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Pepping N, Weinborn M, Pestell CF, Preece DA, Malkani M, Moore S, Gross JJ, Becerra R. Improving emotion regulation ability after brain injury: A systematic review of targeted interventions. Neuropsychol Rehabil 2024:1-41. [PMID: 39230344 DOI: 10.1080/09602011.2024.2398029] [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: 01/16/2024] [Accepted: 08/25/2024] [Indexed: 09/05/2024]
Abstract
Emotion dysregulation is a common sequela after a brain injury, and it can have serious negative consequences for individuals, families, and the community. A systematic review of the literature was conducted to identify and evaluate interventions designed to improve emotion regulation ability in adults with acquired brain injury. Studies were identified on ProQuest, PsycInfo, ScienceDirect, Scopus, and Web of Science; last searched on 3 August 2023. A review protocol was prospectively registered on PROSPERO (CRD42020218175). Risk of bias was assessed using the Cochrane Risk-of-Bias tool (version 2). Sixteen studies were included in the review comprising one case series, five pilot studies, four pre-post studies, and six RCTs. There was a total of 652 participants across studies. Fourteen of the sixteen studies reported statistically significant improvements in at least one emotional functioning variable. Ten studies reported medium-large effect sizes. Limitations included inconsistency in the measurement, reporting of intervention outcomes and processes. Future directions are discussed.
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Affiliation(s)
- Natalie Pepping
- School of Psychological Science, The University of Western Australia, Perth, Australia
| | - Michael Weinborn
- School of Psychological Science, The University of Western Australia, Perth, Australia
| | - Carmela F Pestell
- School of Psychological Science, The University of Western Australia, Perth, Australia
| | - David A Preece
- School of Psychological Science, The University of Western Australia, Perth, Australia
- School of Population Health, Curtin University, Perth, Australia
- Psychological Sciences Research Institute, UCLouvain, Ottignies-Louvain-la-Neuve, Belgium
| | - Maya Malkani
- School of Psychological Science, The University of Western Australia, Perth, Australia
| | - Sammy Moore
- School of Psychological Science, The University of Western Australia, Perth, Australia
| | - James J Gross
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Rodrigo Becerra
- School of Psychological Science, The University of Western Australia, Perth, Australia
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2
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Rowlands L, Salas C, Coetzer R, Buckland S, Turnbull OH. "We can all relate": patient experience of an emotion-oriented group intervention after Acquired Brain Injury. Front Psychol 2024; 15:1384080. [PMID: 38993336 PMCID: PMC11238635 DOI: 10.3389/fpsyg.2024.1384080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/24/2024] [Indexed: 07/13/2024] Open
Abstract
Introduction Group interventions are carried out routinely across neuropsychological rehabilitation services, to improve understanding of brain injury and aspects of impairment. Treatment provided in a group modality can bring additional perceived benefits, such as co-operative learning. However, there are very few studies which explore patient perceptions and experiences of such interventions. In the present study we investigated the experience of attending a group-based educational intervention for the consequences of acquired brain injury (ABI), which had a strong focus on emotion and emotion regulation. Methods Using qualitative semi-structured interviews (approximately 20 minutes), the study explores the lived experience of participating in the seven-session programme, the better to identify the perceived efficacy, salience and value of individual elements. Twenty participants with ABI took part in individual interviews, after completion of the group programme (the Brain Injury Solutions and Emotions Programme, BISEP). The study adopted a descriptive phenomenological philosophy, which focuses on lived experience to explore a phenomenon (i.e. the experience of BISEP). As regards methods, the study employed thematic analysis to cluster experiences into themes of meaning. Results Five themes were identified: (1) 'Long term consequences and psychological needs', which related to the persistent nature of direct consequences of injury and adjustment, and how these result in a need for interventions such as BISEP. (2) 'Positive experiences of participating in the programme', referred to participants' overall experience of the programme and valued elements within it. The remaining themes referred to the programme as (3) a social milieu; (4) a place to learn; and (5) a place to promote positive emotional experiences. Discussion Similar to previous studies, many people reported high acceptability and perceived value of the group programme, and its role in facilitating adjustment and understanding of injury. Of particular importance was the opportunity to socialise with people who "can all relate", in line with a growing emphasis on social rehabilitation. The findings especially highlight the relevance of emotion-focused group programmes for ABI, promoting emotion regulation, and practical tools that are delivered optimistically. Further implications for practice and future research include to focus on long term rehabilitation, a social milieu, and strategies to support adjustment.
