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Kumar DS, Bodt BA, Galloway JC. Real-world environmental enrichment rehabilitation paradigm in people with severe traumatic brain injury: a pilot feasibility study. Brain Inj 2024; 38:742-749. [PMID: 38695288 DOI: 10.1080/02699052.2024.2347551] [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: 04/23/2023] [Accepted: 04/22/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND The use of Environmental Enrichment (EE) has been widely studied in animal models. However, the application of the same in humans is limited to rehabilitation settings. OBJECTIVE To investigate the feasibility of a community-based EE paradigm in adults with brain injury. METHODS Six individuals diagnosed with traumatic brain injury enrolled in the study. The Go Baby Go Café instrumented with a body weight harness system, provided physical and social enrichment as participants performed functional tasks for 2 hours, three times a week, for 2 months. Feasibility and safety outcomes were recorded throughout sessions. Clinical measures including 10-meter walk, timed up and go, jebsen hand function, 6-minute walk, and trail making tests were obtained pre and post intervention. RESULTS All participants completed the study. The attendance was 100% and adherence was 87%. Positive changes in clinical measures were statistically significant for the timed up and go (p = 0.0175), TUG-cognitive (p = 0.0064), 10-meter walk (p = 0.0428), six-minute walk (p = 0.0196), TMT-A (p = 0.034). Changes in JHFT were not significant (p = 0.0506), with one subject recording values counter to the trend. CONCLUSION The Café was a comprehensive EE-based intervention that was feasible, safe, and has the potential to enhance motor and cognitive function in individuals with brain injury.
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Affiliation(s)
- Devina S Kumar
- Burke Neurological Institute, White Plains, New York, USA
| | | | - James C Galloway
- University of Delaware, Newark, Delaware, USA
- Baylor University, Waco, Texas, USA
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Eriksson M, Ekström-Bergström A, Arvidsson S, Jormfeldt H, Thorstensson S, Åström U, Lundgren I, Roxberg Å. Meaning of wellness in caring science based on Rodgers's evolutionary concept analysis. Scand J Caring Sci 2024; 38:185-199. [PMID: 37507842 DOI: 10.1111/scs.13196] [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: 03/17/2023] [Revised: 06/17/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Wellness is a holistic, multidimensional, and process-oriented property on a continuum. It has been used interchangeably with and is undifferentiated from concepts such as health and well-being without an in-depth clarification of its theoretical foundations and a reflection on its meaning. The concept of wellness is frequently used, but its definition remains unclear. AIM To conceptually and theoretically explore the concept of wellness to contribute to a deeper understanding in caring science. METHOD Rodgers' evolutionary concept analysis was applied to the theoretical investigation of data from publications of international origins. The focus was on antecedents, attributes, consequences, surrogate and related terms, and contextual references. A literature search was performed through a manual review of reference lists and an online search in CINAHL and PubMed via EBSCO, and in ProQuest. Abstracts were examined to identify relevant studies for further review. The inclusion criteria were peer-reviewed papers in English; papers published in scientific journals using the surrogate terms 'wellness', 'health', 'health care', and 'health care and wellness'; and papers discussing and/or defining the concept of wellness. Twenty-six studies met the inclusion criteria. RESULTS Based on the findings from this concept analysis, a definition of wellness was developed: 'a holistic and multidimensional concept represented on a continuum of being well that goes beyond health'. Implications for nursing practice were correspondingly presented. CONCLUSION Wellness is defined as a holistic and comprehensive multidimensional concept represented on a continuum of being well, that goes beyond health. It calls attention by applying the salutogenic perspective to health promotion in caring science. It is strongly related to individual lifestyle and health behaviour and is frequently used interchangeably with health and well-being without an in-depth clarification of its theoretical foundation.
