5584. [PMID: 37685651 PMCID: PMC10488924 DOI: 10.3390/jcm12175584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Participation is of major importance for individuals with traumatic brain injury (TBI). This study evaluates participation over a period of one year among persons with TBI in the chronic phase and explores sociodemographic, psychological, and environmental predictors of levels and trajectories of participation. One hundred and twenty home-living survivors of TBI with persistent injury-related consequences at least two years post-injury who participated in a goal-oriented randomized trial were assessed at baseline and after four and twelve months. Linear mixed-effects model analysis was applied to evaluate height, trajectory slope, and predictors of the Participation Assessment with the Recombined Tools-Objective (PART-O) total score and the subscales Productivity, Social Relations, and Being Out and About. Being married, having a higher education, and having good global functioning predicted more frequent participation. Education, executive- and global functions predicted Productivity, while age and being married predicted Social Relations. Participating in the study during the COVID-19 pandemic had a negative impact on Productivity. Participation was relatively stable over 12 months, with a slight decline, but may be influenced by demographic factors and functional consequences. Rehabilitation services should particularly focus on people with TBI living alone with lower levels of global and executive function.
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Affiliation(s)
- Solveig L. Hauger
- Department of Research, Sunnaas Rehabilitation Hospital, 1453 Bjørnemyr, Norway;
- Department of Psychology, Faculty of Social Sciences, University of Oslo, 0316 Oslo, Norway
| | - Ida M. H. Borgen
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (I.M.H.B.); (M.V.F.); (I.K.); (N.A.); (C.R.); (S.C.R.F.)
| | - Marit V. Forslund
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (I.M.H.B.); (M.V.F.); (I.K.); (N.A.); (C.R.); (S.C.R.F.)
| | - Ingerid Kleffelgård
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (I.M.H.B.); (M.V.F.); (I.K.); (N.A.); (C.R.); (S.C.R.F.)
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (I.M.H.B.); (M.V.F.); (I.K.); (N.A.); (C.R.); (S.C.R.F.)
- Center for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, Faculty of Medicine, University of Oslo, 0316 Oslo, Norway
| | - Marianne Løvstad
- Department of Research, Sunnaas Rehabilitation Hospital, 1453 Bjørnemyr, Norway;
- Department of Psychology, Faculty of Social Sciences, University of Oslo, 0316 Oslo, Norway
| | - Paul B. Perrin
- Department of Psychology, School of Data Science, University of Virginia, Charlottesville, VA 22904, USA;
- Central Virginia Veterans Affairs Health Care System, Richmond, VA 23249, USA
| | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (I.M.H.B.); (M.V.F.); (I.K.); (N.A.); (C.R.); (S.C.R.F.)
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0316 Oslo, Norway
| | - Silje C. R. Fure
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (I.M.H.B.); (M.V.F.); (I.K.); (N.A.); (C.R.); (S.C.R.F.)
- Center for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, Faculty of Medicine, University of Oslo, 0316 Oslo, Norway
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10
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Akosile CO, Ngwu NP, Okonkwo UP, Onwuakagba IU, Okoye EC. Neighborhood safety, fall indices, physical activity level and social participation restrictions from a population of community-dwelling older adults in Nsukka, Enugu State, Nigeria. BMC Geriatr 2023; 23:358. [PMID: 37291512 PMCID: PMC10251530 DOI: 10.1186/s12877-023-04059-x] [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: 09/21/2022] [Accepted: 05/23/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Restriction in physical activity (PA) and social participation restriction (PR) can be heightened in the presence of fear of fall (FOF), fall experience, and perceived unsafe neighborhood, particularly among older adults. Despite the enormous benefits of social participation and physical activity, many older adults remain vulnerable to participation restriction and this probably accounts for a significant proportion of health challenges for older adults. OBJECTIVE This study investigated the relationship between neighborhood safety (NS), fall indices, physical activity, and social participation restriction among older adults from selected communities in Nsukka, Enugu state, Nigeria. METHODS This was a cross-sectional survey of 170 recruited via consecutive non-probability sampling techniques. Socio-demographic variables, co-morbidities, and fall prevalence were obtained using a self-administered questionnaire. The study instruments include the PA neighborhood environment scale - Nigeria (PANES-N), PA scale for elderly (PASE), Participation scale (PS), Modified fall efficacy scale (MFES), and Fall risk assessment tool (FRAT) and fall indices. STATISTICAL ANALYSIS Descriptive statistics of mean and standard deviations, frequency counts, and percentages were used to analyze the socio-demographic variables, and Inferential statistics of Spearman rank order correlation were used to determine the relationship among the neighborhood safety, fall indices, physical activity level, and participation restrictions. RESULTS PR has a negative relationship with NS (r = -0.19, p- 0.01), and fall efficacy (r = -0.52, p- 0.001). However, PR has a positive relationship with fall risk (r = 0.36, p = 0.001). CONCLUSION Participation restriction is negatively correlated with neighborhood safety, fall efficacy, and PA. The PR has a positive relationship with fall risk (FR).
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Affiliation(s)
- Christopher Olusanjo Akosile
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, Nnamdi Nnamdi Azikiwe University, Awka, Nigeria
| | - Nnaemeka Pascal Ngwu
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, Nnamdi Nnamdi Azikiwe University, Awka, Nigeria
| | - Uchenna Prosper Okonkwo
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, Nnamdi Nnamdi Azikiwe University, Awka, Nigeria
| | - Ifeoma Uchenna Onwuakagba
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, Nnamdi Nnamdi Azikiwe University, Awka, Nigeria
| | - Emmanuel Chiebuka Okoye
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, Nnamdi Nnamdi Azikiwe University, Awka, Nigeria
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11
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Borgen IMH, Løvstad M, Hauger SL, Forslund MV, Kleffelgård I, Andelic N, Sveen U, Søberg HL, Sigurdardottir S, Winter L, Lindstad MØ, Brunborg C, Røe C. Effect of an Individually Tailored and Home-Based Intervention in the Chronic Phase of Traumatic Brain Injury: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2310821. [PMID: 37145600 PMCID: PMC10163390 DOI: 10.1001/jamanetworkopen.2023.10821] [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] [Received: 12/19/2022] [Accepted: 03/14/2023] [Indexed: 05/06/2023] Open
Abstract
Importance Traumatic brain injury (TBI) can cause long-lasting and heterogeneous difficulties that require an individually tailored approach to rehabilitation. However, high-quality studies of treatment options in the chronic phase of TBI are lacking. Objective To evaluate the effect of a home-based, individualized, and goal-oriented rehabilitation intervention in the chronic phase of TBI. Design, Setting, and Participants This study was an intention-to-treat parallel-group assessor-blinded randomized clinical trial with 1:1 randomization to an intervention or control group. Participants included adults in southeastern Norway who had sustained a TBI more than 2 years earlier, lived at home, and had ongoing TBI-related difficulties. A population-based sample of 555 individuals were invited, and 120 were included. Participants were assessed at baseline, 4 months, and 12 months after inclusion. Specialized rehabilitation therapists provided the intervention in patients' homes or via video conference and telephone. Data collection was conducted between June 5, 2018, and December 14, 2021. Interventions The intervention group received an 8-session individually tailored and goal-oriented rehabilitation program over 4 months. The control group received usual care in their municipality. Main Outcomes and Measures Preestablished primary outcomes were disease-specific health-related quality of life (HRQOL; measured by the Quality of Life After Brain Injury [QOLIBRI] overall scale) and social participation (measured by the Participation Assessment With Recombined Tools-Objective [PART-O] social subscale). Preestablished secondary outcomes included generic HRQOL (measured by the EuroQol 5-dimension 5-level [EQ-5D-5L] questionnaire), difficulty with TBI-related problem management (target outcomes; mean severity calculated across 3 main self-identified problem areas that were individually measured using a 4-point Likert scale), TBI symptoms (measured by the Rivermead Post Concussion Symptoms Questionnaire [RPQ]), psychological distress (depression and anxiety; measured by the Patient Health Questionnaire 9-item scale and the Generalized Anxiety Disorder 7-item scale [GAD-7], respectively), and functional competency (measured by the Patient Competency Rating Scale). Results Among 120 participants in the chronic phase of TBI, the median (IQR) age was 47.5 (31.0-55.8) years, and the median (IQR) time since injury was 4 (3-6) years; 85 (70.8%) were male. A total of 60 participants were randomized to the intervention group, and 60 were randomized to the control group. Between baseline and 12 months, no significant between-group effects were found for the primary outcomes of disease-specific HRQOL (QOLIBRI overall scale score: 2.82; 97.5% CI, -3.23 to 8.88; P = .30) or social participation (PART-O social subscale score: 0.12; 97.5% CI, -0.14 to 0.38; P = .29). At 12 months, the intervention group (n = 57) had significantly higher generic HRQOL (EQ-5D-5L score: 0.05; 95% CI, 0.002-0.10; P = .04) and fewer symptoms of TBI (RPQ total score: -3.54; 95% CI, -6.94 to -0.14; P = .04) and anxiety (GAD-7 score: -1.39; 95% CI, -2.60 to -0.19; P = .02) compared with the control group (n = 55). At 4 months only, the intervention group (n = 59) had significantly less difficulty managing TBI-related problems (target outcomes mean severity score: -0.46, 95% CI, -0.76 to -0.15; P = .003) compared with the control group (n = 59). No adverse events were reported. Conclusions and Relevance In this study, no significant results were observed for the primary outcomes of disease-specific HRQOL or social participation. However, the intervention group reported improvements in secondary outcomes (generic HRQOL and symptoms of TBI and anxiety) that were maintained at 12-month follow-up. These findings suggest that rehabilitation interventions could help patients even in the chronic phase of TBI. Trial Registration ClinicalTrials.gov Identifier: NCT03545594.
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Affiliation(s)
- Ida M. H. Borgen
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Marianne Løvstad
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Solveig L. Hauger
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Marit V. Forslund
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Ingerid Kleffelgård
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Center for Habilitation and Rehabilitation Models and Services, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Unni Sveen
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Department for Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Helene L. Søberg
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | | | - Laraine Winter
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, Pennsylvania
| | - Marte Ørud Lindstad
- Department of Health Sciences in Gjøvik, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Gjøvik, Norway
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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12
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Wilson J, McGiffin JN, Smith M, Garduño-Ortega O, Talis E, Zarate A, Jenkins N, Rath JF, Bushnik T. Comparison of Informational and Educational Resource Provision for Individuals Living With Traumatic Brain Injury Based on Language, Nativity, and Neighborhood. J Head Trauma Rehabil 2023; 38:175-183. [PMID: 36730859 DOI: 10.1097/htr.0000000000000844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To examine a resource provision program for individuals living with moderate-to-severe traumatic brain injury (TBI), using a comparison of the resources provided across social differences of language, nativity, and neighborhood. SETTING The Rusk Rehabilitation TBI Model System (RRTBIMS) collects data longitudinally on individuals from their associated private and public hospitals, located in New York City. PARTICIPANTS A total of 143 individuals with TBI or their family members. DESIGN An observational study of relative frequency of resource provision across variables of language, nativity, and neighborhood, using related-samples nonparametric analyses via Cochran's Q test. MAIN MEASURES Variables examined were language, place of birth, residence classification as medically underserved area/population (MUA), and resource categories. RESULTS Results indicate that US-born persons with TBI and those living in medically underserved communities are provided more resources than those who are born outside the United States or reside in communities identified as adequately medically served. Language was not found to be a factor. CONCLUSION Lessons learned from this research support the development of this resource provision program, as well as guide future programs addressing the gaps in health information resources for groups negatively impacted by social determinants of health (SDoH). An approach with immigrant participants should take steps to elicit questions and requests, or offer resources explicitly. We recommend research looking at what interpreter strategies are most effective and research on SDoH in relation to the dynamic interaction of variables in the neighborhood setting.
