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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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Tsow R, Pollock C, Mehta S, Turcott A, Kang R, Schmidt J. A Look at Traumatic Brain Injury Community Programs in British Columbia: Barriers and facilitators of implementation. Brain Inj 2024; 38:539-549. [PMID: 38465902 DOI: 10.1080/02699052.2024.2327471] [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: 06/13/2023] [Accepted: 03/04/2024] [Indexed: 03/12/2024]
Abstract
RESEARCH OBJECTIVES 1) Characterize the delivery of programs that support acceptance and resiliency for people with brain injury in the healthcare sector; 2) Understand the barriers and facilitators in implementation of programs to support self-acceptance and resiliency for people with brain injury. DESIGN Participatory focus groups were used to explore experiences of conducting brain injury programs and knowledge of the barriers and facilitators to their implementation. Focus group data were analyzed with manifest content analysis to minimally deviate from broad and structural information provided by participants. SETTING Four focus group sessions were conducted online through a video calling platform. PARTICIPANTS 22 individuals from community associations conducting programs for people with brain injury. Participants were recruited from a public brain injury organization database. RESULTS Systemic challenges such as access to and allocation of funding require navigation support. Resource consistency and availability, including stable program leaders and a welcoming atmosphere, are important for program implementation and sustainability. Shared experiences promote connection with the community and personal development. CONCLUSIONS This study informs individual- and community-level approaches to promote meaningful life after brain injury. Findings highlight existing resources and support future programming for people with brain injury.
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Affiliation(s)
- Rebecca Tsow
- Rehabilitation Research Program, Centre for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada a
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Courtney Pollock
- Rehabilitation Research Program, Centre for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada a
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Swati Mehta
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
| | - Alyssa Turcott
- Rehabilitation Research Program, Centre for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada a
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Ruthine Kang
- Rehabilitation Research Program, Centre for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada a
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Julia Schmidt
- Rehabilitation Research Program, Centre for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada a
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
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Moore M, Kempthorne L, Fann JR, Shulein O, Dams-O'Connor K, Kajankova M, Conrick KM, Seeliger J, Hoffman JM. Patient and Caregiver Satisfaction With the Brain Injury Rehabilitation: Improving the Transition Experience (BRITE) Intervention. J Head Trauma Rehabil 2024:00001199-990000000-00154. [PMID: 38758094 DOI: 10.1097/htr.0000000000000949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
OBJECTIVE To ascertain patient and caregiver satisfaction with an individualized case management intervention to improve transition from inpatient rehabilitation care to the community after traumatic brain injury (TBI). SETTING Participants from 6 National Institute on Disability, Independent Living, and Rehabilitation Research-funded TBI Model Systems sites in the United States. PARTICIPANTS Adult, English-speaking patients with TBI who had moderate-to-severe TBI and were discharged from a TBI Model Systems site and who were in the intervention arm of the Brain Injury Rehabilitation: Improving the Transition Experience pragmatic clinical trial, as well as their caregivers. DESIGN A survey of participants in the intervention arm, which included an individualized case management program administered by a TBI Care Manager (TCM) who facilitated resource connection, education, and support. MAIN MEASURES Satisfaction with intervention was measured through Likert-scaled and open-ended questions. The survey was administered verbally through telephone, audio-recorded, and transcribed. Descriptive statistics were calculated for categorical variables, and content analysis was conducted for open-ended responses. RESULTS Patient and caregiver participants were satisfied with the intervention and highlighted the benefits of the interpersonal and practical support provided by the TCM. Participants identified the need for a more intensive intervention and clear expectations of the TCM role, as well as gaps in available medical and rehabilitation services in the community, as areas for improvement. CONCLUSION Patients with TBI and their caregivers reported satisfaction with the individualized case management program in supporting their transition from inpatient rehabilitation to the community. Further research is needed to understand the impact on outcomes.
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Affiliation(s)
- Megan Moore
- Author Affiliations: School of Social Work (Dr Moore and Dr Conrick), Harborview Injury Prevention and Research Center (Dr Moore), Department of Rehabilitation Medicine (Mss Kempthorne and Shulein and Dr Hoffman), Department of Psychiatry and Behavioral Sciences (Dr Fann), University of Washington, Seattle, Washington; Brain Injury Research Center, Department of Rehabilitation Medicine, Department of Neurology (Dr Dams-O'Connor), Department of Rehabilitation and Human Performance Brain Injury Research Center (Dr Kajankova), Icahn School of Medicine at Mount Sinai, New York, New York; and Physical Medicine and Rehabilitation (Ms Seeliger), North Shore Long Island Jewish Medical Group, Manhasset, New York
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Costello RS, Downing MG, Ponsford J. The experience of traumatic brain injury in a culturally and linguistically diverse sample in Australia. Disabil Rehabil 2024; 46:2069-2078. [PMID: 37237438 DOI: 10.1080/09638288.2023.2216473] [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: 07/05/2022] [Accepted: 05/16/2023] [Indexed: 05/28/2023]
Abstract
PURPOSE Individuals from culturally and linguistically diverse (CALD) backgrounds experience poorer outcomes following traumatic brain injury (TBI), including poorer quality of life. The reasons for these poorer outcomes are unclear. Therefore, this study aimed to qualitatively investigate the experience of injury, rehabilitation, and recovery amongst individuals from a CALD background following TBI. MATERIALS AND METHODS Fifteen semi-structured interviews were conducted, and qualitatively analysed using reflexive thematic analysis. RESULTS It was demonstrated that: (a) the cognitive and behavioural consequences of TBI were accompanied by stigma and loss of independence; (b) participants held many beliefs related to their TBI, ranging from bad luck to acceptance. Participants' personal values and beliefs provided strength and resilience, with many viewing the injury as a positive event in their lives; (c) participants were appreciative of the high standard of care they received in hospital and rehabilitation, although communication barriers were experienced; (d) many participants identified with Australian culture, and few believed their cultural background negatively impacted their experience of TBI; (e) external support, particularly from family, was considered central to recovery. CONCLUSION These findings offer insight into the challenges CALD individuals face and factors that may facilitate their recovery and improve functional outcomes.
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Affiliation(s)
- Reannon S Costello
- Monash Epworth Rehabilitation Research Centre (MERRC) and School of Psychological Sciences, Monash University, Australia
| | - Marina G Downing
- Monash Epworth Rehabilitation Research Centre (MERRC) and School of Psychological Sciences, Monash University, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Australia
| | - Jennie Ponsford
- Monash Epworth Rehabilitation Research Centre (MERRC) and School of Psychological Sciences, Monash University, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Australia
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Igoe A, Twomey DM, Allen N, Carton S, Brady N, O'Keeffe F. A longitudinal analysis of factors associated with post traumatic growth after acquired brain injury. Neuropsychol Rehabil 2024; 34:430-452. [PMID: 37022203 DOI: 10.1080/09602011.2023.2195190] [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: 11/01/2022] [Accepted: 03/20/2023] [Indexed: 04/07/2023]
Abstract
ABSTRACTPost-Traumatic Growth (PTG) is a form of positive psychological change that occurs for some individuals following traumatic experiences. High levels of PTG have been reported among survivors of acquired brain injury (ABI). Yet it remains unclear why some survivors of ABI develop PTG and others do not. The present study investigated early and late factors that are associated with long-term PTG in people with moderate to severe ABIs. Participants (n = 32, Mage = 50.59, SD = 12.28) completed self-report outcome measures at two time-points seven years apart (one-year and eight-years post-ABI). Outcome measures assessed emotional distress, coping, quality of life and ongoing symptoms of brain injury, as well as PTG at the later timepoint. Multiple regression analyses indicated that one-year post-ABI, fewer symptoms of depression, more symptoms of anxiety, and use of adaptive coping strategies accounted for a significant amount of variance in later PTG. At eight years post-ABI, fewer symptoms of depression, fewer ongoing symptoms of brain injury, better psychological quality of life and use of adaptive coping strategies explained a substantial amount of variance in PTG. For individuals with ABIs, PTG may be promoted by implementing long-term neuropsychological support which aims to facilitate use of adaptive coping strategies, supports psychological wellbeing and allows individuals to find meaning post-ABI.