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Affiliation(s)
- Monica Eriksson
- Department of Health Sciences, University West, Trollhättan, Sweden
| | | | - Susann Arvidsson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | | | | | - Ulrica Åström
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Ingela Lundgren
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Åsa Roxberg
- Department of Health Sciences, University West, Trollhättan, Sweden
- VID University, Bergen, Norway
- UiT Harstad, Harstad, Norway
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Roth MF, Chick JFB, McLoughlin D, Shin DS, Chadalavada SC, Monroe EJ, Hage AN, Ji I, Lee E, Makary MS. Wellness Among Interventional Radiologists: Results From a Multidimensional Survey. Acad Radiol 2024; 31:1130-1140. [PMID: 37945493 DOI: 10.1016/j.acra.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/09/2023] [Accepted: 09/16/2023] [Indexed: 11/12/2023]
Abstract
RATIONALE AND OBJECTIVES To evaluate wellness among interventional radiologists using a multidimensional survey. MATERIALS AND METHODS An anonymous 53-item survey, including 36 Perceived Wellness Survey (PWS) prompts, was created in Qualtrics (an online survey tool) to assess wellness among interventional radiology attendings and residents. The survey was open from June to September, 2022, 2 years into the COVID-19 Pandemic. The survey was distributed via Society of Interventional Radiology Forums, social media (Twitter, LinkedIn, and Facebook), and personal correspondence. PWS scores were categorized into Wellness Composite and subscores (physical, emotional, intellectual, psychological, social, and spiritual). RESULTS 367 surveys were completed. 300 (81.7%) respondents were male and 67 (18.3%) were female. Respondents included attending physicians (297; 81.0%) and residents (70; 19.0%). Practice settings included academic (174; 47.4%), private (114; 31.0%), private-academic hybrid (62; 16.9%), and others (17; 4.7%). Mean Wellness Composite at academic centers (14.74 ± 3.16; range: 5.42-23.50) was significantly lower than at private (15.22 ± 3.37; range: 6.13-23.51) and hybrid (16.14 ± 2.47; range: 10.20-23.50) practices (p = 0.01). Respondents < 40 years old had significantly lower emotional wellness subscores compared to those ≥ 40 years old (4.34 ± 0.86 vs. 4.60 ± 0.87; p = 0.006). There were no significant differences between geographic regions in the United States, however, International respondents had significantly lower social and intellectual wellness (INT) subscores. Physical wellness subscore (4.00 ± 0.9) was significantly lower than the other subscores (4.59 ± 0.81) (p < .001). Overall mean Wellness Composite was 15.11 ± 3.13 (range: 5.42-23.51). CONCLUSION Overall self-reported wellness was lower among interventional radiologists practicing at academic centers. Interventional Radiologists < 40 years old and residents had lower emotional wellness, while international respondents had lower social and INT. Overall wellness scores were lower than prior PWS studies.
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Affiliation(s)
- Matthew F Roth
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio 43240, USA (M.F.R., D.M., M.S.M.).
| | - Jeffrey Forris Beecham Chick
- Division of Interventional Radiology, Department of Radiology, University of Washington, Seattle, Washington, USA (J.F.B.C., D.S.S.); The Deep Vein Institute, University of Washington, Seattle, Washington, USA (J.F.B.C., D.S.S.)
| | - Dane McLoughlin
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio 43240, USA (M.F.R., D.M., M.S.M.)
| | - David S Shin
- Division of Interventional Radiology, Department of Radiology, University of Washington, Seattle, Washington, USA (J.F.B.C., D.S.S.); The Deep Vein Institute, University of Washington, Seattle, Washington, USA (J.F.B.C., D.S.S.)
| | - Seetharam C Chadalavada
- Division of Interventional Radiology, Department of Radiology, University of Cincinnati, Cincinnati, Ohio, USA (S.C.C.)
| | - Eric J Monroe
- Division of Interventional Radiology, Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA (E.J.M.)
| | - Anthony N Hage
- Division of Vascular and Interventional Radiology, Department of Radiology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA (A.N.H.)
| | - Ido Ji
- Department of Information and Statistics, Chungnam National University, Daejeon, South Korea (I.J., E.L.)
| | - Eunjee Lee
- Department of Information and Statistics, Chungnam National University, Daejeon, South Korea (I.J., E.L.)
| | - Mina S Makary
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio 43240, USA (M.F.R., D.M., M.S.M.)