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Affiliation(s)
- Leanne Rowlands
- School of Psychology, Arden University, Coventry, United Kingdom
- Department of Psychology, Bangor University, Bangor, United Kingdom
| | - Christian Salas
- Clinical Neuropsychology Unit, Centre for Human Neuroscience and Neuropsychology, Faculty of Psychology, Diego Portales University, Santiago, Chile
| | - Rudi Coetzer
- Department of Psychology, Bangor University, Bangor, United Kingdom
- Brainkind, Sussex, United Kingdom
- Medicine, Health & Life Science Faculty, Swansea University, Swansea, United Kingdom
- North Wales Brain Injury Service, Betsi Cadwaladr University Health Board, Colwyn Bay, United Kingdom
| | - Sharon Buckland
- School of Psychology, Arden University, Coventry, United Kingdom
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3
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Zarzycki M, Seddon D, Petrovic M, Morrison V. Supporting Individuals With an Acquired Brain Injury: An Interpretative Phenomenological Study Exploring the Everyday Lives of Caregivers. QUALITATIVE HEALTH RESEARCH 2024:10497323241242046. [PMID: 38884621 DOI: 10.1177/10497323241242046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Acquired brain injury (ABI) is one of the most common causes of disability and death globally. Support from informal caregivers is critical to the well-being and quality of life of people with ABI and supports the sustainability of global health and social care systems. This study presents an in-depth qualitative analysis of the experiences of eight British informal caregivers supporting someone with ABI. Semi-structured interviews were conducted with narratives transcribed verbatim and analysed using interpretative phenomenological analysis (IPA). Three superordinate themes were generated: making sense of brain injury; being consumed by caregiving; and, the changing self. These data highlight the impact of caregiving on the caregiver's illness perceptions and sense of self. By identifying negative and positive changes in the caregiver's sense of self, and dilemmas regarding the care recipient's behaviour, we address less understood aspects of caregiver experiences. Caregiving can pose both challenges to the caregiver's sense of identity and an opportunity for self-growth. Some caregivers exhibit resilience throughout their journey, with post-traumatic growth more apparent in the later stages of caregiving. Illness perceptions shape caregiver well-being and family dynamics and indicate the need to address stigmatisation and discrimination faced by ABI survivors and caregivers. Although some caregivers acquired positive meaning and enrichment from their caregiving, previously described challenges of ABI caregiving are supported. Overall, our findings support the need for timely psychological/mental health support for caregivers, caregiver education, and the provision of short breaks from caregiving.
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Affiliation(s)
- Mikołaj Zarzycki
- Department of Psychology, Liverpool Hope University, Liverpool, UK
| | - Diane Seddon
- School of Health Sciences, College of Medicine and Health, Bangor University, Bangor, UK
| | - Milica Petrovic
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- Depression Research Centre of the German Depression Foundation, Department for Psychiatry, Psychosomatics and Psychotherapy, Goethe University, Frankfurt, Germany
| | - Val Morrison
- School of Psychology and Sports Science, College of Medicine and Health, Bangor University, Bangor, UK
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4
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Watson E, Raghavendra P, Lawn S, Watson J. Improving communication access in psychoeducational interventions for people with complex communication needs: a scoping review and stakeholder consultation. Disabil Rehabil 2023; 45:3388-3406. [PMID: 36172972 DOI: 10.1080/09638288.2022.2127932] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 09/11/2022] [Accepted: 09/18/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Psychoeducational interventions are commonly used to improve mental health among the general population; however, their application among people with complex communication needs is under explored. This scoping review aims to identify the psychoeducational interventions utilised with people with complex communication needs, any adaptations to improve communication access, and outcomes for this population. MATERIALS AND METHODS The scoping review was conducted using the Arksey and O'Malley guidelines and included stakeholder consultations. A systematic search of the literature was conducted. Stakeholder consultations were conducted via semi-structured interviews with informants from three populations: people with complex communication needs, everyday communication partners and mental health workers. RESULTS The search yielded 2112 articles. Twenty-four articles were retained for data extraction. Numerical analysis provided an overview of the existing literature. Thematic analysis highlighted the range of communication access strategies applied within psychoeducational interventions. Common aims and outcomes of interventions occurred across three interrelated themes: education, symptom reduction, and improved coping and wellbeing. Stakeholder consultations enabled contextualisation of literature. CONCLUSIONS People with complex communication needs may benefit from psychoeducational interventions when effective, personalised communication access strategies are employed. Future research should include lived-experience perspectives to ensure the relevance of communication access strategies in mental health support.Implications for rehabilitationThis scoping review adds to the evidence base supporting equitable access to mental health support for people with complex communication needs.A range of specific strategies are presented for mental health workers to consider when working with people with complex communication needs.Positive behaviour support (PBS) practitioners must be equipped to address the psychoeducational and mental health support requirements of people with complex communication needs.
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Affiliation(s)
- Eleanor Watson
- College of Nursing & Health Sciences, Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Parimala Raghavendra
- College of Nursing & Health Sciences, Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Sharon Lawn
- College of Medicine & Public Health, Flinders University, Adelaide, Australia
| | - Joanne Watson
- School of Health & Social Development, Deakin University, Melbourne, Australia
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5
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Beal EM, Pelser C, Coates P. Lockdown life - experiences of partners of individuals with an acquired brain injury during the COVID-19 pandemic: a qualitative study. BRAIN IMPAIR 2023; 24:260-273. [PMID: 38167198 DOI: 10.1017/brimp.2023.7] [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: 03/29/2023]
Abstract
OBJECTIVES The present study sought to investigate the experience of individuals living with their partner with an acquired brain injury (ABI) during the first lock down period of the COVID-19 pandemic. METHOD Semi-structured interviews were conducted with seven partners of individuals who had sustained a range of ABIs. Interviews were transcribed verbatim and thematic analysis was carried out by two of the researchers exploring the unique narratives. RESULTS ABI occurs within a relational framework, which means that it has repercussions not only for the individual but also the entire family system. COVID-19 prevented family systems (living separately) from coming together which negatively impacted them; however, it also slowed life down, with many people working from home with flexible arrangements in place which participants found to be beneficial. Three main themes emerged from the interview data: partner focus, slowing down and support networks. The narratives identified the struggles of having to continue their partner's rehabilitation when face to face services could not visit the home, the importance of establishing routine, the positives of a slower paced life (due to COVID-19) that enabled them to build stronger relationships with their partners, and the difficulties of being separated from family and loved ones. CONCLUSION This research suggests that it is imperative to consider individual experiences and choices. Some families benefited from reduced treatment and a slowed pace of life, whilst others may find this overwhelming and burdensome. The study makes recommendations for supporting couples after an ABI during the ongoing pandemic.