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Affiliation(s)
- Anna Igoe
- University College Dublin, Dublin, Ireland
| | | | | | - Simone Carton
- National Rehabilitation Hospital, Dun Laoghaire, Ireland
| | | | - Fiadhnait O'Keeffe
- University College Dublin, Dublin, Ireland
- Trinity College Dublin, Dublin, Ireland
- National Rehabilitation Hospital, Dun Laoghaire, Ireland
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Lafiatoglou P, Ellis-Hill C, Gouva M, Ploumis A, Mantzoukas S. Older adults' lived experiences of physical rehabilitation for acquired brain injury and their perceptions of well-being: A qualitative phenomenological study. J Clin Nurs 2024; 33:1134-1149. [PMID: 38014630 DOI: 10.1111/jocn.16939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 10/06/2023] [Accepted: 11/13/2023] [Indexed: 11/29/2023]
Abstract
AIM To explore the experiences of older adults (65+) living with acquired brain injury regarding their sense of well-being during physical rehabilitation within the Greek Healthcare System. BACKGROUND With the increasing ageing population and the life-changing effects of acquired brain injury, there is a need to focus on care for older people and their potential to live well. Rehabilitation systems deserve greater attention, especially in improving the well-being of those who are using them. DESIGN A qualitative study design with a hermeneutic phenomenological approach was used. METHODS Fourteen older adults living with acquired brain injury and undergoing physical rehabilitation in Greece were purposively sampled. Semi-structured interviews were conducted to collect data and were thematically analysed using van Manen's and Clarke and Braun's methods. The COREQ checklist was followed. RESULTS Four themes emerged from the analysis: (1) Challenges of new life situation, (2) Seeking emotional and practical support through social interaction, (3) Identifying contextual processes of rehabilitation, (4) Realising the new self. CONCLUSIONS The subjective experiences, intersubjective relations and contextual conditions influence the sense of well-being among older adults living with acquired brain injury, thus impacting the realisation of their new self. The study makes the notion of well-being a more tangible concept by relating it to the degree of adaptation to the new situation and the potential for older adults to create a future whilst living with acquired brain injury. RELEVANCE FOR CLINICAL PRACTICE Identifying the factors that impact older adults' sense of well-being during rehabilitation can guide healthcare professionals in enhancing the quality of care offered and providing more dignified and humanising care. PATIENT OR PUBLIC CONTRIBUTION Older adults living with acquired brain injury were involved in the study as participants providing the research data.
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Affiliation(s)
- Panagiota Lafiatoglou
- Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Caroline Ellis-Hill
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Mary Gouva
- Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Avraam Ploumis
- Department of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Stefanos Mantzoukas
- Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, Greece
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Lindlöf J, Turunen H, Välimäki T, Huhtakangas J, Verhaeghe S, Coco K. Empowering Support for Family Members of Brain Injury Patients in the Acute Phase of Hospital Care: A Mixed-Methods Systematic Review. JOURNAL OF FAMILY NURSING 2024; 30:50-67. [PMID: 37191257 PMCID: PMC10788044 DOI: 10.1177/10748407231171933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
This review aimed to identify and synthesize empowering support for the family members of patients in the acute phase of traumatic brain injury hospital treatment. CINAHL, PubMed, Scopus, and Medic databases were searched from 2010 to 2021. Twenty studies met the inclusion criteria. Each article was critically appraised using the Joanna Briggs Institute Critical Appraisals Tools. Following a thematic analysis, four main themes were identified about the process of empowering traumatic brain injury patients' family members in the acute phases of hospital care: (a) needs-based informational, (b) participatory, (c) competent and interprofessional, and (d) community support. This review of findings may be utilized in future studies focusing on designing, implementing, and evaluating an empowerment support model for the traumatic brain injury patient's family members in the acute care hospitalization to strengthen the current knowledge and develop nursing practices.
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Affiliation(s)
| | | | | | | | | | - Kirsi Coco
- University of Eastern Finland, Kuopio, Finland
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Gmelig Meyling C, Verschuren O, Rentinck ICM, van Driel D, Te Slaa E, Engelbert RH, Gorter JW. "Your brain can't wait": perspectives of children and adolescents with acquired brain injury and their parents on physical rehabilitation during the subacute phase. Disabil Rehabil 2023:1-8. [PMID: 37909065 DOI: 10.1080/09638288.2023.2275742] [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: 03/26/2023] [Accepted: 10/23/2023] [Indexed: 11/02/2023]
Abstract
PURPOSE Physical interventions during subacute rehabilitation have potential to improve functional recovery. This study explored the perspectives of children and adolescents with acquired brain injury (ABI) and their parents with respect to physical rehabilitation during the subacute phase. METHODS Thirteen children and adolescents with ABI and their parents were included and interviewed using semi-structured interviews. Interview transcripts were analysed using inductive thematic analysis approach. RESULTS Six themes were identified: 1) beliefs of physical rehabilitation, 2) content of physical rehabilitation, 3) tailored care, 4) impact of context, 5) communication and 6) transition. The importance of intensive physical practice was widely supported. The positive can-do mentality was emphasised to create an atmosphere of hope, meaning that every effort would be made to achieve maximum recovery. Intensive involvement of parents is considered essential during subacute rehabilitation including an open and mutual dialogue about the focus of rehabilitation, therapy goals and future participation in their own environment. CONCLUSIONS Our findings highlight the need for an intensive rehabilitation approach, tailored to the individual's needs. The perspectives of children and adolescents and their parents in our study contribute to a better understanding of factors that are important for optimal recovery through physical rehabilitation during the subacute phase.
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Affiliation(s)
- Christiaan Gmelig Meyling
- UMC Utrecht Brain Center and Center of Excellence for Rehabilitation Medicine, Utrecht University, Utrecht, The Netherlands
- Department of Paediatric Rehabilitation, De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Institute of Human Movement Studies, Master Program Physiotherapy Specialization Paediatric Physiotherapy, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Olaf Verschuren
- UMC Utrecht Brain Center and Center of Excellence for Rehabilitation Medicine, Utrecht University, Utrecht, The Netherlands
| | - Ingrid C M Rentinck
- Department of Paediatric Rehabilitation, De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Dimara van Driel
- Institute of Human Movement Studies, Master Program Physiotherapy Specialization Paediatric Physiotherapy, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Esmée Te Slaa
- Institute of Human Movement Studies, Master Program Physiotherapy Specialization Paediatric Physiotherapy, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Raoul H Engelbert
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Department of Paediatrics, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan Willem Gorter
- UMC Utrecht Brain Center and Center of Excellence for Rehabilitation Medicine, Utrecht University, Utrecht, The Netherlands
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- CanChild Centre for Childhood Disability Research, Department of Paediatrics, McMaster University, Hamilton, Ontario, Canada
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Collins J, Lizarondo L, Taylor S, Porritt K. Adult patient and carer experiences of planning for hospital discharge after a major trauma event: a qualitative systematic review. Disabil Rehabil 2023; 45:3435-3455. [PMID: 36299236 DOI: 10.1080/09638288.2022.2133180] [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: 01/02/2021] [Accepted: 09/25/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To identify, evaluate and synthesize qualitative literature on adult patients and carer experiences of planning for discharge from an acute setting after a major trauma event. METHODS The JBI approach to meta-aggregation was followed. Qualitative studies exploring patient and carer discharge planning experiences of major trauma were included in the systematic review. A comprehensive search was conducted in five databases, supplemented by grey literature. Eligible studies were appraised for methodological quality by two reviewers and data extracted using standardized JBI tools. RESULTS Four synthesized findings emerged using 69 findings from sixteen papers. (i) Patients and carers feel generally unprepared to manage at home after discharge, (ii) early identification of patients' post discharge needs allows for appropriate referrals and supports to be organised prior to discharge, (iii) patients and carers value participation in the discharge planning process to facilitate a considered, organized and timely discharge from hospital (iv) the timely presentation, delivery, language used, format and relevancy of information impacts how patients and carers manage their discharge. CONCLUSION This meta-synthesis demonstrates that patients and carers predominantly have poor experiences of discharge planning after major trauma. Adoption of patient centered principles may improve patient and carer experiences of the discharge planning process. IMPLICATIONS FOR REHABILITATIONPatients and their carers benefit from a client-centred approach where their needs are recognised and their collaboration encouraged in important decisions, and if they are adequately prepared to reintegrate into their community.Patients can benefit from having a trauma pathway healthcare professional to provide support and advocacy services throughout their hospital admission and after discharge.Discharge planning that is organised, prepared and collaborative leads to a more positive patient experience.Discharge information should be individualised and presented in an easily accessible format for patients and carers.