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Ziegeler B, D' Souza W, Vinton A, Mulukutla S, Shaw C, Carne R. Neurological Health: Not Merely the Absence of Disease: Current Wellbeing Instruments Across the Spectrum of Neurology. Am J Lifestyle Med 2023; 17:299-316. [PMID: 36896041 PMCID: PMC9989493 DOI: 10.1177/15598276221086584] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Well-being and quality of life can vary independently of disease. Instruments measuring well-being and quality of life are commonly used in neurology, but there has been little investigation into the extent in which they accurately measure wellbeing/quality of life or if they merely reflect a diseased state of an individual. DESIGN Systematic searches, thematic analysis and narrative synthesis were undertaken. Individual items from instruments represented in ≥ 5 publications were categorised independently, without prior training, by five neurologists and one well-being researcher, as relating to 'disease-effect' or 'Well-being' with a study-created instrument. Items were additionally categorised into well-being domains. DATA SOURCES MEDLINE, EMBASE, EMCARE and PsycINFO from 1990 to 2020 were performed, across the 13 most prevalent neurological diseases. RESULTS 301 unique instruments were identified. Multiple sclerosis had most unique instruments at 92. SF-36 was used most, in 66 studies. 22 instruments appeared in ≥ 5 publications: 19/22 'well-being' outcome instruments predominantly measured disease effect (Fleiss kappa = .60). Only 1/22 instruments was categorised unanimously as relating to well-being. Instruments predominantly measured mental, physical and activity domains, over social or spiritual. CONCLUSIONS Most neurological well-being or quality-of-life instruments predominantly measure disease effect, rather than disease-independent well-being. Instruments differed widely in well-being domains examined.
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Affiliation(s)
| | | | | | | | - Cameron Shaw
- University Hospital Geelong, Deakin University, Geelong, VIC, Australia
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Sarajuuri J, Vink M, Tokola K. Relationship between late objective and subjective outcomes of holistic neurorehabilitation in patients with traumatic brain injury. Brain Inj 2018; 32:1749-1757. [PMID: 30365344 DOI: 10.1080/02699052.2018.1539247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To explore the relation between objectively measured outcomes of neurorehabilitation and subjective self-appraisal of those outcomes in patients with traumatic brain injury (TBI). METHODS Forty-five adults (34 men; age at injury, mean ± SD, 30.1 ± 10.3 years) with chronic moderate-to-severe TBI (9.7 ± 5.5 years from injury; post-traumatic amnesia, 80% over one week) from two rehabilitation centres, in two countries. The subjects have had to resume working at various levels of competence following post-acute comprehensive neuropsychologically oriented neurorehabilitation, and experienced no functionally incapacitating, medical or psychological problems, for a minimum of six months after discharge. Objective outcome measure was the level of work competence attained post-rehabilitation transposed from the descriptions of the types of work attained by each subject into a number along a 10-point scale. Subjective outcome measure was the personal evaluations by ratings in six consequences of rehabilitation (effort during rehabilitation, meaning in life, productivity, acceptance, social life and intimate relationships) along a 10-point scale. RESULTS The attained work competence was statistically significantly related to the subjective self-appraisal of the ability to establish intimate relationships [odds ratio (OR), 1.79; 95% confidence interval (CI), 1.20-2.68; P = .005]. Otherwise, no association between subjective ratings and the levels of work was found. Of the patients, 67% attained competitive, 22% subsidized, and 11% volunteer or sheltered work. The subjective self-rated outcomes of the patients were relatively good [median, lower quartile (Q1) - upper quartile (Q3): 8 to 9, 7 to 8 - 8 to 9 out of 10]. The lowest ratings were observed for the ability to establish intimate relationships (8, 7-8 out of 10). CONCLUSIONS The results support the need to evaluate rehabilitation outcomes involving both objective measures and subjective appraisals of them. The findings suggest that community functioning and satisfaction with that are distinct aspects of the subjects´ experience that must be considered in the evaluation of rehabilitation. It seems that comprehensive neurorehabilitation improve outcome, and patients with TBI with tailored placements were largely satisfied with the areas of wellness in their life. Additional larger controlled studies are needed to clarify how composition of neurorehabilitation and individualization in outcomes assessment might enhance the outcome of TBI rehabilitation.