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Affiliation(s)
- Erin M Beal
- Merseycare NHS Foundation Trust, The Walton Centre NHS Foundation Trust, Liverpool, England
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, England
| | - Cara Pelser
- The Walton Centre NHS Foundation Trust, Liverpool, England
| | - Peter Coates
- The Walton Centre NHS Foundation Trust, Liverpool, England
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6
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Bohan JK, Nielsen M, Watter K, Kennedy A. "It gave her that soft landing": Consumer perspectives on a transitional rehabilitation service for adults with acquired brain injury. Neuropsychol Rehabil 2023; 33:1144-1173. [PMID: 35543026 DOI: 10.1080/09602011.2022.2070222] [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: 10/20/2021] [Accepted: 04/20/2022] [Indexed: 10/18/2022]
Abstract
Transitional rehabilitation service models for people with acquired brain injury (ABI) may address sub-optimal support for individuals returning home after hospitalization for ABI. This study investigated perspectives of people with ABI and close others who received transitional rehabilitation. A qualitative study involving semi-structured interviews with 10 individuals with ABI and 12 associated close others was conducted as part of a mixed-method evaluation of an Australian transitional rehabilitation service (TRS) pilot project. Thematic analysis based on the Framework method was conducted independently by two researchers. Three broad themes illustrated participants' experience of the TRS: (1) structure after hospital discharge; (2) a "soft landing"; and (3) equipped for community living. Findings suggest that home-based, interdisciplinary transitional rehabilitation after hospital discharge was perceived as an important stage of rehabilitation by participants. Valued features relate to post-hospital rehabilitation structure: a single point of contact to facilitate organization and information exchange, a known discharge destination, and consistent communication; support and therapy within a familiar home environment; and being equipped with relevant knowledge and strategies to manage ongoing challenges. Further research exploring the experiences of individuals with ABI without close family or social support, and research capturing longitudinal outcomes from transitional rehabilitation is recommended.
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Affiliation(s)
- Jaycie K Bohan
- Acquired Brain Injury Transitional Rehabilitation Service, Division of Rehabilitation,Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- School of Health and Rehabilitation Services, The University of Queensland, Brisbane, Australia
| | - Mandy Nielsen
- Acquired Brain Injury Transitional Rehabilitation Service, Division of Rehabilitation,Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Kerrin Watter
- Acquired Brain Injury Transitional Rehabilitation Service, Division of Rehabilitation,Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Areti Kennedy
- Acquired Brain Injury Transitional Rehabilitation Service, Division of Rehabilitation,Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
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7
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Libbon R, Rothberg B, Baker S, Heru A. Multifamily Group Psychotherapy for Patients With Nonepileptic Seizures and Their Families. Am J Psychother 2023:appipsychotherapy20210060. [PMID: 36794444 DOI: 10.1176/appi.psychotherapy.20210060] [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: 02/17/2023]
Abstract
OBJECTIVE Multifamily group (MFG) psychotherapy is widely used for mental and general medical conditions. MFG therapy engages family members in caring for a loved one experiencing illness and helps clarify the impact of illness on family. Use of MFG therapy for patients with nonepileptic seizures (NES) and their families to explore satisfaction with treatment and family functioning is described. METHODS MFG therapy for patients with NES and their participating family members was incorporated into an existing interdisciplinary group-based psychotherapy treatment program. The Family Assessment Device and a novel feedback questionnaire were used to understand the effect of MFG therapy on this population. RESULTS Patients with NES (N=29) and their corresponding family members (N=29) indicated on the feedback questionnaire their satisfaction with having MFG therapy as part of their treatment; satisfaction was also evidenced by a 79% (N=49 of 62) patient participation rate. Patients and family members reported enhanced understanding of the impact of illness on the family and believed MFG therapy would help them communicate about illness and reduce family conflict. Scores on the Family Assessment Device indicated that family members perceived better family functioning than did patients (average scores of 1.84 and 2.99, respectively). CONCLUSIONS The discrepancy in perceived family functioning supports the idea of integrating family members in treatment for patients experiencing NES. The group treatment modality was satisfactory to participants and may prove useful for other kinds of somatic symptom disorders, which are often external manifestations of internal distress. Family members can become treatment allies in psychotherapy when included in treatment.