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Affiliation(s)
- Judith Wilson
- Department of Occupational Therapy, Bellevue Hospital/NYU, New York, New York (Ms Wilson); and Rusk Rehabilitation, NYU Langone Health, New York, New York (Drs McGiffin, Talis, Rath, and Bushnik, Mss Smith, Garduño-Ortega, and Jenkins and Mr Zarate)
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13
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Guerrette MC, McKerral M. Predictors of Social Participation Outcome after Traumatic Brain Injury Differ According to Rehabilitation Pathways. J Neurotrauma 2023; 40:523-535. [PMID: 35974662 DOI: 10.1089/neu.2022.0232] [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: 11/13/2022] Open
Abstract
Social participation (SP) is one of many objectives in the rehabilitation of patients with traumatic brain injury (TBI). Studies on predictors of SP specific to post-acute universally accessible specialized rehabilitation pathways following TBI are scarce. Our objectives were to: 1) characterize SP, as well as a set of pre-injury, injury-related, and post-injury variables in individuals participating in inpatient-outpatient or outpatient rehabilitation pathways within a universally accessible and organized trauma continuum of care; and 2) examine the ability of pre-injury, injury-related, and post-injury variables in predicting SP outcome after TBI according to rehabilitation path. Participants (N = 372) were adults admitted to an inpatient-outpatient rehabilitation pathway or an outpatient rehabilitation pathway after sustaining a TBI between 2016 and 2020, and for whom Mayo-Portland Adaptability Intentory-4 (MPAI-4) outcomes were prospectively obtained at the start and end of rehabilitation. Additional data was collected from medical files. For both rehabilitation pathways, predicted SP outcome was MPAI-4 Participation score at discharge from outpatient rehabilitation. Multiple regression models investigated the predictive value of each variable for SP outcome, separately for each care pathway. Main findings show that for the inpatient-outpatient sample, three variables (education years, MPAI-4 Ability and Adjustment scores at rehabilitation intake) significantly predicted SP outcome, with the regression model accounting for 49% of the variance. For the outpatient sample, five variables (pre-morbid hypertension and mental health diagnosis, total indirect rehabilitation hours received, MPAI-4 Abilities and Adjustment scores at rehabilitation intake) significantly predicted SP outcome, with the regression model accounting for 47% of the variance. In conclusion, different pre-morbid and post-injury variables are involved in predicting SP, depending on the rehabilitation path followed. The predictive value of those variables could help clinicians identify patients more likely of showing poorer SP at discharge and who may require additional or different interventions.
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Affiliation(s)
- Marie-Claude Guerrette
- Department of Psychology, Université de Montréal, Center for Interdisciplinary Research in Rehabilitation of Greater Montreal-IURDPM, Montreal, Quebec, Canada
| | - Michelle McKerral
- Department of Psychology, Université de Montréal, Center for Interdisciplinary Research in Rehabilitation of Greater Montreal-IURDPM, Montreal, Quebec, Canada
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14
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Foote H, Bowen A, Cotterill S, Hill G, Pieri M, Patchwood E. A scoping review to identify process and outcome measures used in acceptance and commitment therapy research, with adults with acquired neurological conditions. Clin Rehabil 2022; 37:808-835. [PMID: 36540937 PMCID: PMC10134096 DOI: 10.1177/02692155221144554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Acceptance and Commitment Therapy interventions are increasing in use in neurological populations. There is a lack of information on the measures available. Purpose To identify and classify the measures used in Acceptance and Commitment Therapy research studies with adults with acquired neurological conditions. Methods PRISMA-ScR guided scoping review. MEDLINE, PsycInfo and CINAHL databases searched (up to date 29/06/2022) with forward and backward searching. All study types included. Extraction of Acceptance and Commitment Therapy process-of-change and health-related outcome measures. Outcomes coded using the Core Outcome Measures in Effectiveness Trials (COMET) taxonomy. Results Three hundred and thirty three papers found on searching. Fifty four studies included and 136 measurement tools extracted. Conditions included multiple sclerosis, traumatic brain injury and stroke. Thirty-eight studies measured processes of change, with 32 measures extracted. The process measure most often used was the Acceptance and Action Questionnaire ( n = 21 studies). One hundred and four health-related outcome measures extracted. Measures exploring quality of life, health status, anxiety and depression occurred most frequently, and were used in all included neurological conditions. COMET domains most frequently coded were emotional functioning/well-being ( n = 50), physical functioning ( n = 32), role functioning ( n = 22) and psychiatric ( n = 22). Conclusions This study provides a resource to support future identification of candidate measures. This could aid development of a Core Outcome Set to support both research and clinical practice. Further research to identify the most appropriate and relevant targets and tools for use in these populations should include expert consensus, patient, carer and public involvement and psychometric examination of measures.
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Affiliation(s)
- Hannah Foote
- Geoffrey Jefferson Brain Research
Centre, The Manchester Academic Health Science Centre, Northern Care Alliance and University of
Manchester, Manchester, UK
- Division of Neuroscience and
Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester,
Manchester, UK
- Hannah Foote, Geoffrey Jefferson Brain
Research Centre, The Manchester Academic Health Science Centre, Northern Care
Alliance and University of Manchester, Manchester, UK.
| | - Audrey Bowen
- Geoffrey Jefferson Brain Research
Centre, The Manchester Academic Health Science Centre, Northern Care Alliance and University of
Manchester, Manchester, UK
- Division of Neuroscience and
Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester,
Manchester, UK
| | - Sarah Cotterill
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Geoff Hill
- South Tees Hospitals NHS Foundation
Trust, The James Cook University Hospital, Middlesbrough, UK
| | | | - Emma Patchwood
- Geoffrey Jefferson Brain Research
Centre, The Manchester Academic Health Science Centre, Northern Care Alliance and University of
Manchester, Manchester, UK
- Division of Neuroscience and
Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester,
Manchester, UK
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15
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Coker J, Charlifue S, Botticello A, Tate DG, Philippus A, Strober L, Forchheimer M, Monden KR. A Study Protocol for a Multisite Randomized Controlled Trial of an Intervention to Improve Outcomes After Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2022; 28:44-55. [PMID: 36457362 PMCID: PMC9678223 DOI: 10.46292/sci22-00013] [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: 11/19/2022]
Abstract
Background The consequences of spinal cord injury (SCI) can place significant demands on an individual's coping mechanisms. Interventions to promote psychological adjustment and coping are often included in inpatient rehabilitation programs; however, following discharge, many individuals with SCI do not receive ongoing counseling or education about psychological adjustment to disability. Effective postacute treatment models are needed to help individuals with SCI build skills that help them adapt to the stresses associated with a chronic physical disability, alleviate the consequences of anxiety and depression, and enhance subjective well-being. Objectives To describe the protocol for a randomized clinical trial (RCT) of a 6-week intervention designed to improve psychosocial outcomes after SCI. Methods To test efficacy and replicability of the intervention, we designed a three-arm, multisite RCT with assessments conducted at six time points. Our primary hypothesis is that participants in the Group arm will report greater improvements in psychosocial outcomes than participants who complete the intervention individually via video (Individual arm) or those who do not receive the intervention (Control arm). We also hypothesize that participants in the Group arm will maintain greater improvements in psychosocial outcomes longer than those in the individual or control arms. Conclusion Results of the RCT will be presented and published to professionals and consumers, and intervention training and materials will be made available upon request.
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Affiliation(s)
| | | | | | | | - Angela Philippus
- Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | | | | | - Kimberley R. Monden
- Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
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16
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Jung W, Thompson HJ, Byun E. Social integration: A concept analysis. Nurs Forum 2022; 57:1551-1558. [PMID: 36403137 DOI: 10.1111/nuf.12843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 10/03/2022] [Accepted: 11/03/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND In recent decades, social isolation has been increasingly linked to serious health conditions. However, social integration (SI) is a complex concept that has not been systematically explored or defined in nursing. It is essential for nurses and healthcare providers to have a clearer concept of SI to better provide holistic care to support optimal health. PURPOSE This concept analysis aimed to clarify the concept of SI in health research and to identify attributes, antecedents, and consequences of the concept of SI to enhance understanding of the concept and its implications for human health. METHODS Walker and Avant's framework was used as the methodology for the concept analysis of SI. A literature search using PubMed, CINAHL, and Embase databases on SI was conducted with keywords: "integration," "social integration," "social relationships," "social participation," "community integration," "socialization." Studies included in the search were published from 2001 to 2021. RESULTS SI is affected by multidimensional individual, societal, and environmental factors. Defining attributes are productive activities, social relationships, community engagement, and leisure activities. SI is effective in promoting multiple aspects of health as well as healthy aging and overall well-being. CONCLUSION The analysis contributes to a comprehensive and fundamental understanding of SI and contributes to helping nurses better understand patients' circumstances that promote or inhibit SI. This knowledge will support the development of interventions that support optimal health and well-being, in assisting patients to remain integrated or reintegrate into society during and following an illness or injury.
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Affiliation(s)
- Wonkyung Jung
- School of Nursing, University of Washington, Seattle, Washington, USA
| | - Hilaire J Thompson
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington, USA
| | - Eeeseung Byun
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington, USA
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17
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Borgen IMH, Kleffelgård I, Hauger SL, Forslund MV, Søberg HL, Andelic N, Sveen U, Winter L, Løvstad M, Røe C. Patient-Reported Problem Areas in Chronic Traumatic Brain Injury. J Head Trauma Rehabil 2022; 37:E336-E345. [PMID: 34743086 DOI: 10.1097/htr.0000000000000744] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aims of this study were to (1) assess self-reported main problem areas reported by patients with traumatic brain injury (TBI) and their family members in the chronic phase, and (2) compare the self-prioritized problems with difficulties captured by questionnaires and neuropsychological screening through linking to the International Classification of Functioning, Disability and Health (ICF). SETTING Outpatient clinic at the Oslo University Hospital, Norway. PARTICIPANTS In total, 120 patients with TBI were recruited, of whom, 78 had a participating family member. Eligibility criteria were a clinical TBI diagnosis with verified intracranial injury, living at home, aged 18 to 72 years, 2 years or more postinjury, and experiencing perceived TBI-related difficulties, reduced physical and mental health, or difficulties with participation in everyday life. Patients with severe psychiatric or neurological disorders or inability to participate in goal-setting processes were excluded. DESIGN Cross-sectional. MAIN MEASURES Target Outcomes, that is, 3 main TBI-related problem areas reported by patients and family members, collected in a semistructured interview; standardized questionnaires of TBI-related symptoms, anxiety, depression, functioning, and health-related quality of life; neuropsychological screening battery. RESULTS Target Outcomes were related to cognitive, physical, emotional, and social difficulties. Target Outcomes were linked to 12 chapters and 112 distinct categories in the ICF, while standardized measures only covered 10 chapters and 28 categories. Some aspects of post-TBI adjustment were found to be insufficiently covered by the ICF classification, such as identity issues, lack of meaningful activities, and feeling lonely. CONCLUSION The Target Outcomes approach is a useful assessment method in a population with chronic TBI. The standardized questionnaires capture the spectrum of problems, whereas the Target Outcomes approach captures the prioritized individual problems hindering everyday life after TBI. While the standardized measures are an irreplaceable part of the assessment, Target Outcomes ensures patient involvement and may help clinicians better tailor relevant rehabilitation efforts.