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Affiliation(s)
- Jaana Sarajuuri
- a Department of Clinical Neuropsychology and Psychology , Validia Rehabilitation , Helsinki , Finland.,b Faculty of Medicine, Department of Psychology and Logopedics , University of Helsinki , Helsinki , Finland
| | - Martie Vink
- c Reade Center for Rehabilitation and Rheumatology , Amsterdam , the Netherlands
| | - Kari Tokola
- d UKK Institute for Health Promotion Research , Tampere , Finland
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Conneeley AL. Quality of Life and Traumatic Brain Injury: A One-Year Longitudinal Qualitative Study. Br J Occup Ther 2016. [DOI: 10.1177/030802260306601002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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A health and wellness intervention for those with moderate to severe traumatic brain injury: a randomized controlled trial. J Head Trauma Rehabil 2013; 27:E57-68. [PMID: 23131971 DOI: 10.1097/htr.0b013e318273414c] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess the efficacy of a standardized 12-week health and wellness group intervention for those with moderate to severe traumatic brain injury (TBI). STUDY DESIGN Randomized controlled trial. PARTICIPANTS Seventy-four individuals with moderate to severe TBI recruited from the outpatient program at a rehabilitation hospital, a Veterans Affairs Medical Center, and the community. METHOD Eligible participants were randomized to treatment (health and wellness therapy group) or wait-list control (treatment, n = 37; wait-list, n = 37). The primary outcome was the Health Promoting Lifestyle Profile-II. RESULTS The results of the mixed-model repeated-measures analysis indicated no differences between treatment and control groups engaging in activities to increase their health and well-being. CONCLUSIONS Findings did not support the efficacy of the intervention. Results may have been impacted by the wide variability of individualized health and wellness goals selected by group members, the structure and/or content of the group, and/or the outcome measures selected.
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Braden CA, Cuthbert JP, Brenner L, Hawley L, Morey C, Newman J, Staniszewski K, Harrison-Felix C. Health and wellness characteristics of persons with traumatic brain injury. Brain Inj 2012; 26:1315-27. [DOI: 10.3109/02699052.2012.706351] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Wagner AK, Brett CA, McCullough EH, Niyonkuru C, Loucks TL, Dixon CE, Ricker J, Arenth P, Berga SL. Persistent hypogonadism influences estradiol synthesis, cognition and outcome in males after severe TBI. Brain Inj 2012; 26:1226-42. [DOI: 10.3109/02699052.2012.667594] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
OBJECTIVE To investigate the contribution of activity-related satisfaction and perceived self-efficacy to global life satisfaction after traumatic brain injury (TBI). PARTICIPANTS Convenience sample of 97 adults who were living in their community at least 6 months after sustaining a TBI. MEASURES Community Integration Questionnaire, Quality of Community Integration Questionnaire, Self-Efficacy Questionnaire for TBI, Perceived Quality of Life Scale, Satisfaction with Life Scale. RESULTS Among demographic and injury-related variables, gender and time since injury made significant contributions to the prediction of global life satisfaction. Productivity made a modest, significant contribution to life satisfaction. Satisfaction with productivity and with leisure/social activities both contributed to global life satisfaction. The greatest contribution to the prediction of global life satisfaction was made by the person's perceived self-efficacy, particularly perceived self-efficacy for the management of cognitive symptoms. Perceived cognitive self-efficacy also appeared to mediate the relation between community integration and global life satisfaction. CONCLUSION Community integration, activity-related satisfaction, and global life satisfaction represent distinct constructs, and dissociable aspects of psychosocial outcome after TBI. Perceived self-efficacy for the management of cognitive symptoms may mediate the relation between the individual's expectations and achievements and thereby contribute to overall subjective well-being.