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8
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Cregan K, Daisley A, Ford C, Gracey F. A qualitative exploration of fatherhood after acquired brain injury (ABI). Neuropsychol Rehabil 2022; 32:2269-2293. [PMID: 34098840 DOI: 10.1080/09602011.2021.1938142] [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: 12/27/2022]
Abstract
Acquired Brain Injury (ABI) significantly affects individuals across multiple areas of intimate, familial, and parental domains. Gender and identity are pivotal research areas in navigating life after ABI. To date, scant research has explored gendered experiences, particularly those related to the masculine lifeworld. This study aimed to explore how men who were fathers before their injuries experience fatherhood after ABI. An Interpretative phenomenological analysis (IPA) methodology was used, and seven fathers participated in the semi-structured interviews (time since injury 1-18 years, age range 27-66 years) which explored their meaning-making. Four superordinate themes were drawn from all interviews through engaging with the qualitative research process: (1) what being a father means, (2) altered relationships with others, (3) becoming lost and finding their way through, and (4) renewed fatherhood. The findings show intersectionality between pre-and post-injury comparisons of self and social identities, alongside the contextual and societal identities in the subjective fathering experiences. Through increased understanding, we may enable fathers to find new ways to resolve, reformulate, and connect to move into their future possible fatherhood. The importance of this research is in giving voice to these less represented men so that we may shape our understanding to aid future fathers post-ABI.
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Affiliation(s)
- Karen Cregan
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK.,North East London NHS Foundation Trust, London, UK
| | - Audrey Daisley
- Department of Clinical Neuropsychology, Oxford Centre for Enablement, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Catherine Ford
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Fergus Gracey
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
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9
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Glennon C, Watson S, Fisher P, Gracey F. The process of identity change following ABI from the perspectives of adolescents and their mothers: A relational grounded theory approach. Neuropsychol Rehabil 2022; 32:1904-1927. [PMID: 35857657 DOI: 10.1080/09602011.2022.2100796] [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: 10/17/2022]
Abstract
This study explored the process of identity adjustment following adolescent brain injury, within the systemic context of the parent-adolescent dyad. Six young people with an ABI (mean age 16.5 years, range 15-18 years; TBI: n = 3) were individually interviewed, and six respective mothers (mean age 45 years, range 37-50 years). A novel relational qualitative grounded theory approach was used, with analyses of dyads linked in an attempt to capture the shared process of adaptation post-injury for young people and their parents. Shared themes emerged for adolescents and mothers regarding "continuity and change" and "acknowledging or rejecting" experiences of change post injury. Adolescents experienced change as an, at times, distressing sense of being "not normal". While mothers turned towards their child, working hard to try to "fix everything", adolescents sought continuity of identity in the context of peer relationships, withdrawing socially to avoid feeling abnormal, reframing or finding new relationships. Some mothers sought to fill social losses through family or disability-specific activity. This study provides a relational understanding of the process of identity adjustment post adolescent BI. Future research and clinical practice should recognize the significant work of mothers, and significance of social relationships to adolescents' emerging post-injury identity.
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Affiliation(s)
- Ciara Glennon
- Department of Clinical Psychology and Psychological Therapies, University of East Anglia, Norwich, UK
| | - Suzanna Watson
- Cambridge Centre for Paediatric Neuropsychological Rehabilitation (CCPNR), Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Paul Fisher
- Department of Clinical Psychology and Psychological Therapies, University of East Anglia, Norwich, UK
| | - Fergus Gracey
- Department of Clinical Psychology and Psychological Therapies, University of East Anglia, Norwich, UK.,Cambridge Centre for Paediatric Neuropsychological Rehabilitation (CCPNR), Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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Bracho-Ponce MJ, Grasso-Cladera A, Salas C, Lassaletta A. ‘I am not who you think I am’: public stigma and invisible brain injury (‘No soy quien creen que soy’: estigma público y daño cerebral invisible). STUDIES IN PSYCHOLOGY 2022. [DOI: 10.1080/02109395.2021.2006947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
| | | | - Christian Salas
- Universidad Diego Portales
- Centro de Estudios en Neurociencia Humana y Unidad de Neuropsicología Clínica
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11
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Ghosh-Cannell C, Fisher P, Ajayi J, Gracey F. The experiences of wives following acquired brain injury (ABI). A qualitative analysis exploring realisations of change following the ABI of a "loved one.". Neuropsychol Rehabil 2022; 33:356-377. [PMID: 34978522 DOI: 10.1080/09602011.2021.2017982] [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: 10/19/2022]
Abstract
The experiences of family members following Acquired Brain Injury (ABI) are well established, with spouses in particular facing multiple relational and personal changes. Qualitative studies have analysed accounts pertaining to a range of sequelae, however, "change" itself has yet to be addressed. This study explored the experiences of realisation of change for married women living with their husbands following ABI. Nine participants took part in semi-structured interviews focussing on becoming aware of changes in both their spouse and themselves post-injury. An Interpretative Phenomenological Analysis (IPA) was completed, arriving at two overarching themes; "bravery to face changes" and "lost and trapped in an unsolvable maze," with accompanying subthemes. Participants generally experienced realisation of change gradually, in some cases finding strategies to control their exposure to distress. They often referred to "acceptance," which held varied meanings, and metaphors appeared to aid personal meaning making. Relationship changes generated both dilemmas and the feeling of being trapped. Overall, this study contributes greater insights into the experiential mechanisms underpinning realisation of change in spouses after brain injury.