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Affiliation(s)
- Jeanette Collins
- JBI, University of Adelaide, Adelaide, Australia
- Jeanette Collins, Rehabilitation in the Home (RITH), Perth, Australia
| | | | - Susan Taylor
- School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
- Occupational Therapy Department, Perth Children's Hospital, Child and Adolescent Health Service, Perth, Australia
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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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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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Hanafy S, Quilico E, Haag H(L, Khoo Y(B, Munce S, Lindsay S, Colantonio A, Mollayeva T. An educational intervention to promote a culture of gender equity among persons with traumatic brain injury and caregivers: A pilot study. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1160850. [PMID: 37180573 PMCID: PMC10169667 DOI: 10.3389/fresc.2023.1160850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/04/2023] [Indexed: 05/16/2023]
Abstract
Background Traumatic brain injury (TBI) outcomes are dependent on patients' biological sex (e.g., hormone levels) and sociocultural gender (e.g., norms, responsibilities). Informal caregivers additionally experience disruptions to identity and roles post-TBI. However, information on this topic remains largely unavailable to patients and caregivers. Purpose This study aimed to determine the effectiveness of a one-time educational intervention on sex and gender influences in TBI for patients and informal caregivers. Materials and methods We conducted a pilot pre-test/post-test randomized control-group design study. Groups (i.e., passive, active and control) consisted a total of 16 persons with TBI and caregivers (75% persons with TBI, 63% women). Individual and group learning gains, and group-average normalized gain, were computed for three learning domains: knowledge, attitude, and skill. An intervention with an average normalized gain of ≥30% was considered effective. Educational intervention evaluation and qualitative comments post-participation were summarized. Results The passive group demonstrated the highest average normalized gain across the three learning domains, including 100% for knowledge, 40% and 61% for attitude, and 37% for skill. The remaining groups did not reach an average normalized gain of ≥30%, except for the attitude domain of the control group (33% and 32%). Two key categories were identified qualitatively: (1) gendered self-expectations post-injury and (2) implications of gender stereotypes in rehabilitation, including the need for rehabilitation treatment to look beyond sex and gender. The post-participation educational session evaluation conveyed high appraisal of content, organization, and usability of the intervention. Conclusion A one-time passive educational intervention on sex and gender in TBI may improve knowledge, attitude, and skill on the topic of sex and gender among adults with TBI and caregivers. Obtaining knowledge and skill on sex and gender effects in TBI can potentially help persons with TBI and caregivers adapt to changes in roles and behaviours post-injury.
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Affiliation(s)
- Sara Hanafy
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Enrico Quilico
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Halina (Lin) Haag
- Faculty of Social Work, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Yuelee (Ben) Khoo
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Sarah Munce
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, University ofToronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Sally Lindsay
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, University ofToronto, Toronto, ON, Canada
| | - Angela Colantonio
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, University ofToronto, Toronto, ON, Canada
| | - Tatyana Mollayeva
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, University ofToronto, Toronto, ON, Canada
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13
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Nielsen M, Watter K, Bohan J, Kennedy A. Implementation and modification of a service model for community transitional rehabilitation for people with acquired brain injury. Brain Inj 2023; 37:446-456. [PMID: 36744835 DOI: 10.1080/02699052.2022.2163292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To examine the implementation of a novel Acquired Brain Injury (ABI) Transition-Specific Service Model in Queensland, Australia to explore its potential for successful operationalization in a clinical context and what, if any, modifications were indicated. METHODS This study is part of a larger evaluation of the ABI Transitional Rehabilitation Service (ABITRS) Pilot Project using a Hybrid Type 1 research design. Data was drawn from a process evaluation nested within the larger study. Stirman et al.'s FRAME guided assessment of modifications made to the proposed Transition-Specific Service Model during implementation. RESULTS The proposed Transition-Specific Service Model provided a foundational framework for establishing an ABI transitional rehabilitation service in Queensland. All designated key service delivery features of the model were implemented; context and content modifications occurred in response to the implementation experience. Priority areas for intervention were comprehensively addressed, with significant changes made to the proposed staffing profile to address an identified need for more senior clinicians. CONCLUSIONS The ABITRS Pilot Project provided an opportunity to test and refine elements of an ABI Transition-Specific Service Model in a clinical context. Knowledge gained from this process has the potential to inform future design of transitional rehabilitation services for acquired brain injury.
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Affiliation(s)
- Mandy Nielsen
- Acquired Brain Injury Transitional Rehabilitation Service, Division of Rehabilitation, Princess Alexandra Hospital, 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, Brisbane, Australia
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Jaycie Bohan
- Acquired Brain Injury Transitional Rehabilitation Service, Division of Rehabilitation, Princess Alexandra Hospital, 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, Brisbane, Australia
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
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14
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Manley K, Saunders K, Wilkinson D, Faruqui R, Sakel M. Co-creating system-wide improvement for people with traumatic brain injury across one integrated care system in the United Kingdom to initiate a transformation journey through co-production. Health Expect 2023; 26:869-881. [PMID: 36715266 PMCID: PMC10010072 DOI: 10.1111/hex.13712] [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: 07/22/2022] [Revised: 01/05/2023] [Accepted: 01/11/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND OBJECTIVE There is a need for better integration of services across communities and sectors for people living with traumatic brain injury (TBI) to meet their complex needs. Building on insights gained from earlier pilot work, here we report the outcomes of a participatory workshop that sought to better understand the challenges, barriers and opportunities that currently exist within the care pathway for survivors of TBI. METHODS A diverse range of stakeholders from the acute and rehabilitation care pathway and the health and social care system were invited to participate in a 3-h workshop. The participants worked in four mixed subgroups using practice development methodology, which promotes person-centred, inclusive and participatory action. RESULTS Thematic analysis identified shared purposes and values that were used to produce a detailed implementation and impact framework for application at both the level of the care interface and the overarching integrated care system. A variety of enablers were identified that related to collective values and behaviours, case management, team leadership and integrated team working, workforce capability, evidence-based practice and resourcing. The clinical, economic, cultural and social outcomes associated with these enablers were also identified, and included patient safety, independence and well-being, reduced waiting times, re-admission rates, staff retention and professional development. CONCLUSION The co-produced recommendations made within the implementation and impact framework described here provide a means by which the culture and delivery of health and social care services can be better tailored to meet the needs of people living with TBI. We believe that the recommendations will help shape the formation of new services as well as the development of existing ones. PATIENT OR PUBLIC CONTRIBUTION Patient and public involvement have been established over a 10-year history of relationship building through a joint forum and events involving three charities representing people with TBI, carers, family members, clinicians, service users, researchers and commissioners, culminating in a politically supported event that identified concerns about the needs of people following TBI. These relationships formed the foundation for the interactive workshop, the focus of this publication.
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Affiliation(s)
- Kim Manley
- Practice Development and Co Director ImpACT Research Group, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK.,England Centre for Practice Development, Faculty of Medicine, Health & Social Care, Canterbury Christ Church University, Canterbury, Kent, UK
| | - Karen Saunders
- Division for the Study of Law, Society and Social Justice, School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, UK.,Department of Physiotherapy and Rehabilitation, Jashore University of Science and Technology, Jashore, Bangladesh
| | - David Wilkinson
- Director of the Division of Human and Social Sciences, School of Psychology, University of Kent, Canterbury, UK
| | - Rafey Faruqui
- Department of Psychiatry, Kent and Medway NHS and Social Care Partnership Trust, Maidstone, UK.,Division for the Study of Law, Society and Social Justice, Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Mohamed Sakel
- Department of Physiotherapy and Rehabilitation, Jashore University of Science and Technology, Jashore, Bangladesh.,Director of Neuro-Rehabilitation Service, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
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15
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Jones TM, Bhanji A, Osman S, Cai XC, Garfinkel S, Weinstein AA. Experiences of caregivers and individuals living with traumatic brain injury in accessing health information: a qualitative investigation. Brain Inj 2023; 37:293-302. [PMID: 36453445 DOI: 10.1080/02699052.2022.2145366] [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: 11/19/2022]
Abstract
BACKGROUND/PURPOSE Rehabilitation and treatment of chronic symptoms of traumatic brain injury (TBI) present life-long challenges. This qualitative study aimed to understand the experience of individuals with TBI and caregivers in finding and using health information and to understand their interest in participating in research. METHODS Participants were recruited through hospital listservs, websites, social media, and word of mouth from across the US. A qualitative constructivism research method was used to analyze responses from semi-structured interviews with 24 individuals, 11 with TBI and 13 caregivers. RESULTS Three major themes emerged from the analyses: 1) processes and resources for finding TBI-related health information, 2) reliability of information, and 3) participation in research. Study participants described using the internet, consulting with healthcare professionals, reading research articles, and seeking out information from other individuals with TBI or caregivers to search for information. Participants also shared their experiences related to evaluating the reliability of information and the impact of individuals with TBI and caregivers participating on research teams. CONCLUSION Participants identified various needs in finding relevant health information and highlighted gaps in searching for and using health information. Participants identified an overarching need for improved dissemination of information that is both accessible and reliable.