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Affiliation(s)
- Keith D Cicerone
- Department of Cognitive Rehabilitation, JFK-Johnson Rehabilitation Institute, Edison, NJ 08820, USA.
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Abstract
High-level mobility is important for participation in many pre-accident activities after traumatic brain injury (TBI). This review examined which measures are used to quantify physical status and mobility after TBI to determine their appropriateness for measuring high-level mobility. Electronic databases, hand searching of several TBI journals, and citation tracking from retrieved articles were used to identify all TBI outcome studies from 1990 through to May 2004. Preliminary screening identified articles that either reported on physical outcome or mobility after TBI or utilized measurement tools with a physical component. Studies were selected for detailed analysis if they reported on mobility or physical outcomes after TBI. The search identified 175 studies that met the inclusion criteria for further analysis. The FIM instrument is the most frequently used outcome measure, highlighting a trend toward using inpatient measures to evaluate long-term outcomes. Only one study used a measurement tool that incorporated a mobility item beyond independent walking and stairs. High-level mobility is seldom measured using standardized outcome measures after TBI, despite independent mobility being one of the major goals of rehabilitation. A high-level mobility scale is needed to address the ceiling effect of outcome scales currently used in TBI rehabilitation and to extend mobility to age-appropriate levels for return to leisure and sporting activities.
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Affiliation(s)
- Gavin Williams
- Physiotherapy Department, Epworth Hospital, Richmond, Victoria, Australia
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Abstract
OBJECTIVES Participation in meaningful life situations is an important aspect of functioning after traumatic brain injury (TBI). However, to date, few studies have included measures of social participation or community integration as outcome measures after TBI rehabilitation. This paper is a selective review of the literature that examines the effects of TBI rehabilitation on measures of participation or community integration. It also addresses the related questions of clinically significant improvements in community integration, variability in patterns of community functioning, and the relationship of participation and quality of life after TBI. DESIGN Literature review. CONCLUSIONS A small number of studies suggest that postacute TBI rehabilitation can produce improvements in participation and community integration. However, a considerable amount of variability in rehabilitation outcomes may be apparent. Analysis of clinically significant changes in individual's functioning suggests that rehabilitation may exert its benefits not only by facilitating improvements, but also by preventing declines in community functioning. Subjective well-being and quality of life have generally been ignored as TBI rehabilitation outcomes. There is considerable evidence that participation and subjective well-being represent distinct and dissociable outcomes after TBI, which may reflect the importance of patients' preferences and values in evaluating the effectiveness of rehabilitation.
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Affiliation(s)
- Keith D Cicerone
- Department of Physical Medicine and Rehabilitation, JFK-Johnson Rehabilitation Institute, Edison, NJ, USA.
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Cicerone KD, Mott T, Azulay J, Friel JC. Community integration and satisfaction with functioning after intensive cognitive rehabilitation for traumatic brain injury11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the author(s) or on any organization with which the author(s) is/are associated. Arch Phys Med Rehabil 2004; 85:943-50. [PMID: 15179648 DOI: 10.1016/j.apmr.2003.07.019] [Citation(s) in RCA: 133] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of an intensive cognitive rehabilitation program (ICRP) compared with standard neurorehabilitation (SRP) for persons with traumatic brain injury (TBI). DESIGN Nonrandomized controlled intervention trial. SETTING Community-based, postacute outpatient brain injury rehabilitation program. PARTICIPANTS Fifty-six persons with TBI. INTERVENTIONS Participants in ICRP (n=27) received an intensive, highly structured program of integrated cognitive and psychosocial interventions based on principles of holistic neuropsychologic rehabilitation. Participants in SRP (n=29) received comprehensive neurorehabilitation consisting primarily of physical therapy, occupational therapy, speech therapy, and neuropsychologic treatment. Duration of treatment was approximately 4 months for both interventions. MAIN OUTCOME MEASURES Community Integration Questionnaire (CIQ); and Quality of Community Integration Questionnaire assessing satisfaction with community functioning and satisfaction with cognitive functioning. Neuropsychologic functioning was evaluated for the ICRP participants. RESULTS Both groups showed significant improvement on the CIQ, with the ICRP group exhibiting a significant treatment effect compared with the SRP group. Analysis of clinically significant improvement indicated that ICRP participants were over twice as likely to show clinical benefit on the CIQ (odds ratio=2.41; 95% confidence interval, 0.8-7.2). ICRP participants showed significant improvement in overall neuropsychologic functioning; participants with clinically significant improvement on the CIQ also showed greater improvement of neuropsychologic functioning. Satisfaction with community functioning was not related to community integration after treatment. Satisfaction with cognitive functioning made a significant contribution to posttreatment community integration; this finding may reflect the mediating effects of perceived self-efficacy on functional outcome. CONCLUSIONS Intensive, holistic, cognitive rehabilitation is an effective form of rehabilitation, particularly for persons with TBI who have previously been unable to resume community functioning. Perceived self-efficacy may have significant impact on functional outcomes after TBI rehabilitation. Measures of social participation and subjective well-being appear to represent distinct and separable rehabilitation outcomes after TBI.