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Affiliation(s)
| | - Paul Fisher
- Department of Clinical Psychology, University of East Anglia, Norwich, UK
| | - Julia Ajayi
- Department of Clinical Psychology, University of East Anglia, Norwich, UK
| | - Fergus Gracey
- Department of Clinical Psychology, University of East Anglia, Norwich, UK
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12
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Whiffin CJ, Gracey F, Ellis-Hill C. The experience of families following traumatic brain injury in adult populations: A meta-synthesis of narrative structures. Int J Nurs Stud 2021; 123:104043. [PMID: 34388366 DOI: 10.1016/j.ijnurstu.2021.104043] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 07/10/2021] [Accepted: 07/15/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Traumatic brain injury has a significant effect on uninjured family members. Typically, this has been examined with a focus on psychopathological outcomes including stress, depression and anxiety. However, in recent years there has been increasing interest in the subjective experiences of families post-injury leading to a plethora of qualitative studies. Therefore, an in-depth examination and synthesis of this literature is now relevant and timely. OBJECTIVE To examine the subjective experiences of families following traumatic brain injury in adult populations in the sub/post-acute period through the synthesis of original qualitative research. DESIGN This paper presents a meta-synthesis using Thomas and Harden's framework of 'thematic synthesis' rooted in a critical realist philosophy. DATA SOURCES In July 2019 five electronic databases, were searched for the terms 'traumatic brain injury', 'family' and 'qualitative'. Studies were included if the primary research reported qualitative data about the subjective experiences of family members of adults with traumatic brain injury and had been published in a peer reviewed journal. Studies with mixed brain injury samples, child or adolescent traumatic brain injury or disorders of consciousness were excluded. Hand searching and citation searches were also completed. REVIEW METHODS Two reviewers screened titles, abstracts and full text and reached consensus through critical discussion. Thirty papers were finally agreed for inclusion in this review. Each study was then assessed for relevance, resonance and rigour using the Critical Appraisal Skills Programme (CASP) tool. Line by line coding of the findings in each paper was conducted as the basis for a thematic analysis and synthesis. RESULTS Descriptive themes were identified followed later by analytical themes. This final stage was informed by a narrative lens and from these, eight narrative functions belonging to four dimensions were identified from the subjective experiences of families post-traumatic brain injury. Specifically, these were: (1) Displacing and Anchoring; (2) Rupturing and Stabilising; (3) Isolating and Connecting; (4) Harming and Healing. CONCLUSIONS The interpretation of the narrative functions revealed the substantial existential work involved in negotiating lives, maintaining family system equilibrium and moving forward. As such, family members have their own unique narrative needs. Despite contemporary service models built around the injured person, service providers are well placed to support families in this everyday narrative work through actively attending to narrative structures and understanding the implications of these for family experience. The study protocol was registered with PROSPERO (International prospective register of systematic reviews) in July 2018 (Registration number: CRD42018085824). Tweetable abstract: This synthesis showed the immense and invisible work required for family members to maintain family system equilibrium and negotiate their lives post-TBI.
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Affiliation(s)
- Charlotte Jane Whiffin
- College of Health, Psychology and Social Care, University of Derby, Kedleston Road, Derby DE22 1GB, United Kingdom.
| | - Fergus Gracey
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, United Kingdom.
| | - Caroline Ellis-Hill
- Faculty of Health and Social Sciences, Bournemouth University, Royal London House R110, Christchurch Road, Bournemouth BH1 3LT, United Kingdom.
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13
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Panday J, Velikonja D, Moll SE, Harris JE. Experiences of inpatient rehabilitation from the perspective of persons with acquired brain injury. Disabil Rehabil 2021; 44:5539-5548. [PMID: 34166176 DOI: 10.1080/09638288.2021.1938706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Perspectives of individuals with acquired brain injury (ABI) regarding inpatient rehabilitation experiences can inform patient-centered care; however, these voices are under-represented in the literature. PURPOSE To explore the experiences, needs, and preferences of patients from an ABI inpatient rehabilitation program in Ontario. METHODS Using an interpretive description approach, we interviewed 12 participants and analyzed the transcripts inductively to generate themes. FINDINGS We identified three major themes: (1) Life Rerouted - participants felt their lives diverted due to ABI, with rehabilitation seen as a way to return to pre-injury life, (2) Autonomy within Rehab highlighted the perceived importance of personal autonomy in decision-making within rehabilitation, and (3) Life (and Recovery) Go On reflected an ongoing recovery process after discharge - leading to mixed emotions. An overall message, "re-establishing personal identity is important to the recovery process," reflected theories of biographical disruption and relational autonomy. IMPLICATIONS Our findings provide a patient perspective for clinicians and administrators to consider. We found that ABI was significantly disruptive to personal identity - resulting in tensions in autonomy while attempting to reclaim a sense of identity. We suggest counseling services and strategies supporting post-injury adjustment, along with ways for rehabilitation professionals to enhance patient autonomy where possible.Implications for rehabilitationSustaining an ABI can significantly disrupt personal identity and sense of autonomy - especially as persons occupy the role of "patient" while in inpatient rehabilitation.Psychological support is recommended to address the impacts of ABI on patients' sense of identity, as well as on family members.Strategies of support might include, providing formal psychotherapy, as well as creating opportunities for patients and family members to discuss the changes they are experiencing, and to establish their personal narratives (e.g., through writing or art) or peer mentorship programs between discharged and current patients.Clinicians can enhance patient autonomy by increasing opportunities for communication with patients about choice; educating patients and family members on the rehabilitation team's decision-making process, and other methods that increase communication and provide consistent up-to-date information to patients and their family members.