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Affiliation(s)
- Ida M H Borgen
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway (Ms Borgen and Drs Kleffelgård, Forslund, Søberg, Andelic, Sveen, and Røe); Department of Psychology, Faculty of Social Sciences (Ms Borgen and Drs Hauger and Løvstad), Institute of Clinical Medicine, Faculty of Medicine (Dr Røe), and Center for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society (Drs Andelic and Røe), University of Oslo, Oslo, Norway; Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway (Drs Hauger and Løvstad); Departments of Physiotherapy (Dr Søberg) and Occupational Therapy Prosthetics and Orthotics (Dr Sveen), Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway; and M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, Pennsylvania (Dr Winter)
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18
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Caron L, Ouellet MC, Hudon C, Predovan D, Sirois MJ, de Guise É, Lamontagne MÈ, Émond M, Le Sage N, Beaulieu-Bonneau S. Cognitive functioning following traumatic brain injury in older adults: associations with social participation and health-related quality of life. Brain Inj 2022; 36:1099-1108. [PMID: 35994259 DOI: 10.1080/02699052.2022.2110284] [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
OBJECTIVES To describe objective and subjective cognitive functioning older adults who sustained TBI at age 65 or over, and to determine whether cognitive functioning is associated with health-related quality of life (HRQoL) and social participation. METHOD The sample consisted of 40 individuals with TBI (mean age = 73 years; 65% mild, 35% moderate/severe TBI). On average 15 months post-injury, they completed measures of objective and subjective cognitive functioning (Telephone Interview for Cognitive Status-Modified, Alphaflex, Medical Outcomes Study Cognitive Functioning Scale), HRQoL (SF-12), and social participation (Participation Assessment with Recombined Tools - Objective). RESULTS Mean score for objective cognitive functioning was lower than normative values, while mean scores for executive functioning and subjective cognitive functioning were comparable to normative values. There was no relationship between objective and subjective measures. Subjective cognitive functioning and (to a lesser extent) global objective cognitive functioning were significantly associated with mental HRQoL but not with physical HRQoL or social participation. CONCLUSION These results underscore the importance of considering both subjective perception and objective performance when assessing and intervening on cognition to promote better mental HRQoL in older adults with TBI.
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Affiliation(s)
- Laurence Caron
- École de Psychologie, Faculté des Sciences Sociales, Université Laval, Québec, QC, Canada.,Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, CIUSSS de la Capitale-Nationale, Québec, QC, Canada
| | - Marie-Christine Ouellet
- École de Psychologie, Faculté des Sciences Sociales, Université Laval, Québec, QC, Canada.,Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, CIUSSS de la Capitale-Nationale, Québec, QC, Canada.,Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Carol Hudon
- École de Psychologie, Faculté des Sciences Sociales, Université Laval, Québec, QC, Canada.,Centre de Recherche CERVO Brain Research Center, Québec, QC, Canada
| | - David Predovan
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, CIUSSS de la Capitale-Nationale, Québec, QC, Canada
| | - Marie-Josée Sirois
- Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada.,Département de Réadaptation, Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - Élaine de Guise
- Département de Psychologie, Université de Montréal, Québec, QC, Canada
| | - Marie-Ève Lamontagne
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, CIUSSS de la Capitale-Nationale, Québec, QC, Canada.,Département de Réadaptation, Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - Marcel Émond
- Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada.,Département de Médecine Familiale et de Médecine d'urgence, Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - Natalie Le Sage
- Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada.,Département de Médecine Familiale et de Médecine d'urgence, Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - Simon Beaulieu-Bonneau
- École de Psychologie, Faculté des Sciences Sociales, Université Laval, Québec, QC, Canada.,Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, CIUSSS de la Capitale-Nationale, Québec, QC, Canada
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Hart T, Rabinowitz A. Changes in social participation between 1 and 2 years following moderate-severe traumatic brain injury. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:945699. [PMID: 36189074 PMCID: PMC9397871 DOI: 10.3389/fresc.2022.945699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/27/2022] [Indexed: 11/23/2022]
Abstract
Objective To examine patterns of change in social participation in persons with moderate-severe traumatic brain injury (msTBI) between 1 and 2 years postinjury, and predictors of observed change. Participants 375 participants with msTBI enrolled in a single TBI Model System site. Measures and Methods The dependent variable in a linear regression was a reliable change score for the Social Relations subscale of the Participation Assessment with Recombined Tools-Objective, administered at 1- and 2-year follow-ups. Predictors of change included demographics, injury severity, social and functional status at Year 1, and changes in function and life circumstances between years 1 and 2. Results Social participation status did not change substantially for 34 of the sample, while approximately equal proportions of the remainder improved or declined. The regression model was significant (p < 0.001). Improvement was predicted by private vs. public insurance and decline was predicted by a reduction in the FIM functional outcome measure from year 1 to year 2. Marginal predictors included education (higher levels predicting improvement) and year 1 marital status (single status predicting decline). Conclusions Longitudinal change in social participation in the chronic phase of msTBI deserves further study, with attention to resource limitations and the impact of changes in functional status.
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Kersey J, Hammel J, Baum C, Huebert K, Malagari E, Terhorst L, McCue M, Skidmore ER. Effect of interventions on activity and participation outcomes for adults with brain injury: a scoping review. Brain Inj 2022; 36:21-31. [DOI: 10.1080/02699052.2022.2034043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Jessica Kersey
- Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, Pennsylvania, USA
| | - Joy Hammel
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Carolyn Baum
- Program in Occupational Therapy, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Kelly Huebert
- Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, Pennsylvania, USA
| | - Emily Malagari
- Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, Pennsylvania, USA
| | - Lauren Terhorst
- Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, Pennsylvania, USA
| | - Michael McCue
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Elizabeth R. Skidmore
- Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, Pennsylvania, USA
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21
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Sanchez-Lara E, Lozano-Ruiz A, Rute-Perez S, Saez-Sanz N, Bombin I, Caracuel A. Participation Predicts Cognitive Functioning in Older Adults Using the PART-O Transformed Scores Systems. J Appl Gerontol 2022; 41:1081-1089. [PMID: 35114842 DOI: 10.1177/07334648211057096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Participation has been shown to be a protective factor for cognition in older adults, but instruments to assess it are limited. The main objective was to determine the validity of two scoring systems (direct vs transformed) for the Participation Assessment with Recombined Tools-Objective (PART-O) by applying structural equation modeling to the relationship between the subscales and the cognitive functions, in a sample of 245 people over 60 years of age. The transformed scores model showed stronger relationships and larger explained variance in overall participation (55.4% vs 37.4%), especially in the Social Relations subscale (31.4% vs 14.6%). Participation was a direct predictor of cognitive functions in both models. Age and depression inversely influenced participation in the transformed scores model. The proposed score transformation for the PART-O provides a more appropriate measurement of the older adults' participation. Participation has a mediating role in the relationship between cognition and both age and depression.
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Affiliation(s)
| | - Alvaro Lozano-Ruiz
- Mind, Brain, and Behavior Research Center (CIMCYC), 16741University of Granada, Granada, Spain.,Department of Personality, Evaluation, and Psychological Treatment, 16741University of Granada, Granada, Spain
| | - Sandra Rute-Perez
- Mind, Brain, and Behavior Research Center (CIMCYC), 16741University of Granada, Granada, Spain.,Department of Developmental and Educational Psychology, 16741University of Granada, Granada, Spain
| | - Noelia Saez-Sanz
- Mind, Brain, and Behavior Research Center (CIMCYC), 16741University of Granada, Granada, Spain
| | - Igor Bombin
- Reintegra Foundation, Centro de Rehabilitación Neurologica, Oviedo, Spain
| | - Alfonso Caracuel
- Mind, Brain, and Behavior Research Center (CIMCYC), 16741University of Granada, Granada, Spain.,Department of Developmental and Educational Psychology, 16741University of Granada, Granada, Spain
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22
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Benavides AM, Finn JA, Tang X, Ropacki S, Brown RM, Smith AN, Stevens LF, Rabinowitz AR, Juengst SB, Johnson-Greene D, Hart T. Psychosocial and Functional Predictors of Depression and Anxiety Symptoms in Veterans and Service Members With TBI: A VA TBI Model Systems Study. J Head Trauma Rehabil 2021; 36:397-407. [PMID: 33656470 DOI: 10.1097/htr.0000000000000647] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify psychosocial and functional predictors of self-reported depression and anxiety symptoms at year 2 following traumatic brain injury (TBI). SETTING Five Department of Veterans Affairs (VA) Polytrauma Rehabilitation Centers (PRCs) within the TBI Model Systems (TBIMS). PARTICIPANTS A total of 319 service members/veterans enrolled in VA TBIMS who were eligible for and completed both 1- and 2-year follow-up evaluations. DESIGN Secondary analysis from multicenter prospective longitudinal study. MAIN MEASURES Demographic, injury-related, military, mental health, and substance use variables. Questionnaires included the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Neurobehavioral Symptom Inventory. Rating scales included the Participation Assessment with Recombined Tools-Objective and Disability Rating Scale. RESULTS The final sample was largely male (96%) and predominantly White (65%), with a median age of 27 years. In unadjusted analyses, pre-TBI mental health treatment history and year 1 employment status, community activity, sleep difficulties, and self-reported depression and anxiety symptoms were associated with year 2 PHQ-9 scores; pre-TBI mental health treatment history and year 1 community activity, social contact, problematic substance use, sleep difficulties, and self-reported depression and anxiety symptoms were associated with year 2 GAD-7 scores. In multivariable analyses, only year 1 community activity and depression symptoms uniquely predicted year 2 PHQ-9 scores, and only year 1 employment status, community activity, problematic substance use, and anxiety symptoms uniquely predicted year 2 GAD-7 scores. CONCLUSION Anxiety and depression commonly occur after TBI and are important treatment targets. Some predictors (eg, participation and substance use) are modifiable and amenable to treatment as well. Early identification of anxiety and depression symptoms is key.
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Affiliation(s)
- Angela M Benavides
- Extended Care & Rehabilitation, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota (Drs Benavides and Finn); Department of Psychiatry, University of Minnesota-Twin Cities, Minneapolis (Dr Finn); Biostatistics Program, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock (Dr Tang); Polytrauma System of Care, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Dr Ropacki); Center of Innovation for Disability and Rehabilitation Research, James A. Haley Veterans Affairs Medical Center, and Department of Anthropology, University of South Florida, Tampa, Florida (Dr Brown); Defense and Veterans Brain Injury Center, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia (Mr Smith and Dr Stevens); Departments of Psychology and Physical Medicine & Rehabilitation, Virginia Commonwealth University, Richmond (Dr Stevens); Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania (Drs Rabinowitz and Hart); Department of Rehabilitation, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania (Dr Rabinowitz); Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas (Dr Juengst); and Department of Physical Medicine and Rehabilitation, Miller School of Medicine, University of Miami, Miami, Florida (Dr Johnson-Greene)
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23
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Stevens LF, Ketchum JM, Sander AM, Callender L, Dillahunt-Aspillaga C, Dreer LE, Finn JA, Gary KW, Graham KM, Juengst SB, Kajankova M, Kolakowsky-Hayner S, Lequerica AH, Rabinowitz AR. Race/Ethnicity and Community Participation Among Veterans and Service Members With Traumatic Brain Injury: A VA Traumatic Brain Injury Model Systems Study. J Head Trauma Rehabil 2021; 36:408-417. [PMID: 33656479 DOI: 10.1097/htr.0000000000000657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine racial/ethnic disparities in community participation among veterans and active duty service members with traumatic brain injury (TBI). SETTING Five Department of Veterans Affairs (VA) TBI Model Systems (TBIMS) Polytrauma Rehabilitation Centers (PRCs). Participants: Three hundred forty-two community-dwelling adults (251 White, 34 Black, and 57 Hispanic) with TBI enrolled in the VA TBIMS National Database who completed a 1-year follow-up interview. Mean age was 38.6 years (range, 19-84 years). DESIGN Cross-sectional analysis of a prospective observational cohort study. Main Measures: Community participation at 1 year postinjury assessed by 3 domains of the Participation Assessment with Recombined Tools-Objective (PART-O): Out & About, Productivity, and Social Relations. RESULTS Significant differences were observed among race/ethnicity groups in PART-O Productivity and Out & About domains without controlling for relevant participant characteristics; Productivity scores were significantly higher for non-Hispanic Black than for non-Hispanic White participants (t = 2.40, P = .0169). Out & About scores were significantly higher for Hispanic than for non-Hispanic White participants (t = 2.79, P = .0056). However, after controlling for demographic, injury severity, and 1-year follow-up characteristics, only differences in the Out & About domain remained statistically significant (t = 2.62, P = .0094), with scores being significantly higher for Hispanics than for non-Hispanic Whites. CONCLUSIONS The results, which differ from findings from studies conducted in non-VA healthcare settings where there are greater racial/ethnic disparities in participation outcomes, could reflect differences between military and civilian samples that may reduce disparities.