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Affiliation(s)
- Tammie M Jones
- Department of Health Administration and Policy, George Mason University, Fairfax, Virginia, USA
| | - Alaanah Bhanji
- Department of Global and Community Health, George Mason University, Fairfax, Virginia, USA
| | - Sarah Osman
- Department of Global and Community Health, George Mason University, Fairfax, Virginia, USA
| | | | | | - Ali A Weinstein
- Department of Global and Community Health, George Mason University, Fairfax, Virginia, USA
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16
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O'Shannessy E, Reeder S, Vishwanath S, Hill S, Perta A, Jolliffe L, Morarty J, Hunter P, Lannin NA. Mixed methods study to understand the experiences of adults with acquired brain injury and their family members who receive specialised rehabilitation. BRAIN IMPAIR 2023; 24:39-53. [PMID: 38167579 DOI: 10.1017/brimp.2022.3] [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: 11/06/2022]
Abstract
BACKGROUND AND AIM Rehabilitation therapy is a key part of the recovery pathway for people with severe acquired brain injury (ABI). The aim of this study was to explore inpatients' and their family members' experiences of a specialist ABI rehabilitation service. METHODS A cross sectional, prospective mixed method study was undertaken at a metropolitan specialist ABI rehabilitation unit in Victoria, Australia. All inpatients and their family members of the service were invited to complete a satisfaction survey. Employing purposive sampling, semi-structured interviews were conducted with inpatients and/or their family members. RESULTS In total, 111 people completed the satisfaction survey and 13 were interviewed. High levels of satisfaction with the specialist service were reported; the majority of inpatients (74%) and family members (81%) rated the overall quality of care received in the service as 'high' or 'very high'. Interviews revealed four main themes: (i) satisfaction with rehabilitation services, (ii) inconsistent communication, (iii) variable nursing care, and (iv) strengths and weakness of the rehabilitation environment. Overall, important components of a positive experience were being involved in decision making and discharge planning, effective communication and information processes, and being able to form therapeutic relationships with staff. Key sources of dissatisfaction for inpatients and family members related to inconsistency in care, accessing information about treatments in a format easily understood, and communication. CONCLUSION Specialised rehabilitation is valued by inpatients and their family members alike. The findings highlight the importance of exploring inpatient experiences to optimise service delivery in a tailored, specialised rehabilitation programme.
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Affiliation(s)
| | - Sandra Reeder
- Department of Neuroscience, Monash University Central Clinical School, Melbourne, VIC, Australia
| | - Swarna Vishwanath
- Department of Neuroscience, Monash University Central Clinical School, Melbourne, VIC, Australia
| | - Sophie Hill
- La Trobe University, Melbourne, VIC, Australia
| | | | - Laura Jolliffe
- Alfred Health, Melbourne, VIC, Australia
- Department of Occupational Therapy, Monash University, Melbourne, VIC, Australia
| | | | | | - Natasha A Lannin
- Alfred Health, Melbourne, VIC, Australia
- Department of Neuroscience, Monash University Central Clinical School, Melbourne, VIC, Australia
- La Trobe University, Melbourne, VIC, Australia
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17
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Hennessy MJ, Sullivan KA. A 'Network of Understanding and Compassion': A Qualitative Study of Survivor Perspectives on Unmet Needs After Traumatic Brain Injury (TBI) in Regional Communities. BRAIN IMPAIR 2023; 24:27-38. [PMID: 38167578 DOI: 10.1017/brimp.2021.18] [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] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This qualitative study aimed to identify the service and support needs of people with a recent history of traumatic brain injury (TBI) living in the community. METHODS A postal survey was sent to 662 people 6-18 months after hospital admission for a mild-to-severe TBI. The survey included an open-ended item ('wish-basket') for collecting ideas about important unmet needs. RESULTS Responses from 53 individuals were coded and processed using thematic analysis. Five themes (n = 39) were identified, three of which were related to personal needs. These personal wishes were about being symptom-free, independent and emotionally supported by, and connected to, loved ones. The remaining themes were about the wished-for changes to the health system and society, such as wishing for health care continuity (as opposed to being abandoned), and for greater understanding and support by society. CONCLUSIONS There is scope to improve the services and support for people living with TBI in the community. This includes reconsidering the way that discharge occurs, addressing the personal needs that remain when living in the community and promoting greater social awareness of TBI to counteract disadvantage.
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Affiliation(s)
| | - Karen A Sullivan
- Queensland University of Technology School of Psychology and Counselling, Kelvin Grove, Brisbane, Queensland, Australia
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18
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Laurie K, Foster M, Gustafsson L. Personal experiences of appropriate access to post-acute care services in acquired brain injury: a scoping review. BRAIN IMPAIR 2023; 24:1-26. [PMID: 38167584 DOI: 10.1017/brimp.2021.33] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
People with an acquired brain injury (ABI) experience substantial access inequalities and unmet health needs, with many experiencing insufficient access to appropriate rehabilitation in the community. To deepen our understanding of what appropriate access to post-acute care services is for this population, and to facilitate optimal recovery, there is a need to synthesise research from the service user perspective. A scoping review study was conducted to identify key characteristics of 'appropriate' access to post-acute care services, as defined by the personal experiences of adults with ABI. Electronic scientific databases Medline, PsycINFO, Proquest Central and CINAHL were searched for studies published between 2000 and 2020. The initial search identified 361 articles which, along with articles retrieved from reference list searches, resulted in 52 articles included in the final analysis. Results indicated that a majority of the studies sampled participants with an average of over 1 year post-injury, with some studies sampling participants ranging over 10 years in difference in time post-injury. A thematic synthesis was conducted and results indicated a number of dominant elements which relate to (1) the characteristics of services: provider expertise, interpersonal qualities, partnership and adaptability; (2) characteristics of the health system: navigable system, integrated care, adequacy, and opportunity. These findings provide some insight into what might be considered appropriate. However, rigorous research, focused on personalised access to post-acute care services, is recommended to verify and elaborate on these findings.
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Affiliation(s)
- Kirstyn Laurie
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute, Brisbane, Queensland, Australia
- School of Health Sciences and Social Work, Griffith University, Brisbane, Queensland, Australia
| | - Michele Foster
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute, Brisbane, Queensland, Australia
- School of Health Sciences and Social Work, Griffith University, Brisbane, Queensland, Australia
| | - Louise Gustafsson
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute, Brisbane, Queensland, Australia
- School of Health Sciences and Social Work, Griffith University, Brisbane, Queensland, Australia
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19
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Talbot KJ, Krüger E, Pillay BS. Experiences of acquired brain injury one-month post-discharge from acute hospitalisation. Afr J Disabil 2023; 12:1037. [PMID: 36876022 PMCID: PMC9982487 DOI: 10.4102/ajod.v12i0.1037] [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: 03/09/2022] [Accepted: 12/12/2022] [Indexed: 02/24/2023] Open
Abstract
Background Healthcare professionals may have a preconceived idea about life after an acquired brain injury (ABI). Understanding lived experiences of individuals with ABI and their significant others, post-hospitalisation, may improve communication between healthcare professionals and individuals directly influenced by the ABI. Objective To describe perceived experiences of individuals with ABI, and their significant others, regarding rehabilitation services and returning to daily activities, one-month post-discharge from acute hospitalisation. Method Semi-structured interviews, via an online platform, expanded on the experiences of six dyads (individuals with an ABI and their significant others). Data were thematically analysed. Results Six main themes emerged that best described participants' experiences; two of which were shared between individuals with ABI and their significant others (SO). Individuals with an ABI acknowledged recovery as their priority and highlighted the importance of patience. The need for counselling and additional support from healthcare professionals and peers arose. The SO expressed a need for written information, improved communication from healthcare professionals, and education regarding the implications of an ABI. The coronavirus disease 2019 (COVID-19) pandemic negatively influenced all participants' overall experiences, mainly because of termination of visiting hours. Psychosocial intervention would have been beneficial to all participants. Faith influenced most participants' attitudes towards recovery and adapting post-ABI. Conclusion Most participants accepted their new reality but required additional support to cope emotionally. Individuals with an ABI would benefit from opportunities to share experiences with and learn from others in a similar situation. Streamlined services and improved communication may alleviate anxiety among families during this crucial transitional period. Contribution This article provides valuable information on the perspectives and experiences of individuals with ABI and their significant others during the transition from acute hospitalisation. The findings can assist with the continuity of care, integrative health and supportive strategies during the transition period post-ABI.
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Affiliation(s)
- Kirsten J Talbot
- Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
| | - Esedra Krüger
- Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
| | - Bhavani S Pillay
- Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
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20
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Nalder E, King G, Hunt AW, Hartman LR, Szigeti Z, Drake E, Shah R, Shahzad M, Resnick M, Pereira G, Lenton E. Indicators of life success from the perspective of individuals with traumatic brain injury: a scoping review. Disabil Rehabil 2023; 45:330-343. [PMID: 35037526 DOI: 10.1080/09638288.2021.2025274] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE The purpose was to synthesize qualitative literature and identify indicators of life success (positive life outcomes and experiences) that can help in understanding resiliency in the context of traumatic brain injury (TBI). METHODS This scoping review involved searching nine online databases for population (TBI) and context (qualitative literature). Searches retrieved 42 852 articles and, after two-stage screening, 76 articles met the inclusion criteria of reporting indicators of life success from the perspective of individuals with TBI. RESULTS Most studies were conducted in North America, Australia, or Europe. Participants were people living with TBI (mild to severe), of all age ranges. Positive life experiences were organized within four domains: understanding of oneself and one's life, social relationships and interaction, doing (engagement in activities, sense of control and accomplishment), and hope for the future. CONCLUSIONS The positive life experiences reflect both processes and outcomes (indicators of success) and highlight the need for a multidimensional approach when seeking to understand resiliency following TBI. The transactional framework of life experiences can be applied in future TBI resiliency research to understand how individuals negotiate adversity through experiences promoting understanding of oneself and the world, social relationships, engagement in activity and hope. Implications for rehabilitationRehabilitation services should consider how to afford opportunities for engagement in activity, social interaction, meaning making (i.e., coming to new understandings), and hope.With respect to engaging in activity and social relationships, having social interaction, being understood, being active and productive, having autonomy, and having accomplishments, reflect important experiences to enable within rehabilitation services.Rehabilitation professionals should consider how providing opportunities for their clients to have positive life experiences may contribute toward an adaptive and empowered mindset.