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Affiliation(s)
- Janelle Panday
- School of Rehabilitation Science, McMaster University, Institute for Applied Health Sciences, Hamilton, Canada
| | - Diana Velikonja
- Hamilton Health Sciences, Regional Rehabilitation Centre, Hamilton, Canada.,Department of Psychology and Behavioural Neurosciences, DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Sandra E Moll
- School of Rehabilitation Science, McMaster University, Institute for Applied Health Sciences, Hamilton, Canada
| | - Jocelyn E Harris
- School of Rehabilitation Science, McMaster University, Institute for Applied Health Sciences, Hamilton, Canada
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Allen N, Hevey D, Carton S, O'Keeffe F. Life is about "constant evolution": the experience of living with an acquired brain injury in individuals who report higher or lower posttraumatic growth. Disabil Rehabil 2021; 44:3479-3492. [PMID: 33459069 DOI: 10.1080/09638288.2020.1867654] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To explore the experience of living with an Acquired Brain Injury (ABI) in individuals who report higher or lower posttraumatic growth (PTG). METHOD A multi-method design was employed. Participant scores on the Posttraumatic Growth Inventory (PTGI) were used to identify groups for qualitative comparative analysis. Individual semi-structured interviews were conducted with fourteen individuals with ABI. Data were analysed thematically. RESULTS Four themes emerged. The first two themes: "In my mind I was fine" surviving in aftermath of acquiring a brain injury and The everyday as "derailing" capture the transition process from an initial rehabilitation state characterised by neuropsychological and avoidance coping, towards active rebuilding for PTG. Internal building blocks for PTG and Growing in the social world: "you need to have that social connection" elaborate on the internal (e.g., acceptance, integration of the pre and post-injury self) and external (e.g., social relationships) factors seen to facilitate or obstruct PTG. CONCLUSIONS Under certain conditions, individuals living with ABI may construe positive growth from their experiences. Practitioners can support PTG development by providing individual and family-based supports aimed at increasing acceptance, the integration of self, and social connection throughout all stages of ABI rehabilitation.IMPLICATIONS FOR REHABILITATIONInternal factors such as having a flexible and positive mindset and external factors such as one's social environment can affect how individuals living with an ABI construe positive growth.Individuals with ABI and their families require access to individualised longitudinal support for neuropsychological and social challenges that can result in increased distress and obstruct the development of PTG.Efforts to facilitate acceptance and support the integration of the pre and post-injury self through recognition of continuity of self and processing of new schematic beliefs can benefit PTG development.Rehabilitation providers should support individuals with ABI to develop or maintain a positive social identity within new or existing social groups.
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Affiliation(s)
- Niamh Allen
- School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - David Hevey
- School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Simone Carton
- National Rehabilitation Hospital, Dún Laoghaire, Dublin, Ireland
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15
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Rowlands L, Coetzer R, Turnbull OH. Building the bond: Predictors of the alliance in neurorehabilitation. NeuroRehabilitation 2020; 46:271-285. [PMID: 32310195 DOI: 10.3233/nre-193005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Neurorehabilitation services are often delivered through group psycho-education programmes. However, little is known about the therapeutic process at work during such sessions. The present study is the first to gain insight into the therapeutic alliance, during a seven-session group programme. In addition, cognitive, emotional, and demographic predictors of the alliance, and participants' feelings towards their group members, were investigated, together with predictors of patient engagement. METHODS Forty-five participants with an acquired brain injury completed a series of questionnaires, and neuropsychological assessment, following group psycho-education. The group facilitator completed a parallel therapeutic alliance questionnaire, and rated participants' engagement. RESULTS Results demonstrated that a strong alliance can be formed in seven group sessions. Notably, no demographic or cognitive factors appear to pose a barrier to developing a therapeutic alliance, nor to group attraction. CONCLUSION High levels of depression, however, may be a challenge, and clinicians may need to tailor their clinical skills to ensure a good therapeutic relationship with such patients. To promote engagement, clinicians may also need to provide additional support to patients with lower levels of education, working memory, and episodic memory impairment.
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Affiliation(s)
- Leanne Rowlands
- School of Psychology, Bangor University, Bangor, UK.,The North Wales Brain Injury Service, Betsi Cadwaladr University Health Board, Colwyn Bay, UK
| | - Rudi Coetzer
- School of Psychology, Bangor University, Bangor, UK.,The North Wales Brain Injury Service, Betsi Cadwaladr University Health Board, Colwyn Bay, UK
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16
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Ownsworth T, Karlsson L. A systematic review of siblings' psychosocial outcomes following traumatic brain injury. Disabil Rehabil 2020; 44:496-508. [PMID: 32478586 DOI: 10.1080/09638288.2020.1769206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: To investigate the psychosocial impact of TBI on siblings and to identify the factors associated with their psychosocial functioning.Methods: A systematic search of six databases (CINAHL, Medline, Scopus, PsychINFO, Web of Science and Embase) was conducted from 1980 to May 1st, 2020. Studies involving siblings of a child or adult with TBI that employed validated self-report measures of psychosocial functioning were included. Quality of methodology was appraised by two reviewers.Results: Thirteen articles were identified, reporting on 11 cross-sectional studies. Although there were mixed findings overall, siblings typically reported greater mood symptoms and distress related to family functioning as compared to the norms and control samples. Siblings' psychosocial functioning was comparable to other family members, although they were less likely to be primary caregivers. Having a brother or sister with behavioural problems and low levels of social support were the factors most consistently related to poor psychosocial functioning in siblings.Conclusions: Siblings of individuals with TBI may experience negative changes in psychosocial functioning. They are at greater risk of poor psychosocial functioning when their brother or sister with TBI has behavioural problems and when they perceive low social support. Longitudinal studies on siblings' adjustment trajectory over time and research on support interventions for siblings are recommended.Implications for RehabilitationTraumatic brain injury can have a negative impact on siblings' psychosocial functioning with respect to mood and distress related to family functioning.As siblings experience similar impacts on their psychosocial functioning to other family members, specific focus on their adjustment to role changes may be needed.Siblings with a brother or sister with behavioural problems and those perceiving lower social support may particularly benefit from monitoring and support.