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Affiliation(s)
- Lillian Flores Stevens
- Departments of Psychology and Physical Medicine and Rehabilitation, Virginia Commonwealth University, and Defense and Veterans Brain Injury Center (DVBIC), Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia (Dr Stevens); Research Department, Craig Hospital, Englewood, Colorado (Dr Ketchum); Research Services, James A. Haley Veterans Hospital, Tampa, Florida (Drs Ketchum and Dillahunt-Aspillaga); H. Ben Taub Department of Physical Medicine & Rehabilitation, Baylor College of Medicine and Harris Health System, and Brain Injury Research Center, TIRR Memorial Herman, Houston, Texas (Dr Sander); Baylor Research Institute at Baylor Institute for Rehabilitation, Dallas, Texas (Ms Callender); Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, Texas (Dr Juengst); Rehabilitation and Mental Health Counseling Program, Department of Child and Family Studies, College of Family and Community Sciences, University of South Florida, Tampa (Dr Dillahunt-Aspillaga); Departments of Physical Medicine and Rehabilitation and Ophthalmology and Visual Sciences, University of Alabama at Birmingham (Dr Dreer); Minneapolis Veterans Affairs Health Care System, and Department of Psychiatry, University of Minnesota-Twin Cities, Minneapolis (Dr Finn); Department of Rehabilitation Counseling, Virginia Commonwealth University, Richmond (Dr Gary); Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York City, New York (Drs Kajankova and Kolakowsky-Hayner); Kessler Foundation, East Hanover, New Jersey (Dr Lequerica); Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark (Dr Lequerica); and Moss Rehabilitation Research Institute, Elkins, Pennsylvania (Dr Rabinowitz)
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24
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Kersey J, Terhorst L, Hammel J, Baum C, Toglia J, O'Dell MW, Heinemann AW, McCue M, Skidmore ER. Detecting change in community participation with the Enfranchisement scale of the community participation indicators. Clin Rehabil 2021; 36:251-262. [PMID: 34723687 DOI: 10.1177/02692155211052188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study determined the sensitivity to change of the Enfranchisement scale of the Community Participation Indicators in people with stroke. DATA SOURCES We analyzed data from two studies of participants with stroke: an intervention study and an observational study. MAIN MEASURES The Enfranchisement Scale contains two subscales: the Importance subscale (feeling valued by and contributing to the community; range: 14-70) and the Control subscale (choice and control: range: 13-64). DATA ANALYSIS Assessments were administered 6 months apart. We calculated minimum detectable change and minimal clinically important difference. RESULTS The Control subscale analysis included 121 participants with a mean age of 61.2 and mild-moderate disability (Functional Independence Measure, mean = 97.9, SD = 24.7). On the Control subscale, participants had a mean baseline score of 51.4 (SD = 10.4), and little mean change (1.3) but with large variation in change scores (SD = 11.5). We found a minimum detectable change of 9 and a minimum clinically important difference of 6. The Importance subscale analysis included 116 participants with a mean age of 60.7 and mild-moderate disability (Functional Independence Measure, mean = 98.9, SD = 24.5). On the Importance subscale, participants had a mean baseline score of 44.1 (SD = 12.7), and again demonstrated little mean change (1.08) but with large variation in change scores (SD = 12.6). We found a minimum detectable change of 11 and a minimum clinically important difference 7. CONCLUSIONS The Control subscale required 9 points of change, and the Importance subscale required 11 points of change, to achieve statistically and clinically meaningful changes, suggesting adequate sensitivity to change.
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Affiliation(s)
- Jessica Kersey
- OTR/L, Department of Occupational Therapy, 6614University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, PA, USA
| | - Lauren Terhorst
- Department of Occupational Therapy, 6614University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, PA, USA
| | - Joy Hammel
- OTR/L, Department of Occupational Therapy, 14681University of Illinois at Chicago, Chicago, IL, USA
| | - Carolyn Baum
- OTR/L, Program in Occupational Therapy and Departments of Neurology & Social Work, 7548Washington University in St Louis, St Louis, MO, USA
| | - Joan Toglia
- OTR/L, School of Health and Natural Sciences, 2986Mercy College, Dobbs Ferry, NY, USA
| | - Michael W O'Dell
- Department of Rehabilitation Medicine, 116366New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
| | - Allen W Heinemann
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael McCue
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Elizabeth R Skidmore
- OTR/L, Department of Occupational Therapy, 6614University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, PA, USA
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25
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Corrigan JD, Vuolo M, Bogner J, Botticello AL, Pinto SM, Whiteneck GG. Do state supports for persons with brain injury affect outcomes in the 5 Years following acute rehabilitation? Health Place 2021; 72:102674. [PMID: 34700065 DOI: 10.1016/j.healthplace.2021.102674] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 08/11/2021] [Accepted: 09/17/2021] [Indexed: 10/20/2022]
Abstract
While a substantial literature has examined the effects of individual and family-level factors on outcomes following traumatic brain injury (TBI), minimal attention has been directed to the potential influence of the larger environmental context on outcomes. The purpose of the current study was to investigate the effects of state-level resources and supports as an environmental factor influencing long-term outcomes from TBI using data from the TBI Model Systems. We examined the effects of U.S. state supports that specifically target people with TBI (federal funding for state brain injury programs, per capita revenue generated by brain injury trust funds, and expenditures for brain injury specific Medicaid waivers) and one measure of the relative quality of a state's Long-Term Services and Supports (LTSS) for all people with disabilities. The primary hypothesis was that community participation, global functioning, and life satisfaction will be higher on average among people with TBI living in states with more brain injury specific programs and resources and better LTSS. The results of multilevel and fixed-effects modeling indicated that state supports have a small but significant impact on participation and life satisfaction. The most consistent finding indicated that states with better LTSS had higher levels of community participation and life satisfaction on average for people with TBI over and above individual-level differences and fluctuations in these outcomes over time. There was some indication that more brain injury specific supports also result in better participation in the community. These findings deserve replication and extension to include other environmental factors, particularly community level characteristics, that might affect outcomes from TBI.
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Affiliation(s)
| | - Mike Vuolo
- The Ohio State University, Columbus, OH, USA
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26
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Assessment of Participation within the International Classification of Functioning, Disability, and Health (ICF): The Turkish Validity and Reliability of the Participation Scale. Occup Ther Int 2021; 2021:6658773. [PMID: 34629995 PMCID: PMC8481058 DOI: 10.1155/2021/6658773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 08/23/2021] [Accepted: 08/27/2021] [Indexed: 11/18/2022] Open
Abstract
Objective The aim of the study was to investigate the reliability and validity of the Turkish version of the Participation Scale (P-Scale). Methods A total of 152 students, with a mean age of 20.27 ± 2.19, participated in the study. Sociodemographic information (age, gender, and family income) was recorded; all participants completed the P-Scale twice with a 15-day interval. Translation and cross-cultural adaptation were performed to analyze the validity and reliability of the P-Scale. Cronbach's alpha and McDonald's alpha were used for scale reliability statistics and explanatory (EFA) and confirmatory (CFA) factor analysis; Mardia's multivariate normality and assumption tests were used for the validity of the scale. The factor extraction methods were minimum rank factor analysis in EFA and weighted least squares mean and variance adjusted estimator polychoric correlation matrix in CFA. Results Internal consistency of the scale was found good with Cronbach's alpha (0.852) and excellent with McDonald's alpha (0.924). The EFA and CFA resulted in two-factored structure, with the explained variance found to be higher than 30%. Conclusions Analysis demonstrated that the P-Scale had a satisfactory level of reliability and validity in Turkish university students.
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27
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Rabinowitz AR, Kumar RG, Sima A, Venkatesan UM, Juengst SB, O'Neil-Pirozzi TM, Watanabe TK, Goldin Y, Hammond FM, Dreer LE. Aging with Traumatic Brain Injury: Deleterious Effects of Injury Chronicity Are Most Pronounced in Later Life. J Neurotrauma 2021; 38:2706-2713. [PMID: 34082606 PMCID: PMC8822416 DOI: 10.1089/neu.2021.0038] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Understanding the effects of age on longitudinal traumatic brain injury (TBI) outcomes requires attention to both chronic and evolving TBI effects and age-related changes in health and function. The present study examines the independent and interactive effects of aging and chronicity on functional outcomes after TBI. We leveraged a well-defined cohort of individuals who sustained a moderate/severe TBI and received acute inpatient rehabilitation at specialized centers with high follow up rate as part of their involvement in the TBI Model Systems longitudinal study. We selected individuals at one of two levels of TBI chronicity (either 2 or 10 years post-injury) and used an exact matching procedure to obtain balanced chronicity groups based on age and other characteristics (N = 1993). We found that both older age and greater injury chronicity were related to greater disability, reduced functional independence, and less community participation. There was a significant age by chronicity interaction, indicating that the adverse effects of greater time post-injury were most pronounced among survivors who were age 75 or older. The inflection point at roughly 75 years of age was corroborated by post hoc analyses, dividing the sample by age at 75 years and examining the interaction between age group and chronicity. These findings point to a need for provision of rehabilitation services in the chronic injury period, particularly for those who are over 75 years old. Future work should investigate the underlying mechanisms of this interaction towards the goal of developing interventions and models of care to promote healthy aging with TBI.