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Affiliation(s)
- Emily Nalder
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- March of Dimes Canada, East York, Canada
| | - Gillian King
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Bloorview Research Institute & Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Anne W Hunt
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Laura R Hartman
- Bloorview Research Institute & Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Zara Szigeti
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Bloorview Research Institute & Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Emma Drake
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Riya Shah
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Maryam Shahzad
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Myles Resnick
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Giles Pereira
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Erica Lenton
- Gerstein Science Information Centre, University of Toronto, Toronto, Canada
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21
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Guldager R, Nordentoft S, Poulsen I, Aadal L, Loft MI. Wants and needs for involvement experienced by relatives of patients with an acquired brain injury: a scoping review. JBI Evid Synth 2022; 21:886-912. [PMID: 36729839 DOI: 10.11124/jbies-22-00022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This scoping review identifies and maps the breadth of available evidence on relatives' wants and needs for involvement in the care of patients with an acquired brain injury. INTRODUCTION Acquired brain injuries often occur suddenly and unexpectedly. Suffering from an acquired brain injury has major consequences, not only for the patients, due to the devastating impact on their physical, cognitive, social, and psychological well-being, but also for the relatives who may need to take on a lifelong role as carers. Research has cited some benefits of involving relatives in the care of patients, including positive effects on the patients' health outcomes; however, there are few studies showing how relatives can be involved. INCLUSION CRITERIA Studies that defined or assessed relatives' wants and needs for involvement with the care of patients with an acquired brain injury in all settings were included. Studies were included if they described any kind of wants and needs for involvement experienced from the perspective of relatives. The review considered all study designs, except for literature reviews. METHODS The JBI methodology for conducting a scoping review was employed in accordance with an a priori published protocol. An extensive search was conducted in MEDLINE (PubMed), CINAHL (EBSCO), and Embase (Ovid). Gray literature was searched using Grey Matters and BASE. The initial search was conducted in February 2020 and updated in September 2021. This review was limited to studies published in English, German, or Scandinavian languages since January 2010. The data were extracted using a data extraction tool (authors, year of publication, country of origin, setting, study methods, and findings related to wants and needs for involvement) created by the authors. The review findings are reported as a descriptive summary, with tables and figures supporting the data. RESULTS The search identified 3854 studies, 31 of which were included. The studies were published between 2010 and 2021 and were conducted across 9 countries. In total, 16 studies applied a qualitative study design, 4 studies used a descriptive approach, 4 studies used a quantitative research design, 4 studies reported using a mixed methods design, and 3 studies employed a multi-methods design. The studies were conducted across a variety of settings, ranging from acute care to home. The international literature on the involvement of relatives with patients with acquired brain injuries comprises multiple published studies on different aspects of the topic and within various care contexts. The findings identified few studies describing wants and needs experienced by relatives in relation to involvement in the patient's disease trajectory. CONCLUSIONS The findings show that relatives' wants and needs are primarily related to information and communication, but are also related to collaboration with health care professionals. The findings illustrate that the complexity of involvement is comprehensive, with multiple aspects to consider.
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Affiliation(s)
- Rikke Guldager
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
| | - Sara Nordentoft
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
| | - Ingrid Poulsen
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre Hospital Hvidovre, Denmark.,Research Unit Nursing and Health Care, Aarhus University, Aarhus, Denmark
| | - Lena Aadal
- Hammel Neurorehabilitation and Research Centre, Hammel, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mia Ingerslev Loft
- Research Unit Nursing and Health Care, Aarhus University, Aarhus, Denmark.,Department of Neurology, Rigshospitalet, Copenhagen, Denmark
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22
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Hudson C, Radford K, Kettlewell J. A Qualitative Study to Understand the Impact of Caring for Traumatic Injury Survivors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16202. [PMID: 36498277 PMCID: PMC9737134 DOI: 10.3390/ijerph192316202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/08/2022] [Accepted: 12/02/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Following traumatic injury, an informal carer is often required to support recovery. Understanding the impact of caregiving is important to inform intervention design. AIM to explore the impact of caring on family and caregiver finances, employment, social life, and psychological wellbeing. METHOD Semi-structured interviews conducted with carers of traumatic injury survivors. Interviews were audio recorded, transcribed and thematically analysed, informed by the Roy Adaptation Model (RAM) and International Classification of Functioning, Disability and Health (ICF). RESULTS Ten participants were interviewed. Key themes included (1) financial impact/employment issues, (2) relationships and support and (3) psychological impact. Most carers did not receive professional support with daily care post-discharge. Carers' employers responded positively, supporting them even after extensive leave. Carers received inconsistent communication whilst visiting trauma survivors in hospital; carers with healthcare experience were favoured. Navigating and receiving benefits was complex. Some carers found it difficult to accept the trauma survivor's injury, whilst others focused on achieving goals. CONCLUSIONS Support from professional services is limited outside hospital settings for non-brain injuries. Future interventions and healthcare services should acknowledge the lack of psychological support for carers. Researchers should consider using the ICF/RAM when designing interventions to ensure the full impact on carers is addressed.
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Affiliation(s)
- Catherine Hudson
- Centre for Rehabilitation and Ageing Research, University of Nottingham, Nottingham NG7 2RD, UK
| | - Kate Radford
- Centre for Rehabilitation and Ageing Research, University of Nottingham, Nottingham NG7 2RD, UK
| | - Jade Kettlewell
- Centre for Academic Primary Care, University of Nottingham, Nottingham NG7 2RD, UK
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23
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Maas AIR, Menon DK, Manley GT, Abrams M, Åkerlund C, Andelic N, Aries M, Bashford T, Bell MJ, Bodien YG, Brett BL, Büki A, Chesnut RM, Citerio G, Clark D, Clasby B, Cooper DJ, Czeiter E, Czosnyka M, Dams-O’Connor K, De Keyser V, Diaz-Arrastia R, Ercole A, van Essen TA, Falvey É, Ferguson AR, Figaji A, Fitzgerald M, Foreman B, Gantner D, Gao G, Giacino J, Gravesteijn B, Guiza F, Gupta D, Gurnell M, Haagsma JA, Hammond FM, Hawryluk G, Hutchinson P, van der Jagt M, Jain S, Jain S, Jiang JY, Kent H, Kolias A, Kompanje EJO, Lecky F, Lingsma HF, Maegele M, Majdan M, Markowitz A, McCrea M, Meyfroidt G, Mikolić A, Mondello S, Mukherjee P, Nelson D, Nelson LD, Newcombe V, Okonkwo D, Orešič M, Peul W, Pisică D, Polinder S, Ponsford J, Puybasset L, Raj R, Robba C, Røe C, Rosand J, Schueler P, Sharp DJ, Smielewski P, Stein MB, von Steinbüchel N, Stewart W, Steyerberg EW, Stocchetti N, Temkin N, Tenovuo O, Theadom A, Thomas I, Espin AT, Turgeon AF, Unterberg A, Van Praag D, van Veen E, Verheyden J, Vyvere TV, Wang KKW, Wiegers EJA, Williams WH, Wilson L, Wisniewski SR, Younsi A, Yue JK, Yuh EL, Zeiler FA, Zeldovich M, Zemek R. Traumatic brain injury: progress and challenges in prevention, clinical care, and research. Lancet Neurol 2022; 21:1004-1060. [PMID: 36183712 PMCID: PMC10427240 DOI: 10.1016/s1474-4422(22)00309-x] [Citation(s) in RCA: 195] [Impact Index Per Article: 97.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/22/2022] [Indexed: 02/06/2023]
Abstract
Traumatic brain injury (TBI) has the highest incidence of all common neurological disorders, and poses a substantial public health burden. TBI is increasingly documented not only as an acute condition but also as a chronic disease with long-term consequences, including an increased risk of late-onset neurodegeneration. The first Lancet Neurology Commission on TBI, published in 2017, called for a concerted effort to tackle the global health problem posed by TBI. Since then, funding agencies have supported research both in high-income countries (HICs) and in low-income and middle-income countries (LMICs). In November 2020, the World Health Assembly, the decision-making body of WHO, passed resolution WHA73.10 for global actions on epilepsy and other neurological disorders, and WHO launched the Decade for Action on Road Safety plan in 2021. New knowledge has been generated by large observational studies, including those conducted under the umbrella of the International Traumatic Brain Injury Research (InTBIR) initiative, established as a collaboration of funding agencies in 2011. InTBIR has also provided a huge stimulus to collaborative research in TBI and has facilitated participation of global partners. The return on investment has been high, but many needs of patients with TBI remain unaddressed. This update to the 2017 Commission presents advances and discusses persisting and new challenges in prevention, clinical care, and research. In LMICs, the occurrence of TBI is driven by road traffic incidents, often involving vulnerable road users such as motorcyclists and pedestrians. In HICs, most TBI is caused by falls, particularly in older people (aged ≥65 years), who often have comorbidities. Risk factors such as frailty and alcohol misuse provide opportunities for targeted prevention actions. Little evidence exists to inform treatment of older patients, who have been commonly excluded from past clinical trials—consequently, appropriate evidence is urgently