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Affiliation(s)
- Tamara Ownsworth
- School of Applied Psychology, Menzies Health Institute Queensland, Griffith University, Mt Gravatt, Australia
| | - Lina Karlsson
- School of Applied Psychology, Menzies Health Institute Queensland, Griffith University, Mt Gravatt, Australia
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17
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Affiliation(s)
- Matteo Farinella
- Presidential Scholar in Society and Neuroscience, Columbia University, New York, New York, USA
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18
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Hart T, Driver S, Sander A, Pappadis M, Dams-O'Connor K, Bocage C, Hinkens E, Dahdah MN, Cai X. Traumatic brain injury education for adult patients and families: a scoping review. Brain Inj 2018; 32:1295-1306. [PMID: 30084694 DOI: 10.1080/02699052.2018.1493226] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Traumatic brain injury (TBI) is increasingly viewed as a chronic condition, bringing long-term needs for patient and caregiver knowledge pertaining to symptom and problem management over time. In light of these needs, we performed a scoping review of the literature on brain injury education provided to adult patients and/ or family members affected by TBI. Objectives were to describe the types of educational interventions that have been developed; to review the effects of these interventions; and to determine gaps that might be filled by future research efforts. Of 88 articles meeting search criteria and subjected to data extraction, 34 concerned education about mild TBI and 54, moderate to severe TBI. Most mild TBI articles focused on education in the Emergency Room, while most moderate/ severe TBI education was directed toward family members/ caregivers and was frequently combined with other treatment components, making the effects of education difficult to discern. Only 1 article incorporated elements of self-management training (SMT), a model proved effective in other chronic health conditions. We recommend further exploration of SMT principles in long-term TBI care, as well as more precise definition of treatment components in all patient and family interventions, so that the specific effects of education and other treatment elements may be more readily evaluated.
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Affiliation(s)
- Tessa Hart
- a Moss Rehabilitation Research Institute , Elkins Park , PA , USA
| | - Simon Driver
- b Department of Rehabilitation Research , Baylor Scott and White Institute for Rehabilitation , Dallas , TX , USA
| | - Angelle Sander
- c Department of Physical Medicine and Rehabilitation , Baylor College of Medicine , Houston , TX , USA.,d Brain Injury Research Center , TIRR Memorial Hermann , Houston , TX , USA
| | - Monique Pappadis
- d Brain Injury Research Center , TIRR Memorial Hermann , Houston , TX , USA.,e Division of Rehabilitation Sciences, School of Health Professions , University of Texas Medical Branch at Galveston , TX , USA
| | - Kristen Dams-O'Connor
- f Department of Rehabilitation Medicine, Department of Neurology Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Claire Bocage
- g American Institutes for Research , Washington , DC , USA
| | - Emma Hinkens
- g American Institutes for Research , Washington , DC , USA
| | - Marie N Dahdah
- b Department of Rehabilitation Research , Baylor Scott and White Institute for Rehabilitation , Dallas , TX , USA.,h Department of Medical Psychology , Baylor Scott and White Medical Center , Plano , TX , USA
| | - Xinsheng Cai
- g American Institutes for Research , Washington , DC , USA
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19
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Luzinat KJ, Analytis P, Hicks AJ, Warren N, Ponsford JL. The experience of a recreational camp for families with a child or young person with acquired brain injury. Neuropsychol Rehabil 2018; 30:233-248. [DOI: 10.1080/09602011.2018.1461657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Katrina J. Luzinat
- Monash-Epworth Rehabilitation Research Centre, Monash University, Melbourne, Australia
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Penelope Analytis
- Monash-Epworth Rehabilitation Research Centre, Monash University, Melbourne, Australia
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Amelia J. Hicks
- Monash-Epworth Rehabilitation Research Centre, Monash University, Melbourne, Australia
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Narelle Warren
- School of Social Sciences, Faculty of Arts, Monash University, Melbourne, Australia
| | - Jennie L. Ponsford
- Monash-Epworth Rehabilitation Research Centre, Monash University, Melbourne, Australia
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
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20
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Whiffin CJ, Ellis-Hill C, Bailey C, Jarrett N, Hutchinson PJ. We are not the same people we used to be: An exploration of family biographical narratives and identity change following traumatic brain injury. Neuropsychol Rehabil 2017; 29:1256-1272. [DOI: 10.1080/09602011.2017.1387577] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Caroline Ellis-Hill
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Christopher Bailey
- School of Health Sciences, The University of Nottingham, Queen’s Medical Centre, Nottingham, UK
| | - Nikki Jarrett
- Health Sciences, Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Peter J. Hutchinson
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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21
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Fadyl JK, Theadom A, Channon A, McPherson KM. Recovery and adaptation after traumatic brain injury in New Zealand: Longitudinal qualitative findings over the first two years. Neuropsychol Rehabil 2017; 29:1095-1112. [DOI: 10.1080/09602011.2017.1364653] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Joanna K. Fadyl
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
| | - Alice Theadom
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Alexis Channon
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
| | - Kathryn M. McPherson
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
- Health Research Council of New Zealand, Auckland, New Zealand
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22