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Affiliation(s)
| | - Raj G. Kumar
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Adam Sima
- Corrona, LLC, Waltham, Massachusetts, USA
| | | | - Shannon B. Juengst
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Therese M. O'Neil-Pirozzi
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
- Department of Communication Sciences and Disorders, Northeastern University, Charlestown, Massachusetts, USA
| | | | - Yelena Goldin
- Department of Cognitive Rehabilitation, Hackensack Meridian JFK University Medical Center, Edison, New Jersey, USA
- Department of Physical Medicine and Rehabilitation, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Flora M. Hammond
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine Rehabilitation Hospital of Indiana, Indianapolis, Indiana, USA
| | - Laura E. Dreer
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama, USA
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28
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Beaulieu CL, Peng J, Hade EM, Montgomery E, Gilchrist K, Corrigan JD, Horn SD, Bogner J. Quasi-Contextualized Speech Treatment in Traumatic Brain Injury Inpatient Rehabilitation: Effects on Outcomes During the First Year After Discharge. J Head Trauma Rehabil 2021; 36:E312-E321. [PMID: 33656472 DOI: 10.1097/htr.0000000000000649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the effect of providing quasi-contextualized speech therapy, defined as metacognitive, compensatory, or strategy training applied to cognitive and language impairments to facilitate the performance of future real-life activities, on functional outcomes up to 1 year following traumatic brain injury (TBI). SETTING Acute inpatient rehabilitation. PARTICIPANTS Patients enrolled during the TBI-Practice-Based Evidence (TBI-PBE) study (n = 1760), aged 14 years or older, who sustained a severe, moderate, or complicated mild TBI, received speech therapy in acute inpatient rehabilitation at one of 9 US sites, and consented to follow-up 3 and 9 months postdischarge from inpatient rehabilitation. DESIGN Propensity score methods applied to a database consisting of multisite, prospective, longitudinal observational data. MAIN MEASURES Participation Assessment with Recombined Tools-Objective-17, FIM Motor and Cognitive scores, Satisfaction With Life Scale, and Patient Health Questionnaire-9. RESULTS When at least 5% of therapy time employed quasi-contextualized treatment, participants reported better community participation during the year following discharge. Quasi-contextualized treatment was also associated with better motor and cognitive function at discharge and during the year after discharge. The benefit, however, may be dependent upon a balance of rehabilitation time that relied on contextualized treatment. CONCLUSIONS The use of quasi-contextualized treatment may improve outcomes. Care should be taken, however, to not provide quasi-contextualized treatment at the expense of contextualized treatment.
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Affiliation(s)
- Cynthia L Beaulieu
- Division of Rehabilitation Psychology, Department of Physical Medicine and Rehabilitation, The Ohio State University College of Medicine, Columbus (Drs Beaulieu, Corrigan, and Bogner); Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus (Dr Hade and Ms Peng); Department of Rehabilitation Services, The Ohio State University Medical Center, Columbus (Ms Montgomery); Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (Dr Horn); and Speech Pathology Department, Intermountain Medical Center, Murray, Utah (Ms Gilchrist)
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29
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Niemeier JP, Hammond FM, O'Neil-Pirozzi TM, Venkatesan UM, Bushnik T, Zhang Y, Kennedy RE. Refining understanding of life satisfaction in elderly persons with traumatic brain injury using age-defined cohorts: a TBI model systems study. Brain Inj 2021; 35:1284-1291. [PMID: 34516315 DOI: 10.1080/02699052.2021.1972153] [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: 10/20/2022]
Abstract
OBJECTIVE Examine effects of age cohort on post-injury life satisfaction in elderly persons with TBIDesign: Retrospective cohortSetting: TBI Model Systems centers. PARTICIPANTS 5,109 elderly participants with TBI in the TBI Model Systems National DatabaseInterventions: Not applicableMain Outcome Measures: Demographics, injury characteristics and cause, outcomes, age at time of analysis, time to follow commands, maximum follow-up period, and scores on the Satisfaction With Life Scale (SWLS) and Participation Assessment with Recombined Tools-Objective (PART-O) scores at 1, 2, 5, or 10 years post-injury. RESULTS Life satisfaction post-TBI across groups increased with age. The young-old sub-group demonstrated the poorest life satisfaction outcomes, while the oldest sub-group experienced greatest life satisfaction. In contrast, participation decreased with age. CONCLUSIONS Findings show diversity in satisfaction with life following moderate to severe TBI for three elderly age-cohorts. Differences may be due to variations in generation-based lived experience, in perceived meaningfulness of participation, could echo prior evidence of greater resilience in the oldest group, or could reflect bias within the study sample. Further research into between- and within- differences for elderly TBI age cohorts is needed to more precisely meet their needs for physical and functional rehabilitation as well as psychological supports.
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Affiliation(s)
- Janet P Niemeier
- Department of Psychology, University of Alabama, Birmingham, Alabama, United States
| | - Flora M Hammond
- Indiana University School of Medicine, Rehabilitation Hospital of Indiana, Indianapolis, Indiana, United States
| | - Therese M O'Neil-Pirozzi
- Spaulding Rehabilitation Hospital, Northeastern University, Boston, Massachusetts, United States
| | | | - Tamara Bushnik
- Rusk Rehabilitation, New York University Langone Health, New York, New York, United States
| | - Yue Zhang
- University of Alabama, Birmingham, Alabama, United States
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30
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Sander AM, Ketchum JM, Lequerica AH, Pappadis MR, Bushnik T, Hammond FM, Sevigny M. Primary Language and Participation Outcomes in Hispanics With Traumatic Brain Injury: A Traumatic Brain Injury Model Systems Study. J Head Trauma Rehabil 2021; 36:E218-E225. [PMID: 33656477 PMCID: PMC8249338 DOI: 10.1097/htr.0000000000000655] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the relationship between primary language and participation outcomes in English- and Spanish-speaking persons with complicated mild to severe traumatic brain injury (TBI) at 1 year post-injury. SETTING Community following discharge from inpatient rehabilitation. PARTICIPANTS A total of 998 Hispanic participants with outcomes available at year 1 follow-up; 492 (49%) indicated English as their primary language and 506 (51%) indicated Spanish as their primary language. DESIGN Prospective, multicenter, cross-sectional, observational cohort study. MAIN MEASURES Community participation at 1 year post-injury was assessed by 3 domains of the Participation Assessment with Recombined Tools-Objective (PART-O): Out and About, Productivity, and Social Relations. RESULTS Unadjusted group comparisons showed better participation outcomes for English versus Spanish speakers for all PART-O domains and for the Balanced Total score. After controlling for relevant covariates, English-speaking participants had significantly better PART-O Balanced Total scores and better scores on the Social Relations domain, although effect sizes were small. CONCLUSIONS Hispanic persons with TBI whose primary language is Spanish may require greater assistance integrating socially back into their communities after TBI. However, potential cultural differences in value placed on various social activities must be considered. Potential cultural bias inherent in existing measures of participation should be investigated in future studies.
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Affiliation(s)
- Angelle M Sander
- Department of Physical Medicine & Rehabilitation, Baylor College of Medicine and Harris Health System, Houston, Texas (Dr Sander); Brain Injury Research Center, TIRR Memorial Herman, Houston, Texas (Drs Sander and Pappadis); Research Department, Craig Hospital, Englewood, Colorado (Dr Ketchum and Mr Sevigny); Kessler Foundation, East Hanover, New Jersey, and Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark, New Jersey (Dr Lequerica); Division of Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch at Galveston, Galveston, Texas (Dr Pappadis); Rusk Rehabilitation and NYU Langone Health, New York, New York (Dr Bushnik); and Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana (Dr Hammond)
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Kim YJ, Joshi V, Wu Q. Subjective factors of depressive symptoms, ambulation, pain, and fatigue are associated with physical activity participation in cardiac arrest survivors with fatigue. Resusc Plus 2021; 5:100057. [PMID: 34223329 PMCID: PMC8244480 DOI: 10.1016/j.resplu.2020.100057] [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] [Received: 07/02/2020] [Revised: 11/18/2020] [Accepted: 11/21/2020] [Indexed: 02/08/2023] Open
Abstract
AIM This study aimed to examine the associations between participation in physical activities and objective and subjective factors modifiable by rehabilitation in cardiac arrest survivors with fatigue. METHODS Participants in a clinical feasibility study (N = 19) completed several subjective (patient-reported) and objective outcome measures on one occasion only. The associations between an individual's level of participation in physical activities (Participation Objective Participation Subjective) and their levels of cognition (Computer Assessment of Mild Cognitive Impairment), body movement (Keitel Functional Test), depressive symptoms (Center for Epidemiologic Studies Depression Scale), ambulation and pain (Health Utilities Index Mark 3), and fatigue impact (Modified Fatigue Impact Scale) were explored. Pearson's correlation coefficientr was calculated for all associations, except for body movement (Spearman's correlation coefficient rs ). RESULTS As hypothesized, we found weak-to-moderate, positive associations between participation in physical activities and objective factors of cognition (r = 0.370) and body movement (rs = 0.414) and a subjective factor of ambulation ability (r = 0.501). We found moderate, negative associations between participation in physical activities and subjective factors of depressive symptoms (r=-0.590), pain (r=-0.495), physical fatigue impact (r=-0.629), cognitive fatigue impact (r=-0.591), and psychosocial fatigue impact (r=-0.557). CONCLUSION The moderate, negative and positive associations between participation in physical activities and subjective factors suggest that subjective complaints of depressive symptoms, ambulation ability, pain, and fatigue impact may be important factors when seeking to improve participation in physical activities. In particular, addressing physical and cognitive endurance as well as perceptions of fatigue may hold the key to increasing physical activity in cardiac arrest survivors with fatigue.
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Affiliation(s)
- Young Joo Kim
- 600 Moye Blvd, MS668, HSB3305, Department of Occupational Therapy, College of Allied Health Sciences, East Carolina University, Greenville, NC, 27834, USA
| | - Vicky Joshi
- Danish Knowledge Centre for Rehabilitation and Palliative Care (REHPA), University of Southern Denmark, and Odense University Hospital, Denmark
| | - Qiang Wu
- 600 Moye Blvd, 2209 East Carolina Heart Institute, Department of Biostatistics, College of Allied Health Sciences, East Carolina University, Greenville, NC, 27834, USA
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Fann JR, Hart T, Ciol MA, Moore M, Bogner J, Corrigan JD, Dams-O'Connor K, Driver S, Dubiel R, Hammond FM, Kajankova M, Watanabe TK, Hoffman JM. Improving transition from inpatient rehabilitation following traumatic brain injury: Protocol for the BRITE pragmatic comparative effectiveness trial. Contemp Clin Trials 2021; 104:106332. [PMID: 33652127 DOI: 10.1016/j.cct.2021.106332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/15/2021] [Accepted: 02/22/2021] [Indexed: 01/03/2023]
Abstract
Moderate to severe traumatic brain injury (TBI) is a common cause of long-term disability. Due to challenges that include inconsistent access to follow-up care, persons with TBI being discharged from inpatient rehabilitation facilities (IRFs) are at risk for rehospitalization, poor reintegration into the community, family stress, and other unfavorable outcomes resulting from unmet needs. In a six-center randomized pragmatic comparative effectiveness study, the BRITE trial (Brain Injury Rehabilitation: Improving the Transition Experience, ClinicalTrials.govNCT03422276), we compare the effectiveness of two existing methods for transition from IRF to community living or long-term nursing care. The Rehabilitation Discharge Plan (RDP) includes patient/family education and referrals for continued care. The Rehabilitation Transition Plan (RTP) provides RDP plus individualized, manualized care management via phone or videoconference, for 6 months. Nine hundred patients will be randomized (1:1) to RDP or RTP, with caregivers also invited to participate and contribute caregiver-reported outcomes. Extensive stakeholder input, including active participation of persons with TBI and their families, has informed all aspects of trial design and implementation planning. We hypothesize that RTP will result in better patient- and caregiver-reported outcomes (societal participation, quality of life, caregiver well-being) and more efficient use of healthcare resources at 6-months (primary outcome) and 12-months post-discharge, compared to RDP alone. Planned analyses will explore which participants benefit most from each transition model. With few exclusion criteria and other pragmatic features, the findings of this trial are expected to have a broad impact on improving transitions from inpatient TBI rehabilitation. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT03422276.