required. Although increasing age is associated with worse outcomes from TBI, age should not dictate limitations in therapy. However, patients injured by low-energy falls (who are mostly older people) are about 50% less likely to receive critical care or emergency interventions, compared with those injured by high-energy mechanisms, such as road traffic incidents. Mild TBI, defined as a Glasgow Coma sum score of 13–15, comprises most of the TBI cases (over 90%) presenting to hospital. Around 50% of adult patients with mild TBI presenting to hospital do not recover to pre-TBI levels of health by 6 months after their injury. Fewer than 10% of patients discharged after presenting to an emergency department for TBI in Europe currently receive follow-up. Structured follow-up after mild TBI should be considered good practice, and urgent research is needed to identify which patients with mild TBI are at risk for incomplete recovery. The selection of patients for CT is an important triage decision in mild TBI since it allows early identification of lesions that can trigger hospital admission or life-saving surgery. Current decision making for deciding on CT is inefficient, with 90–95% of scanned patients showing no intracranial injury but being subjected to radiation risks. InTBIR studies have shown that measurement of blood-based biomarkers adds value to previously proposed clinical decision rules, holding the potential to improve efficiency while reducing radiation exposure. Increased concentrations of biomarkers in the blood of patients with a normal presentation CT scan suggest structural brain damage, which is seen on MR scanning in up to 30% of patients with mild TBI. Advanced MRI, including diffusion tensor imaging and volumetric analyses, can identify additional injuries not detectable by visual inspection of standard clinical MR images. Thus, the absence of CT abnormalities does not exclude structural damage—an observation relevant to litigation procedures, to management of mild TBI, and when CT scans are insufficient to explain the severity of the clinical condition. Although blood-based protein biomarkers have been shown to have important roles in the evaluation of TBI, most available assays are for research use only. To date, there is only one vendor of such assays with regulatory clearance in Europe and the USA with an indication to rule out the need for CT imaging for patients with suspected TBI. Regulatory clearance is provided for a combination of biomarkers, although evidence is accumulating that a single biomarker can perform as well as a combination. Additional biomarkers and more clinical-use platforms are on the horizon, but cross-platform harmonisation of results is needed. Health-care efficiency would benefit from diversity in providers. In the intensive care setting, automated analysis of blood pressure and intracranial pressure with calculation of derived parameters can help individualise management of TBI. Interest in the identification of subgroups of patients who might benefit more from some specific therapeutic approaches than others represents a welcome shift towards precision medicine. Comparative-effectiveness research to identify best practice has delivered on expectations for providing evidence in support of best practices, both in adult and paediatric patients with TBI. Progress has also been made in improving outcome assessment after TBI. Key instruments have been translated into up to 20 languages and linguistically validated, and are now internationally available for clinical and research use. TBI affects multiple domains of functioning, and outcomes are affected by personal characteristics and life-course events, consistent with a multifactorial bio-psycho-socio-ecological model of TBI, as presented in the US National Academies of Sciences, Engineering, and Medicine (NASEM) 2022 report. Multidimensional assessment is desirable and might be best based on measurement of global functional impairment. More work is required to develop and implement recommendations for multidimensional assessment. Prediction of outcome is relevant to patients and their families, and can facilitate the benchmarking of quality of care. InTBIR studies have identified new building blocks (eg, blood biomarkers and quantitative CT analysis) to refine existing prognostic models. Further improvement in prognostication could come from MRI, genetics, and the integration of dynamic changes in patient status after presentation. Neurotrauma researchers traditionally seek translation of their research findings through publications, clinical guidelines, and industry collaborations. However, to effectively impact clinical care and outcome, interactions are also needed with research funders, regulators, and policy makers, and partnership with patient organisations. Such interactions are increasingly taking place, with exemplars including interactions with the All Party Parliamentary Group on Acquired Brain Injury in the UK, the production of the NASEM report in the USA, and interactions with the US Food and Drug Administration. More interactions should be encouraged, and future discussions with regulators should include debates around consent from patients with acute mental incapacity and data sharing. Data sharing is strongly advocated by funding agencies. From January 2023, the US National Institutes of Health will require upload of research data into public repositories, but the EU requires data controllers to safeguard data security and privacy regulation. The tension between open data-sharing and adherence to privacy regulation could be resolved by cross-dataset analyses on federated platforms, with the data remaining at their original safe location. Tools already exist for conventional statistical analyses on federated platforms, however federated machine learning requires further development. Support for further development of federated platforms, and neuroinformatics more generally, should be a priority. This update to the 2017 Commission presents new insights and challenges across a range of topics around TBI: epidemiology and prevention (section 1 ); system of care (section 2 ); clinical management (section 3 ); characterisation of TBI (section 4 ); outcome assessment (section 5 ); prognosis (Section 6 ); and new directions for acquiring and implementing evidence (section 7 ). Table 1 summarises key messages from this Commission and proposes recommendations for the way forward to advance research and clinical management of TBI.
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Affiliation(s)
- Andrew I R Maas
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - David K Menon
- Division of Anaesthesia, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Geoffrey T Manley
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Mathew Abrams
- International Neuroinformatics Coordinating Facility, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Åkerlund
- Department of Physiology and Pharmacology, Section of Perioperative Medicine and Intensive Care, Karolinska Institutet, Stockholm, Sweden
| | - Nada Andelic
- Division of Clinical Neuroscience, Department of Physical Medicine and Rehabilitation, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Marcel Aries
- Department of Intensive Care, Maastricht UMC, Maastricht, Netherlands
| | - Tom Bashford
- Division of Anaesthesia, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Michael J Bell
- Critical Care Medicine, Neurological Surgery and Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Yelena G Bodien
- Department of Neurology and Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Benjamin L Brett
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - András Büki
- Department of Neurosurgery, Faculty of Medicine and Health Örebro University, Örebro, Sweden
- Department of Neurosurgery, Medical School; ELKH-PTE Clinical Neuroscience MR Research Group; and Neurotrauma Research Group, Janos Szentagothai Research Centre, University of Pecs, Pecs, Hungary
| | - Randall M Chesnut
- Department of Neurological Surgery and Department of Orthopaedics and Sports Medicine, University of Washington, Harborview Medical Center, Seattle, WA, USA
| | - Giuseppe Citerio
- School of Medicine and Surgery, Universita Milano Bicocca, Milan, Italy
- NeuroIntensive Care, San Gerardo Hospital, Azienda Socio Sanitaria Territoriale (ASST) Monza, Monza, Italy
| | - David Clark
- Brain Physics Lab, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Betony Clasby
- Department of Sociological Studies, University of Sheffield, Sheffield, UK
| | - D Jamie Cooper
- School of Public Health and Preventive Medicine, Monash University and The Alfred Hospital, Melbourne, VIC, Australia
| | - Endre Czeiter
- Department of Neurosurgery, Medical School; ELKH-PTE Clinical Neuroscience MR Research Group; and Neurotrauma Research Group, Janos Szentagothai Research Centre, University of Pecs, Pecs, Hungary
| | - Marek Czosnyka
- Brain Physics Lab, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Kristen Dams-O’Connor
- Department of Rehabilitation and Human Performance and Department of Neurology, Brain Injury Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Véronique De Keyser
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Ramon Diaz-Arrastia
- Department of Neurology and Center for Brain Injury and Repair, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Ari Ercole
- Division of Anaesthesia, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Thomas A van Essen
- Department of Neurosurgery, Leiden University Medical Center, Leiden, Netherlands
- Department of Neurosurgery, Medical Center Haaglanden, The Hague, Netherlands
| | - Éanna Falvey
- College of Medicine and Health, University College Cork, Cork, Ireland
| | - Adam R Ferguson
- Brain and Spinal Injury Center, Department of Neurological Surgery, Weill Institute for Neurosciences, University of California San Francisco and San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA
| | - Anthony Figaji
- Division of Neurosurgery and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Melinda Fitzgerald
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA, Australia
- Perron Institute for Neurological and Translational Sciences, Nedlands, WA, Australia
| | - Brandon Foreman
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute, University of Cincinnati, Cincinnati, OH, USA
| | - Dashiell Gantner
- School of Public Health and Preventive Medicine, Monash University and The Alfred Hospital, Melbourne, VIC, Australia
| | - Guoyi Gao
- Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine
| | - Joseph Giacino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School and Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Benjamin Gravesteijn
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Fabian Guiza
- Department and Laboratory of Intensive Care Medicine, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Deepak Gupta
- Department of Neurosurgery, Neurosciences Centre and JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Mark Gurnell
- Metabolic Research Laboratories, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Juanita A Haagsma