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Affiliation(s)
- Keith D Cicerone
- Cognitive Rehabilitation Department, JFK-Johnson Rehabilitation Institute, 2048 Oak Tree Road, Edison, NJ 08820, USA.
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Branca B, Lake AE. Psychological and Neuropsychological Integration in Multidisciplinary Pain Management After TBI. J Head Trauma Rehabil 2004; 19:40-57. [PMID: 14732830 DOI: 10.1097/00001199-200401000-00005] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The intersection of traumatic brain injury and posttraumatic chronic pain poses a significant challenge for the health practitioner. Effective intervention requires psychological and neuropsychological evaluation, multidisciplinary teamwork, and an understanding of a wide range of pain disorders and their relationship to traumatic brain injury. Assessment must include documentation of both current functioning and premorbid history. Pain interacts with cognitive impairment, mood and anxiety disorders, dysinhibition syndromes, and personality disorders, posing significant diagnostic dilemmas and treatment challenges. Coordinated care requires multiple, ongoing interventions from a variety of specialists. Patient involvement, focusing on internal locus of control, mediates successful treatment.
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Affiliation(s)
- Barbaranne Branca
- Michigan Head-Pain and Neurological Institute, Ann Arbor, Mich 48104, USA.
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Johnston MV, Miklos CS. Activity-related quality of life in rehabilitation and traumatic brain injury. Arch Phys Med Rehabil 2002; 83:S26-38. [PMID: 12474169 DOI: 10.1053/apmr.2002.37100] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To review approaches to assessment of quality of life (QOL) outcomes in rehabilitation, focusing particularly on traumatic brain injury (TBI), and to introduce the concept of activity-related QOL. DATA SOURCES A conceptual review, based on extensive searches of MEDLINE, PsychInfo, and other information sources. STUDY SELECTION Studies indexed under QOL and brain injury. DATA EXTRACTION Literature search on key words quality of life and traumatic brain injury. DATA SYNTHESIS Past research in rehabilitation and TBI has concentrated largely on assessment of function or activity. Although research on QOL after TBI remains limited, many studies have made inferences about QOL without actually assessing it. Persons with TBI experience serious long-enduring problems with QOL. Progress has been made in measurement of QOL and understanding of predictors of QOL after TBI. CONCLUSIONS Future research in rehabilitation would do well to consider not only activity outcomes but also the affective quality of everyday life, and the connections between the two. Measures of activity-related QOL may provide a more sensitive, valid, and useful evaluation of rehabilitative therapies than other approaches. Further research is needed to improve measurement and interpretation of QOL assessments. By assessing both objective and subjective features of outcomes, outcomes assessment becomes more complete and potentially more useful.
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Affiliation(s)
- Mark V Johnston
- Kessler Medical Rehabilitation Research and Education Corp, West Orange, NJ 07072, USA
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