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Affiliation(s)
- Jesse R Fann
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195, United States of America.
| | - Tessa Hart
- Moss Rehabilitation Research Institute, 50 Township Line Road, Elkins Park, PA 19027, United States of America.
| | - Marcia A Ciol
- Department of Rehabilitation Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356490, Seattle, WA 98195, United States of America.
| | - Megan Moore
- School of Social Work and Harborview Injury Prevention and Research Center, University of Washington, 4101 15(th) Avenue NE, Seattle, WA 98105, United States of America.
| | - Jennifer Bogner
- Department of Physical Medicine and Rehabilitation, The Ohio State University, 480 Medical Center Drive, Columbus, OH 43210, United States of America.
| | - John D Corrigan
- Department of Physical Medicine and Rehabilitation, The Ohio State University, 480 Medical Center Drive, Columbus, OH 43210, United States of America.
| | - Kristen Dams-O'Connor
- Department of Rehabilitation Medicine, Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place Box 1163, New York, NY 10029, United States of America. Kristen.dams-o'
| | - Simon Driver
- Department of Sports Therapy and Research, Baylor Scott and White Research Institute, 3434 Live Oak, Dallas, TX 75204, United States of America.
| | - Rosemary Dubiel
- Department of Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, 909 N. Washington Avenue, Dallas, TX 75246, United States of America.
| | - Flora M Hammond
- Department of Physical Medicine and Rehabilitation, Indian University School of Medicine, 4141 Shore Drive, Indianapolis, IN 46254, United States of America.
| | - Maria Kajankova
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place Box 1163, New York, NY 10029, United States of America.
| | - Thomas K Watanabe
- Department of Physical Medicine and Rehabilitation, MossRehab at Elkins Park/Einstein Healthcare Network, 60 Township Line Road, Elkins Park, PA 19027, United States of America.
| | - Jeanne M Hoffman
- Department of Rehabilitation Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356490, Seattle, WA 98195, United States of America.
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Brunner M, Hemsley B, Togher L, Dann S, Palmer S. Social Media and People With Traumatic Brain Injury: A Metasynthesis of Research Informing a Framework for Rehabilitation Clinical Practice, Policy, and Training. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:19-33. [PMID: 33332986 DOI: 10.1044/2020_ajslp-20-00211] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose The aim of the study was to investigate the experiences of people with traumatic brain injury (TBI) and rehabilitation professionals in use of social media after TBI. Design Metasynthesis of a multilevel mixed-methods research design was used in the study. Method A qualitative metasynthesis of (a) evidence in the literature regarding the use of communication technologies and social media after TBI, (b) Twitter data and network analysis, (c) interviews with people with TBI (n = 13), (d) focus groups with TBI rehabilitation professionals (n = 11), and (e) a review of current guidance on safe use of social media was conducted. Results People with TBI adopt a trial-and-error approach to using social media. Their meaningful use and a sense of connection enable them to develop social media mastery. TBI rehabilitation professionals' concerns regarding potential risks associated with using social media might lead them to restrict social media use during rehabilitation. Conclusions Access to proactive training in social media use and a supportive network of rehabilitation professionals, family, and friends can enable people with TBI to develop social media mastery through working collaboratively on social media goals. This metasynthesis of research culminates in an evidence-based protocol for assessing and supporting a person with TBI's social media goals to guide clinical practice and future research in the field.
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Affiliation(s)
- Melissa Brunner
- Department of Speech Pathology, Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
- Department of Speech Pathology, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Bronwyn Hemsley
- Department of Speech Pathology, Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
- Faculty of Education and Arts, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Leanne Togher
- Department of Speech Pathology, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Stephen Dann
- College of Business and Economics, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Stuart Palmer
- Melbourne Centre for the Study of Higher Education, The University of Melbourne, Victoria, Australia
- WorkSafe Victoria, Geelong, Australia
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Neumann D, Sander AM, Perkins SM, Bhamidipalli SS, Hammond FM. Negative Attribution Bias and Related Risk Factors After Brain Injury. J Head Trauma Rehabil 2021; 36:E61-E70. [PMID: 32769831 PMCID: PMC7769858 DOI: 10.1097/htr.0000000000000600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE In participants with traumatic brain injury (TBI) and peer controls, examine (1) differences in negative attributions (interpret ambiguous behaviors negatively); (2) cognitive and emotional factors associated with negative attributions; and (3) negative attribution associations with anger responses, life satisfaction, and participation. SETTING Two TBI outpatient rehabilitation centers. PARTICIPANTS Participants with complicated mild to severe TBI (n = 105) and peer controls (n = 105). DESIGN Cross-sectional survey study. MAIN MEASURES Hypothetical scenarios describing ambiguous behaviors were used to assess situational anger and attributions of intent, hostility, and blame. Executive functioning, perspective taking, emotion perception and social inference, alexithymia, aggression, anxiety, depression, participation, and life satisfaction were also assessed. RESULTS Compared with peer controls, participants with TBI rated behaviors significantly more intentional, hostile, and blameworthy. Regression models explained a significant amount of attribution variance (25%-43%). Aggression was a significant predictor in all models; social inference was also a significant predictor of intent and hostility attributions. Negative attributions were associated with anger responses and lower life satisfaction. CONCLUSION People with TBI who have higher trait aggression and poor social inferencing skills may be prone to negative interpretations of people's ambiguous actions. Negative attributions and social inferencing skills should be considered when treating anger problems after TBI.
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Affiliation(s)
- Dawn Neumann
- Departments of Physical Medicine and Rehabilitation (Drs Neumann and Hammond) and Biostatistics (Dr Perkins and Ms Bhamidipalli), Indiana University School of Medicine, Indianapolis; Rehabilitation Hospital of Indiana, Indianapolis (Drs Neumann and Hammond); Division of Clinical Neuropsychology and Rehabilitation Psychology, H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine and Harris Health System, Houston, Texas (Dr Sander); and Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas (Dr Sander)
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35
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Understanding the Multidimensional Nature of Sexuality After Traumatic Brain Injury. Arch Phys Med Rehabil 2020; 101:2080-2086. [DOI: 10.1016/j.apmr.2020.06.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 01/11/2023]
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Brain Injury Functional Outcome Measure (BI-FOM): A Single Instrument Capturing the Range of Recovery in Moderate-Severe Traumatic Brain Injury. Arch Phys Med Rehabil 2020; 102:87-96. [PMID: 33022273 PMCID: PMC9255898 DOI: 10.1016/j.apmr.2020.09.377] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 08/30/2020] [Accepted: 09/01/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To develop a measure of global functioning after moderate-severe TBI with similar measurement precision but a longer measurement range than the FIM. DESIGN Phase 1: retrospective analysis of 5 data sets containing FIM, Disability Rating Scale, and other assessment items to identify candidate items for extending the measurement range of the FIM; Phase 2: prospective administration of 49 candidate items from phase 1, with Rasch analysis to identify a unidimensional scale with an extended range. SETTING Six TBI Model System rehabilitation hospitals. PARTICIPANTS Individuals (N=184) with moderate-severe injury recruited during inpatient rehabilitation or at 1-year telephone follow-up. INTERVENTIONS Participants were administered the 49 assessment items in person or via telephone. MAIN OUTCOME MEASURES Item response theory parameters: item monotonicity, infit/outfit statistics, and Factor 1 variance. RESULTS After collapsing misordered rating categories and removing misfitting items, we derived the Brain Injury Functional Outcome Measure (BI-FOM), a 31-item assessment instrument with high reliability, greatly extended measurement range, and improved unidimensionality compared with the FIM. CONCLUSIONS The BI-FOM improves global measurement of function after moderate-severe brain injury. Its high precision, relative lack of floor and ceiling effects, and feasibility for telephone follow-up, if replicated in an independent sample, are substantial advantages.
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Silva MA, VandenBussche Jantz AB, Klocksieben F, Monden KR, Rabinowitz AR, Cotner BA, Dillahunt-Aspillaga C, Nakase-Richardson R. Unmet Rehabilitation Needs Indirectly Influence Life Satisfaction 5 Years After Traumatic Brain Injury: A Veterans Affairs TBI Model Systems Study. Arch Phys Med Rehabil 2020; 102:58-67. [PMID: 32949552 DOI: 10.1016/j.apmr.2020.08.012] [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: 05/04/2020] [Revised: 08/14/2020] [Accepted: 08/18/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To describe the association between unmet rehabilitation needs and life satisfaction 5 years after traumatic brain injury (TBI). DESIGN Prospective observational cohort. SETTING Five Veterans Affairs (VA) Polytrauma Rehabilitation Centers. PARTICIPANTS VA TBI Model Systems participants (N=301); 95% male; 77% white; average age, 39±14y). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Satisfaction With Life Scale (SWLS). RESULTS Average SWLS score was 22±8. Univariable analyses demonstrated several statistically significant predictors of life satisfaction, including employment status, participation, psychiatric symptom severity, past year mental health treatment, and total number of unmet rehabilitation needs (all P<.05). Multivariable analyses revealed that depression and participation were each associated with life satisfaction. An ad hoc mediation model suggested that unmet rehabilitation needs total was indirectly related to life satisfaction. Total unmet rehabilitation needs ranged from 0-21 (mean, 2.0±3.4). Correlational analyses showed that 14 of the 21 unmet rehabilitation needs were associated with life satisfaction. CONCLUSIONS Findings support the need for rehabilitation engagement in later stages of TBI recovery. Ongoing assessment of and intervention for unmet rehabilitation needs in the chronic phase of recovery have the potential to mitigate decline in life satisfaction.
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Affiliation(s)
- Marc A Silva
- Mental Health & Behavioral Sciences Section (MHBSS), James A. Haley Veterans' Hospital, Tampa, Florida; Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, Florida; Department of Psychology, University of South Florida, Tampa, Florida; Defense and Veterans Brain Injury Center (DVBIC), James A. Haley Veterans' Hospital, Tampa, Florida.
| | | | - Farina Klocksieben
- Department of Internal Medicine, University of South Florida, Tampa, Florida
| | - Kimberley R Monden
- Craig Hospital, Research Department, Englewood, Colorado; Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota
| | | | - Bridget A Cotner
- Research Service, James A. Haley Veterans' Hospital, Tampa, Florida; Department of Anthropology, University of South Florida, Tampa, Florida
| | | | - Risa Nakase-Richardson
- Mental Health & Behavioral Sciences Section (MHBSS), James A. Haley Veterans' Hospital, Tampa, Florida; Defense and Veterans Brain Injury Center (DVBIC), James A. Haley Veterans' Hospital, Tampa, Florida; Department of Internal Medicine, University of South Florida, Tampa, Florida
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Rabinowitz AR, Chervoneva I, Hart T, O'Neil-Pirozzi TM, Juengst SB, Hoffman JM. Heterogeneity in Temporal Ordering of Depression and Participation After Traumatic Brain Injury. Arch Phys Med Rehabil 2020; 101:1973-1979. [PMID: 32653581 DOI: 10.1016/j.apmr.2020.05.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 05/25/2020] [Accepted: 05/29/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine heterogeneity in the temporal patterns of depression and participation over the first 2 years post traumatic brain injury (TBI). DESIGN Observational prospective longitudinal study. SETTING Inpatient rehabilitation centers, with 1- and 2-year follow-up conducted primarily by telephone. PARTICIPANTS Persons with TBI (N=2307) enrolled in the Traumatic Brain Injury Model Systems database, followed at 1 and 2 years post injury. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Patient Health Questionnaire-9 (PHQ-9) and Participation Assessment With Recombined Tools-Objective (PART-O). RESULTS Using latent class modeling we examined heterogeneity in the longitudinal relationship between PHQ-9 and PART-O. The identified 6 classes were most distinct in terms of (1) level of PHQ-9 score and (2) association between the year 1 PART-O score and year 2 PHQ-9 score. For most participants, PART-O at year 1 predicted PHQ-9 at year 2 more than the reverse. However, there was a subgroup of participants that demonstrated the reverse pattern, PHQ-9 predicting later PART-O, who were on average, older and in the "other" employment category. CONCLUSIONS Results suggest that links between participation and depression are stronger for some people living with TBI than for others and that variation in the temporal sequencing of these 2 constructs is associated with demographic characteristics. These findings illustrate the value in accounting for population heterogeneity when evaluating temporal among outcome domains.