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Bellon M, Sando S, Crocker R, Farnden J, Duras M. Information, connection and giving back: peer support outcomes for families following acquired brain injury in South Australia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:204-214. [PMID: 26494119 DOI: 10.1111/hsc.12294] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/02/2015] [Indexed: 06/05/2023]
Abstract
This study aimed to identify the experiences and outcomes of participation in Families4Families Inc., a peer support network for families following acquired brain injury (ABI) in South Australia. Prior to the programme's launch in January 2013, new members of the network were invited to participate in pre- and post-programme phone interviews to identify benefits and limitations of the programme, and identify outcomes of participation. Fifty-five members (20 people with ABI; 35 caregivers) participated in pre-programme interviews, with 34 repeating the final interview at the end of the 18-month pilot programme in June 2014. Interview transcripts were imported into Nvivo 10, where comments were analysed using inductive data-driven thematic analysis. Responses to rating questions were analysed using SPSS 20. Attendance records indicate that 39 of 55 participants were involved in the programme (12 active, 27 occasional) and 16 participants did not attend. Active attenders reported that they provided and received higher levels of support and information than those who attended only occasionally, including the significantly higher development of new friendships and contacts (P < 0.001). Statistically significant improvements in knowledge of services by both active and occasional attenders were reported (P = 0.014 and 0.026 respectively) with non-significant improvements for non-attenders. Qualitative analysis of interview transcripts revealed three major thematic benefits of involvement. These include the opportunity to access information, receive emotional support and give back to others in the network. Reasons for no longer participating in the network are explored. Peer support programmes can enable families to share experiences, knowledge, positive coping strategies, understanding of systems and develop new social networks that last beyond the programme. The continuing need for extended regional access is highlighted, with follow-up and referral to counselling and other services also critical to ensure members are appropriately supported through difficult personal experiences.
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Affiliation(s)
- Michelle Bellon
- Disability and Community Inclusion, School of Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Sandi Sando
- Disability and Community Inclusion, School of Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Ruth Crocker
- Disability and Community Inclusion, School of Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | | | - Melissa Duras
- Disability and Community Inclusion, School of Health Sciences, Flinders University, Adelaide, South Australia, Australia
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23
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Baker A, Barker S, Sampson A, Martin C. Caregiver outcomes and interventions: a systematic scoping review of the traumatic brain injury and spinal cord injury literature. Clin Rehabil 2016; 31:45-60. [DOI: 10.1177/0269215516639357] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aim: To identify factors reported with negative and positive outcomes for caregivers of the traumatic brain injury and spinal cord injury cohorts, to investigate what interventions have been studied to support carers and to report what effectiveness has been found. Methods: Scoping systematic review. Electronic databases and websites were searched from 1990 to December 2015. Studies were agreed for inclusion using pre-defined criteria. Relevant information from included studies was extracted and quality assessment was completed. Data were synthesised using qualitative methods. Results: A total of 62 studies reported caregiver outcomes for the traumatic brain injury cohort; 51 reported negative outcomes and 11 reported positive outcomes. For the spinal cord injury cohort, 18 studies reported caregiver outcomes; 15 reported negative outcomes and three reported positive outcomes. Burden of care was over-represented in the literature for both cohorts, with few studies looking at factors associated with positive outcomes. Good family functioning, coping skills and social support were reported to mediate caregiver burden and promote positive outcomes. A total of 21 studies further described interventions to support traumatic brain injury caregivers and four described interventions to support spinal cord injury caregivers, with emerging evidence for the effectiveness of problem-solving training. Further research is required to explore the effects of injury severity of the care recipient, as well as caregiver age, on the outcome of the interventions. Conclusion: Most studies reported negative outcomes, suggesting that barriers to caregiving have been established, but not facilitators. The interventions described to support carers are limited and require further testing to confirm their effectiveness.
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Affiliation(s)
- Anne Baker
- School of Allied Health, Australian Catholic University, Melbourne, Australia
| | - Samantha Barker
- Institute for Safety, Compensation and Recovery Research, Monash University, Melbourne, Australia
| | - Amanda Sampson
- Institute for Safety, Compensation and Recovery Research, Monash University, Melbourne, Australia
| | - Clarissa Martin
- Department of Physiotherapy, Monash University, Melbourne, Australia
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24
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Tantillo M, McGraw JS, Hauenstein EJ, Groth SW. Partnering with patients and families to develop an innovative multifamily therapy group treatment for adults with anorexia nervosa. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/21662630.2015.1048478] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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25
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Thapliyal P, Hay PJ. Treatment experiences of males with an eating disorder: a systematic review of qualitative studies. ACTA ACUST UNITED AC 2014. [DOI: 10.3402/tdp.v2.25552] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Phillipa J. Hay
- School of MedicineUniversity of Western Sydney, Sydney, Australia
- Centre for Health ResearchUniversity of Western Sydney, Sydney, Australia
- School of Medicine James Cook University, Townsville, Australia
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