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Flora M Hammond
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Rehabilitation Hospital of Indiana, Indianapolis, IN, USA
| | - Gregory Hawryluk
- Section of Neurosurgery, GB1, Health Sciences Centre, University of Manitoba, Winnipeg, MB, Canada
| | - Peter Hutchinson
- Brain Physics Lab, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Mathieu van der Jagt
- Department of Intensive Care, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Sonia Jain
- Biostatistics Research Center, Herbert Wertheim School of Public Health, University of California, San Diego, CA, USA
| | - Swati Jain
- Brain Physics Lab, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Ji-yao Jiang
- Department of Neurosurgery, Shanghai Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hope Kent
- Department of Psychology, University of Exeter, Exeter, UK
| | - Angelos Kolias
- Brain Physics Lab, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Erwin J O Kompanje
- Department of Intensive Care, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Fiona Lecky
- Centre for Urgent and Emergency Care Research, Health Services Research Section, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Hester F Lingsma
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Marc Maegele
- Cologne-Merheim Medical Center, Department of Trauma and Orthopedic Surgery, Witten/Herdecke University, Cologne, Germany
| | - Marek Majdan
- Institute for Global Health and Epidemiology, Department of Public Health, Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovakia
| | - Amy Markowitz
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Michael McCrea
- Department of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Geert Meyfroidt
- Department and Laboratory of Intensive Care Medicine, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Ana Mikolić
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Pratik Mukherjee
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - David Nelson
- Section for Anesthesiology and Intensive Care, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Lindsay D Nelson
- Department of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Virginia Newcombe
- Division of Anaesthesia, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - David Okonkwo
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Matej Orešič
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Wilco Peul
- Department of Neurosurgery, Leiden University Medical Center, Leiden, Netherlands
| | - Dana Pisică
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Neurosurgery, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jennie Ponsford
- Monash-Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Louis Puybasset
- Department of Anesthesiology and Intensive Care, APHP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Rahul Raj
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Chiara Robba
- Department of Anaesthesia and Intensive Care, Policlinico San Martino IRCCS for Oncology and Neuroscience, Genova, Italy, and Dipartimento di Scienze Chirurgiche e Diagnostiche, University of Genoa, Italy
| | - Cecilie Røe
- Division of Clinical Neuroscience, Department of Physical Medicine and Rehabilitation, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Jonathan Rosand
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | - David J Sharp
- Department of Brain Sciences, Imperial College London, London, UK
| | - Peter Smielewski
- Brain Physics Lab, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Murray B Stein
- Department of Psychiatry and Department of Family Medicine and Public Health, UCSD School of Medicine, La Jolla, CA, USA
| | - Nicole von Steinbüchel
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Goettingen, Germany
| | - William Stewart
- Department of Neuropathology, Queen Elizabeth University Hospital and University of Glasgow, Glasgow, UK
| | - Ewout W Steyerberg
- Department of Biomedical Data Sciences Leiden University Medical Center, Leiden, Netherlands
| | - Nino Stocchetti
- Department of Pathophysiology and Transplantation, Milan University, and Neuroscience ICU, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nancy Temkin
- Departments of Neurological Surgery, and Biostatistics, University of Washington, Seattle, WA, USA
| | - Olli Tenovuo
- Department of Rehabilitation and Brain Trauma, Turku University Hospital, and Department of Neurology, University of Turku, Turku, Finland
| | - Alice Theadom
- National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Studies, Auckland University of Technology, Auckland, New Zealand
| | - Ilias Thomas
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Abel Torres Espin
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Alexis F Turgeon
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, CHU de Québec-Université Laval Research Center, Québec City, QC, Canada
| | - Andreas Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Dominique Van Praag
- Departments of Clinical Psychology and Neurosurgery, Antwerp University Hospital, and University of Antwerp, Edegem, Belgium
| | - Ernest van Veen
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | | | - Thijs Vande Vyvere
- Department of Radiology, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences (MOVANT), Antwerp University Hospital, and University of Antwerp, Edegem, Belgium
| | - Kevin K W Wang
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
| | - Eveline J A Wiegers
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - W Huw Williams
- Centre for Clinical Neuropsychology Research, Department of Psychology, University of Exeter, Exeter, UK
| | - Lindsay Wilson
- Division of Psychology, University of Stirling, Stirling, UK
| | - Stephen R Wisniewski
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Alexander Younsi
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - John K Yue
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Esther L Yuh
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Frederick A Zeiler
- Departments of Surgery, Human Anatomy and Cell Science, and Biomedical Engineering, Rady Faculty of Health Sciences and Price Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada
| | - Marina Zeldovich
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Goettingen, Germany
| | - Roger Zemek
- Departments of Pediatrics and Emergency Medicine, University of Ottawa, Children’s Hospital of Eastern Ontario, ON, Canada
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Hillebregt C, Trappenburg M, Tonkens E. 'Let us be'. Social support needs of people with acquired long-term disabilities and their caregivers in rehabilitation practice in the Netherlands. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4384-e4394. [PMID: 35570392 DOI: 10.1111/hsc.13838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/22/2022] [Accepted: 04/22/2022] [Indexed: 06/15/2023]
Abstract
In many European countries, including the Netherlands, current care policies encourage 'active citizens' to support each other rather than having individuals rely on paid professional help. Rehabilitation centres also put greater emphasis on social networks assisting adults with acquired long-term disabilities and their caregivers. Often these adults and their caregivers feel insufficiently prepared to cope with the disability in daily life and struggle with community integration. However, little is known about the factors that make vulnerable people accept or decline support from their social networks. We researched the social support needs of persons with acquired disabilities and their caregivers eligible for a family group conference intervention by conducting 19 semi-structured interviews in rehabilitation centres in the Netherlands. A thematic analysis revealed that most couples (15) were reluctant to request (more) support from their social network, even though many of them had a good network to rely on. We identified five reasons for this reluctance: (1) not accustomed asking support, (2) not wanting to be a (bigger) burden, (3) fear of intrusion into one's privacy and independence, (4) fear or problematic motivations such as curiosity or pity and (5) lack of reliability, competence, or comprehension. The main factor seemed to be the lack of reciprocity: couples do not see sufficient options to reciprocate the necessary support. Therefore, before instigating social support-centred interventions such as family group conferences, social care and other health professionals should be aware of any factors causing a sense of reluctance and explore the experiences of an imbalance in reciprocity.
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Affiliation(s)
| | - Margo Trappenburg
- Chair of Foundations of Social Work, University of Humanistic Studies, Utrecht, The Netherlands
| | - Evelien Tonkens
- Chair of Citizenship and Humanisation of the Public Sector, University of Humanistic Studies, Utrecht, The Netherlands
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Hiatt J, Young A, Brown T, Banks M, Segon B, Bauer J. A qualitative comparison of the nutrition care experiences of carers supporting patients with head and neck cancer throughout surgery and radiation treatment and survivorship. Support Care Cancer 2022; 30:9359-9368. [PMID: 36109395 PMCID: PMC9633518 DOI: 10.1007/s00520-022-07348-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 08/24/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE To understand and compare the nutrition care experiences of carers supporting patients throughout surgery and radiation treatment for head and neck cancer (HNC) to inform changes to service delivery in the inpatient and outpatient setting to ensure carers needs in their supportive role throughout the treatment and survivorship period are met. METHODS As part of a larger study, narrative interviews were completed with fourteen carers of patients diagnosed with HNC at 2 weeks, 3 months and 12 months post-treatment completion. Reflexive thematic analysis was used to interpret and understand differences in carer experiences of nutrition care between surgery and radiation treatment. RESULTS Two main themes across each treatment modality were identified: (1) access to information and support from healthcare professionals and (2) adjustment to the physical and psychological impact of treatment. CONCLUSION This study highlights the increasing need to ensure carers are included in the provision of nutrition information and support to patients throughout and beyond their treatment trajectory. Having structured support available to patients and carers throughout radiation treatment meant that carer needs were reduced. However, without the opportunity for structured support in the inpatient setting, many carers expressed high care needs in supporting patients in the post-surgical phase. IMPLICATIONS FOR CANCER SURVIVORS Providing carers with access to structured support for nutrition care in the inpatient and outpatient setting can reduce their supportive care needs throughout the treatment and survivorship period.