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Affiliation(s)
| | - Inna Chervoneva
- Department of Pharmacology and Experimental Therapeutics, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Tessa Hart
- Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania
| | - Therese M O'Neil-Pirozzi
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts; Department of Communication Sciences and Disorders, Northeastern University, Boston, Massachusetts
| | - Shannon B Juengst
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jeanne M Hoffman
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington
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Sodders MD, Killien EY, Stansbury LG, Vavilala MS, Moore M. Race/Ethnicity and Informal Caregiver Burden After Traumatic Brain Injury: A Scoping Study. Health Equity 2020; 4:304-315. [PMID: 32760875 PMCID: PMC7398439 DOI: 10.1089/heq.2020.0007] [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] [Accepted: 06/12/2020] [Indexed: 01/07/2023] Open
Abstract
Background: Informal caregivers for persons with traumatic brain injury (TBI) face a range of unique issues, and racial/ethnic group differences in caregiver challenges are poorly understood. We undertook a scoping study of peer-reviewed literature to assess the quantity and quality of available research describing differences by race/ethnicity in informal caregiving roles and burden. Methods: Using Arksey and O'Malley's framework and guided by the Preferred Reporting Items of Systematic Reviews and Meta-analyses Extension for Scoping Reviews, we conducted electronic searches of PubMed, CINAHL, PsycARTICLES, PsycINFO, Social Work Abstracts, Embase, and Scopus to identify peer-reviewed studies that examined TBI informal caregiver burden and reported on the influences of race or ethnicity. Results: Among 4523 unique publications identified and screened, 11 studies included sufficient race/ethnicity data and were included in the analysis. Of these, six studies described civilian populations and five described military Veterans Affairs (VA). Included studies revealed that nonwhite caregivers and white caregivers use different approaches and coping strategies in their caregiving role. Some studies found differences in caregiver burden by race or ethnicity, others did not. Most were limited by a small sample size and overdependence on assessment tools not validated for the purposes or populations for which they were used. This was particularly true for race/ethnicity as a factor in TBI caregiver burden in VA groups, where essential characteristics moderate the association of race/ethnicity with socioeconomic factors. Conclusions: This scoping study highlights the paucity of information on race/ethnicity as a factor in TBI caregiver burden and roles, and suggests that innovative and alternative approaches to research are needed to explore needed changes in practice.
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Affiliation(s)
- Mark D Sodders
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA.,Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, Washington, USA.,Department of Anesthesiology and Pain Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Elizabeth Y Killien
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA.,Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Lynn G Stansbury
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA.,Department of Anesthesiology and Pain Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Monica S Vavilala
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA.,Department of Anesthesiology and Pain Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Megan Moore
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA.,School of Social Work, University of Washington, Seattle, Washington, USA
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Hammond FM, Ketchum J, Dams-O'Connor K, Corrigan JD, Miller C, Haarbauer-Krupa J, Faul M, Trexler LE, Harrison-Felix C. Mortality Secondary to Unintentional Poisoning after Inpatient Rehabilitation among Individuals with Moderate to Severe Traumatic Brain Injury. J Neurotrauma 2020; 37:2507-2516. [PMID: 32438850 DOI: 10.1089/neu.2020.7038] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Studies have shown reduced life expectancy following moderate-severe traumatic brain injury (TBI) with death from unintentional poisoning (UP) being 11 times higher following TBI than in the general population. The characteristics of those who die of unintentional poisoning are compared with the characteristics of those who die of other causes (OC) in a retrospective cohort who received inpatient rehabilitation following TBI and enrolled in the TBI Model Systems National Database between 1989 and 2017 (n = 15,835 cases with 2,238 deaths recorded). Seventy-eight cases (3.5%) of deaths were the result of UP, 76% were the result of OC, and 20.5% were from an unknown cause. Among the UP deaths, 90% involved drugs (of these, 67% involved narcotic drugs and 14% involved psychostimulants), and 8% involved alcohol. Age-adjusted risk for UP death was associated with: white/non-Hispanic race/ethnicity, living alone, non-institutionalization, pre- and post-injury illicit drug use and alcohol/drug problem use, any alcohol use at last follow-up, better Functional Independence MeasureTM (FIM) scores, history of arrest, moderate disability (vs. severe disability or good recovery), less supervision needed, and greater anxiety. Adults who receive inpatient rehabilitation for TBI who die from UP are distinguishable from those who die of OC. Factors such as pre-injury substance use in the context of functional independence may be regarded as targets for prevention and/or intervention to reduce substance use and substance-related mortality among survivors of moderate-severe TBI. The current findings may have implications for medical care, surveillance, prevention, and health promotion.
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Affiliation(s)
- Flora M Hammond
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine and Rehabilitation Hospital of Indiana, Indianapolis, Indiana, USA
| | - Jessica Ketchum
- Research Department, Craig Hospital, Englewood, Colorado, USA.,Traumatic Brain Injury Model Systems National Data and Statistical Center, Englewood, Colorado, USA
| | - Kristen Dams-O'Connor
- Department of Rehabilitation Medicine, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - John D Corrigan
- Department of Physical Medicine & Rehabilitation, Ohio State University, Columbus, Ohio, USA
| | - Cate Miller
- National Institute on Disability, Independent Living, and Rehabilitation Research, Administration for Community Living, Department of Health and Human Services, Washington, DC, USA
| | - Juliet Haarbauer-Krupa
- Traumatic Brain Injury Team, Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark Faul
- Traumatic Brain Injury Team, Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lance E Trexler
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine and Rehabilitation Hospital of Indiana, Indianapolis, Indiana, USA
| | - Cynthia Harrison-Felix
- Research Department, Craig Hospital, Englewood, Colorado, USA.,Traumatic Brain Injury Model Systems National Data and Statistical Center, Englewood, Colorado, USA
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Sander AM, Clark AN, Arciniegas DB, Tran K, Leon-Novelo L, Ngan E, Bogaards J, Sherer M, Walser R. A randomized controlled trial of acceptance and commitment therapy for psychological distress among persons with traumatic brain injury. Neuropsychol Rehabil 2020; 31:1105-1129. [PMID: 32408846 DOI: 10.1080/09602011.2020.1762670] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Psychological distress is common in persons with traumatic brain injury (TBI) but treatments remain underdeveloped. This randomized controlled trial of Acceptance and Commitment Therapy (ACT) was designed to address this gap. Ninety-three persons with medically-documented complicated mild to severe TBI, normal-to-mildly impaired memory, and clinically significant psychological distress in the chronic phase of recovery were randomized to receive eight weeks of ACT (manualized with adaptations to address TBI-related cognitive impairments) or a single session of needs assessment, brief counseling/education, and referral. The ACT group showed significantly greater reduction of psychological distress (Brief Symptom Inventory 18) and demonstrated improvements in psychological flexibility and commitment to action (Acceptance and Action Questionnaire-II (AAQ-II) scores). The number of treatment responders (post-treatment BSI 18 GSI T scores <63) was larger in the ACT group than in the control group. Entry of AAQ-II scores into the model of between-group differences in BSI 18 GSI T scores indicated that core ACT processes explained the variance in treatment group outcomes. Provision of ACT reduces psychological distress in persons with TBI in the chronic phase of recovery when adaptations are made to accommodate TBI-related cognitive impairments. Additional clinical trials with a structurally equivalent control group are needed.
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Affiliation(s)
- Angelle M Sander
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA.,Brain Injury Research Center, TIRR Memorial Hermann, Houston, TX, USA.,Department of Physical Medicine and Rehabilitation, Harris Health System, Houston, TX, USA
| | - Allison N Clark
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA.,Brain Injury Research Center, TIRR Memorial Hermann, Houston, TX, USA.,Department of Physical Medicine and Rehabilitation, Harris Health System, Houston, TX, USA
| | - David B Arciniegas
- Brain Injury Research Center, TIRR Memorial Hermann, Houston, TX, USA.,Marcus Institute for Brain Health, University of Colorado, Denver, CO, USA
| | - Kim Tran
- Brain Injury Research Center, TIRR Memorial Hermann, Houston, TX, USA
| | - Luis Leon-Novelo
- Department of Biostatistics and Data Science, School of Public Health , University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Esther Ngan
- Department of Biostatistics and Data Science, School of Public Health , University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jay Bogaards
- Brain Injury Research Center, TIRR Memorial Hermann, Houston, TX, USA
| | - Mark Sherer
- Brain Injury Research Center, TIRR Memorial Hermann, Houston, TX, USA
| | - Robyn Walser
- National Center for Posttraumatic Stress Disorder, Palo Alto, CA, USA
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Borgen IMH, Løvstad M, Andelic N, Hauger S, Sigurdardottir S, Søberg HL, Sveen U, Forslund MV, Kleffelgård I, Lindstad MØ, Winter L, Røe C. Traumatic brain injury-needs and treatment options in the chronic phase: Study protocol for a randomized controlled community-based intervention. Trials 2020; 21:294. [PMID: 32216840 PMCID: PMC7099773 DOI: 10.1186/s13063-020-4195-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 02/20/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) is often associated with life-long medical, cognitive, emotional, and behavioral changes. Although long-lasting disabilities are expected, research on effective treatment options in the chronic phase of TBI is scarce. METHODS/DESIGN This study protocol describes a randomized controlled trial (RCT) aimed at evaluating the effectiveness of a goal-oriented and community-based intervention for increasing community integration, quality of life, and functional independence in the chronic phase of complicated mild to severe TBI. Participants will be recruited from Oslo University Hospital, Norway. Patients aged 18-72 years living at home with MRI/CT-verified intracranial abnormalities, a TBI diagnosis, a time since injury of ≥ 2 years, and who experience either current TBI-related problems or restrictions in community integration will be included. The 120 participants will be randomized 1:1 to either (a) an intervention group, which will receive an in-home intervention program over 4 months, or (b) a control group receiving standard care in the municipalities. The intervention will consist of six home visits and two telephone contacts with a rehabilitation professional. A SMART-goal approach will be adopted to target the individual's self-reported TBI difficulties in everyday life. Primary outcomes will be self-reported quality of life and participation. Secondary outcomes include symptom burden, emotional functioning, and clinician-assessed global outcome and need for rehabilitation services. Outcomes will be evaluated at baseline and 4-5 and 12 months after baseline. Caregiver burden and general health will be assessed in participating family members. Goal attainment and acceptability will be evaluated in the intervention group. A process evaluation will be carried out to evaluate protocol adherence, and a cost-effectiveness analysis will be applied if the intervention is found to be effective. DISCUSSION The current study provides an innovative approach to rehabilitation in the chronic phase of TBI evaluated using an RCT design that may inform treatment planning, health policies, and coordination of patient care. Further, the study may demonstrate new modes of establishing collaboration and knowledge transition between specialized rehabilitation facilities and local rehabilitation services that may improve patient outcomes. TRIAL REGISTRATION ClinicalTrials.gov, NCT03545594. Registered on June 4th, 2018.
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Affiliation(s)
- Ida Maria H. Borgen
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Marianne Løvstad
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Center for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Solveig Hauger
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | | | - Helene L. Søberg
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Unni Sveen
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Marit V. Forslund
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Ingerid Kleffelgård
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Marte Ørud Lindstad
- Department of Health Sciences in Gjøvik, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Gjøvik, Norway
| | - Laraine Winter
- Philadelphia Research and Education Foundation, Philadelphia, PA USA
- Nursing Service, Department of Veterans Affairs Medical Center, Philadelphia, PA USA
| | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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43
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The Association Between Community Participation and Social Internet Use Among Adults With Traumatic Brain Injury. J Head Trauma Rehabil 2020; 35:254-261. [DOI: 10.1097/htr.0000000000000566] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Erler KS, Kew CL, Juengst SB. Participation differences by age and depression 5 years after moderate-to-severe traumatic brain injury. Int Rev Psychiatry 2020; 32:12-21. [PMID: 31533497 DOI: 10.1080/09540261.2019.1656175] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Participation restrictions, including restrictions in employment, recreational activities, and social interactions, and depression are common after traumatic brain injury (TBI) and can profoundly affect individuals. Participation and depression demonstrate complex relationships with each other and over time as individuals age. This study (1) identified differences in participation between different age groups; (2) determined if participation differed between those with and without clinically significant depressive symptoms within each age group; and (3) determined the effect of the interaction between age groups and the presence or absence of clinically significant depressive symptoms on participation in community-dwelling adults with a moderate-to-severe TBI. Results indicate that, among community-dwelling adults 5 years post-TBI, there are significant differences in participation between age groups across the lifespan, with younger adults generally having higher levels of participation. Individuals with clinically significant depressive symptoms participate less than individuals without it within the same age group, except for adults over 65 years-old. For the productivity domain, age interacted with depressive symptoms, such that the presence of clinically significant depressive symptoms was associated with a larger difference in productivity in early-to-middle adulthood. Based on these findings, depression should be considered when providing interventions for participation and vice versa.
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Affiliation(s)
- Kimberly S Erler
- Department of Occupational Therapy, MGH Institute of Health Professions, Boston, MA, USA
| | - Chung Lin Kew
- Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Shannon B Juengst
- Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA
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45
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Development and Calibration of the TBI-QOL Ability to Participate in Social Roles and Activities and TBI-QOL Satisfaction With Social Roles and Activities Item Banks and Short Forms. Arch Phys Med Rehabil 2020; 101:20-32. [DOI: 10.1016/j.apmr.2019.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 07/18/2019] [Accepted: 07/25/2019] [Indexed: 11/21/2022]
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46
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Responsiveness of the Traumatic Brain Injury–Quality of Life (TBI-QOL) Measurement System. Arch Phys Med Rehabil 2020; 101:54-61. [DOI: 10.1016/j.apmr.2017.11.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 11/17/2017] [Indexed: 01/01/2023]
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47
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Malone C, Erler KS, Giacino JT, Hammond FM, Juengst SB, Locascio JJ, Nakase-Richardson R, Verduzco-Gutierrez M, Whyte J, Zasler N, Bodien YG. Participation Following Inpatient Rehabilitation for Traumatic Disorders of Consciousness: A TBI Model Systems Study. Front Neurol 2019; 10:1314. [PMID: 31920935 PMCID: PMC6930171 DOI: 10.3389/fneur.2019.01314] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 11/27/2019] [Indexed: 11/13/2022] Open
Abstract
Severe traumatic brain injury (TBI) may result in a disorder of consciousness (DoC) and lead to substantial long-term disability. While level of independence with activities of daily living, especially for persons who recover consciousness during inpatient rehabilitation, generally improves over time, the degree of change in participation remains unknown. We determined level of participation among persons with TBI between 2005 and 2017 who were admitted to inpatient rehabilitation unable to follow commands and subsequently enrolled in the TBI Model Systems National Database. Participation on the Participation Assessment with Recombined Tools-Objective (PART-O) Productivity, Social Relations, and Out and About subscales was evaluated at 1-5 years post-injury. We used a mixed-effects model to longitudinally compare participation between persons who did and did not regain command-following during inpatient rehabilitation. We further explored the level of participation associated with increasing levels of functional independence (FIM). The analysis included 333 persons (229 recovered command-following during rehabilitation, mean age = 35.46 years, 74.9% male). Participation across groups, at all follow-up time points, on all PART-O subscales, was remarkably low (mean range = 0.021-1.91, maximum possible score = 5). Performance was highest on the Social Relations subscale and lowest on the Productivity subscale. Longitudinal analyses revealed no difference in level of participation or change in participation across time for persons who regained command-following during rehabilitation compared to those who did not. While productivity increased over time, social participation did not and participation outside the home increased more for younger than for older persons. Across all three PART-O subscales, FIM Motor scores positively predicted participation. FIM Cognitive scores positively predicted level of participation on the Productivity and Social Relations subscales. Exploratory analyses revealed that even persons who achieved independence on the FIM Motor and Cognitive subscales had low levels of participation across domains and follow-up years. In summary, persons with severe TBI who were admitted to inpatient rehabilitation unable to follow commands were found to be unlikely to participate in productive tasks, social endeavors, or activities outside of the home up to 5 years post-injury, even if functional independence was recovered.
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Affiliation(s)
- Christopher Malone
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States.,Neurorehabilitation Laboratory, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Kimberly S Erler
- Department of Occupational Therapy, MGH Institute of Health Professions, Boston, MA, United States
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States.,Neurorehabilitation Laboratory, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Flora M Hammond
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Shannon B Juengst
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Joseph J Locascio
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - Risa Nakase-Richardson
- Mental Health and Behavioral Science, Defense and Veterans Brain Injury Center, James A. Haley Veterans Hospital, Tampa, FL, United States.,Division of Pulmonary and Sleep Medicine, Department of Internal Medicine, University of South Florida, Tampa, FL, United States
| | - Monica Verduzco-Gutierrez
- Department of Physical Medicine and Rehabilitation, McGovern Medical School at the University of Texas Health Science Center at Houston, and TIRR Memorial Hermann, Houston, TX, United States
| | - John Whyte
- Moss Rehabilitation Research Institute, Elkins Park, PA, United States
| | - Nathan Zasler
- Department of Physical Medicine and Rehabilitation, Concussion Care Centre of Virginia, Ltd. and Tree of Life Services, Virginia Commonwealth University, Richmond, VA, United States
| | - Yelena G Bodien
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States.,Neurorehabilitation Laboratory, Spaulding Rehabilitation Hospital, Boston, MA, United States.,Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
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Lequerica AH, Weber E, Dijkers MP, Dams-O'Connor K, Kolakowsky-Hayner SA, Bell KR, Bushnik T, Goldin Y, Hammond FM. Factors associated with the remission of insomnia after traumatic brain injury: a traumatic brain injury model systems study. Brain Inj 2019; 34:187-194. [PMID: 31640430 DOI: 10.1080/02699052.2019.1682193] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To examine the factors associated with the remission of insomnia by examining a sample of individuals who had insomnia within the first two years after traumatic brain injury (TBI) and assessing their status at a secondary time point.Design and Methods: Secondary data analysis from a multicenter longitudinal cohort study. A sample of 40 individuals meeting inclusion criteria completed a number of self-report scales measuring sleep/wake characteristics (Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Insomnia Severity Index, Sleep Hygiene Index), fatigue and depression (Multidimensional Assessment of Fatigue, Patient Health Questionnaire-9), and community participation (Participation Assessment with Recombined Tools-Objective). One cohort was followed at 1 and 2 years post-injury (n = 19) while a second cohort was followed at 2 and 5 years post-injury (n = 21).Results: Remission of insomnia was noted in 60% of the sample. Those with persistent insomnia had significantly higher levels of fatigue and depression at their final follow-up and poorer sleep hygiene across both follow-up time-points. A trend toward reduced community participation among those with persistent insomnia was also found.Conclusion: Individuals with persistent post-TBI insomnia had poorer psychosocial outcomes. The chronicity of post-TBI insomnia may be associated with sleep-related behaviors that serve as perpetuating factors.
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Affiliation(s)
- Anthony H Lequerica
- Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, USA.,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Erica Weber
- Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, USA.,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Marcel P Dijkers
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kristen Dams-O'Connor
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Kathleen R Bell
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, TX, USA
| | - Tamara Bushnik
- Rusk Rehabilitation, NYU Langone Health, New York, NY, USA
| | - Yelena Goldin
- Cognitive Rehabilitation Department, JFK-Johnson Rehabilitation Institute, Edison, NJ, USA.,Department of Physical Medicine and Rehabilitation, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Flora M Hammond
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, West Lafayette, IN, USA.,Rehabilitation Hospital of Indiana, Indianapolis, IN, USA
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The Association of Rehospitalization With Participation 5 Years After Traumatic Brain Injury. J Head Trauma Rehabil 2019; 33:E77-E84. [PMID: 29601342 DOI: 10.1097/htr.0000000000000386] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether rehospitalization during the first 2 years after moderate to severe traumatic brain injury (TBI) is associated with poor participation at 5 years post-TBI, after controlling for demographic and severity factors. SETTING TBI Model Systems Program. PARTICIPANTS Community-dwelling individuals with TBI, 16 years or older (n = 1940). DESIGN Retrospective data analysis of a multicenter prospective study. MAIN MEASURES Participation Assessment with Recombined Tools-Objective (PART-O). RESULTS After controlling for demographic and severity factors, a general linear model indicated that rehospitalization status (ie, never rehospitalized during years 1 and 2, rehospitalized either during year 1 or 2, or rehospitalized during both years 1 and 2) predicted less participation at 5 years post-TBI (P = .0353). The PART-O scores were in the hypothesized direction, with the lowest covariate-adjusted mean participation score found for the group with rehospitalizations during both years and the highest covariate-adjusted mean participation score found in the group with no rehospitalizations. Examining total number of rehospitalizations during years 1 and 2, rather than rehospitalization status, yielded analogous results (P = .0148). CONCLUSIONS This study suggests that rehospitalization in the first 2 years after TBI is negatively associated with participation at 5 years after injury. Since participation is considered a key indicator of successful TBI rehabilitation, minimizing the need for rehospitalizations and promoting health in the community setting should be a priority of postacute care for individuals with TBI.
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50
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Philippus A, Ketchum JM, Payne L, Hawley L, Harrison-Felix C. Volunteering and its association with participation and life satisfaction following traumatic brain injury. Brain Inj 2019; 34:52-61. [PMID: 31615280 DOI: 10.1080/02699052.2019.1679886] [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: 01/07/2023]
Abstract
Background: Volunteering has been found to improve life satisfaction and participation in the general population, but its impact has not been thoroughly studied among those with traumatic brain injury (TBI). It is important to investigate whether volunteering is helpful in addressing participation and life satisfaction to inform future treatment.Objective: To characterize those who volunteer after moderate-severe TBI and to investigate the association of volunteering with participation and life satisfaction after TBI.Methods: Using data from a single site contributing to the TBI Model Systems National Database, a retrospective analysis of 725 individuals with TBI was conducted. General Linear Models were used to compare outcomes of those who volunteer and those who do not after controlling for important covariates.Results: Volunteers were more likely to be employed/students, have better current functioning, be further post-injury, non-Hispanic white, and have more education. Significant relationships, after controlling for covariates, were found between volunteering and higher life satisfaction, more frequent community engagement, and greater social relations. No significant relationship between volunteering and productivity emerged.Conclusions: Given the positive relationship between volunteer status with life satisfaction and aspects of participation, future research should investigate the barriers/facilitators of volunteering to improve well-being and participation after TBI.
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Affiliation(s)
- Angela Philippus
- Craig Hospital Research Department, Englewood, Colorado, USA.,Clinical Science Graduate Program (CLSC), University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | - Lisa Payne
- Craig Hospital Research Department, Englewood, Colorado, USA
| | - Lenore Hawley
- Craig Hospital Research Department, Englewood, Colorado, USA
| | - Cynthia Harrison-Felix
- Craig Hospital Research Department, Englewood, Colorado, USA.,Department of Physical Medicine and Rehabilitation, University of Colorado, Denver, USA
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