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Affiliation(s)
- Joanne Hiatt
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Australia. .,Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Level 2, Dr James Mayne Building, Butterfield Street, 4029, Herston, QLD, Australia.
| | - Adrienne Young
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Australia.,Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Level 2, Dr James Mayne Building, Butterfield Street, 4029, Herston, QLD, Australia
| | - Teresa Brown
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Australia.,Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Level 2, Dr James Mayne Building, Butterfield Street, 4029, Herston, QLD, Australia
| | - Merrilyn Banks
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Australia.,Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Level 2, Dr James Mayne Building, Butterfield Street, 4029, Herston, QLD, Australia
| | - Bronwyn Segon
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Australia
| | - Judith Bauer
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Australia.,Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Level 2, Dr James Mayne Building, Butterfield Street, 4029, Herston, QLD, Australia
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Currie S, Douglas J, Winkler D. 'What's next?' The journey from hospital to community engagement from the perspectives of adults following severe acquired brain injury: a scoping review protocol. BMJ Open 2022; 12:e064226. [PMID: 36130757 PMCID: PMC9494587 DOI: 10.1136/bmjopen-2022-064226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Community integration and social participation remain a challenge for many individuals following acquired brain injury (ABI) and the transition from hospital to home is a complex journey. It is important to conceptualise this transition from the perspective of people with ABI, to inform future research with the overall aim of improving the experience of community re-engagement and maintaining important relationships within social networks. METHODS AND ANALYSIS The methodology outlined by Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis: extension for Scoping Reviews will be used to guide the review. A comprehensive electronic database search will be conducted in MEDLINE, CINAHL, Scopus, Embase and PsychINFO. The search will aim to locate only published, qualitative or mixed methods studies and will be limited to citations published in English, from January 2014 to the date of final search completion. Quality assessment using the Critical Appraisal Skills Programme will be completed and reported.Data extraction will include participant and study characteristics.Finally, qualitative data from each citation, including participant quotes, will be extracted and thematic analysis will be completed to support conceptualisation of community participation from those who have experienced the transition to the community following discharge from hospital. Three individuals with lived experiences of ABI will be engaged as paid consultants to review and comment on the findings of the review. ETHICS AND DISSEMINATION It is intended that the findings from this review will be made available to relevant stakeholders through peer-reviewed publications and conference presentations. This scoping review does not require an ethics application.
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Affiliation(s)
- Suzanne Currie
- Living with Disability Research Centre, La Trobe University, Bundoora, Victoria, Australia
- Research Unit, Summer Foundation, Blackburn, Victoria, Australia
- Physiotherapy Department, Alfred Health, Melbourne, Victoria, Australia
| | - Jacinta Douglas
- Living with Disability Research Centre, La Trobe University, Bundoora, Victoria, Australia
- Research Unit, Summer Foundation, Blackburn, Victoria, Australia
| | - Di Winkler
- Living with Disability Research Centre, La Trobe University, Bundoora, Victoria, Australia
- Research Unit, Summer Foundation, Blackburn, Victoria, Australia
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Wang JN, Liu LM, Dela Rosa R, Sun MJ, Qian YM, Sun MYZ, Xu TY. Experiences of family caregivers of patients with post-traumatic hydrocephalus from hospital to home: a qualitative study. BMC Health Serv Res 2022; 22:1132. [PMID: 36071481 PMCID: PMC9454203 DOI: 10.1186/s12913-022-08502-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background Post-traumatic hydrocephalus (PTH) is a complication of traumatic brain injury (TBI) that requires treatment and postoperative care. The shunt is one of the main treatments for PTH, which presents with dysfunction and infection. Considering brain injury, hydrocephalus shunt malfunction, and infection, family caregivers need to be responsible for caring for PTH patients, recognizing shunt malfunction and infection, and managing those patients accordingly from hospital to home. Understanding the experiences and needs of caregivers is beneficial for knowing their competency and quality of health care, ameliorating and ensuring future transition care. The study aimed to explore the feelings, experiences, and needs of family caregivers when caring for patients with TBI, PTH and shunts. Methods This was exploratory research of a purposive sample of 12 family caregivers of adult patients with TBI, PTH and shunts in five neurosurgery departments at a general hospital in Zhengzhou, Henan Province, China, using a semi-structured interview method. Data were collected from October 2021 to March 2022 before being analyzed by content analysis methods. Results Caregivers required professional and social knowledge and support in the areas of TBI, PTH and shunts, caregiving interventions, psychological care needs, and health insurance, just as caregivers do, but unlike other general caregivers, care for patients with TBI, PTH, and shunt is fraught with uncertainty and the need to manage shunt setting, and caregivers often experience 'complex emotional reaction' during the transitional period, where care needs and complex emotions may lead to a lack of caregiver confidence, which in turn may affect caregiving behaviors, and experiences that affect care may be mediated through caregiving confidence. The perceived availability of resources, particularly those that are still available to them when they return home, has a significant impact on participants' emotional response and sense of confidence. Conclusions The emotional response and the impact of stressor caregivers after TBI, PTH, and shunt was important, and sometimes confidence in care appeared to be an intermediate and useful factor that needed to be considered as health professionals prepared to develop care resources on how to manage and empower patients with TBI, PTH, and shunt. Meanwhile, there may be gaps and inequities in supportive care for patients diagnosed with TBI, PTH, and shunt in China.
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Affiliation(s)
- Jia-Nan Wang
- School of Nursing and Health, Zhengzhou University, 100 Science Avenue, High-tech district, Zhengzhou City, 450000, Henan province, China
| | - La-Mei Liu
- School of Nursing and Health, Zhengzhou University, 100 Science Avenue, High-tech district, Zhengzhou City, 450000, Henan province, China.
| | - Ronnell Dela Rosa
- School of Nursing, Philippine Women's University, 1743 Taft Avenue, 1004, Malate, Manila, Philippines.,Bataan Peninsula State University, College of Nursing and Midwifery, City of Balanga, 2100, Bataan, Philippines
| | - Meng-Jie Sun
- School of Nursing and Health, Zhengzhou University, 100 Science Avenue, High-tech district, Zhengzhou City, 450000, Henan province, China
| | - Yu-Meng Qian
- School of Nursing and Health, Zhengzhou University, 100 Science Avenue, High-tech district, Zhengzhou City, 450000, Henan province, China
| | - Meng-Yao Zhuan Sun
- School of Nursing and Health, Zhengzhou University, 100 Science Avenue, High-tech district, Zhengzhou City, 450000, Henan province, China
| | - Tong-Yao Xu
- School of Nursing and Health, Zhengzhou University, 100 Science Avenue, High-tech district, Zhengzhou City, 450000, Henan province, China
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Nielsen IH, Poulsen I, Larsen K, Larsen NS. Life goals as a driving force in traumatic brain injury rehabilitation: a longitudinal dyadic perspective. Brain Inj 2022; 36:1158-1166. [PMID: 36047479 DOI: 10.1080/02699052.2022.2109748] [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
BACKGROUND Traumatic brain injury significantly impacts survivors and their families. Rehabilitation following traumatic brain injury is often complex due to the physical, psychological, and socio-economic problems survivors face. Life goals are considered a motivational factor in rehabilitation. OBJECTIVE The aim was to explore expectations, problems, and strategies for goal setting in survivors of traumatic brain injury and their family caregivers for one-year during rehabilitation. METHODS A longitudinal qualitative study using dyadic interviews with survivors and family caregivers was carried out at three time points during the first year following traumatic brain injury. Data was analyzed according to Braun and Clarke's thematic analysis. RESULTS Eight survivors of traumatic brain injury and their family caregivers completed 24 interviews. Three themes and one sub-theme were identified: 1) life goals as a driving force (subtheme: dyadic discrepancies and conflicts); 2) conflicts between specific, measurable, achievable, realistic, and timed (SMART) goals and life goals; and 3) changing perceptions of the impact of impairments. CONCLUSIONS Life goals are important motivation in the rehabilitation process. Health care professionals must integrate life goals and rehabilitation goals (i.e. SMART goals) to decrease barriers and survivor ambivalence about rehabilitation. Involving both survivors and family caregivers in goal setting increases rehabilitation success.
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Affiliation(s)
- Iben Husted Nielsen
- Department of Nursing and Nutrition, University College Copenhagen, Copenhagen, Denmark
| | - Ingrid Poulsen
- Department of Brain and Spinal Cord Injury, Copenhagen University Hospital - Rigshospitalet, Hvidovre, Denmark.,Department of Nursing and Health Care, Aarhus University, Aarhus C, Denmark
| | - Kristian Larsen
- Department of Public Health, University of Copenhagen, Copenhagen N, Denmark.,Copenhagen University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital - Rigshospitalet, Copenhagen N, Denmark.,Faculty of Health Sciences, Oslo Metropolitan University, Norway
| | - Niels Sandholm Larsen
- Department of Nursing and Nutrition, University College Copenhagen, Copenhagen, Denmark
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Eliacin J, Fortney SK, Rattray NA, Kean J. Patients' and caregivers' perspectives on healthcare navigation in Central Indiana, USA after brain injury. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:988-997. [PMID: 33471969 DOI: 10.1111/hsc.13275] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 06/12/2023]
Abstract
Little research has documented the experiences of patients with traumatic brain injury (TBI) and their caregivers in navigating health systems for TBI care. In this qualitative study, we conducted semi-structured interviews with 62 participants (34 patients with moderate or severe TBI and 28 caregivers) from Central Indiana. Data were collected from January to September 2016 and analysed using a constructivist grounded theory approach. Participants discussed three significant challenges about navigating health services for TBI care: lack of support for care navigation, financial barriers, and communication barriers. Participants described how navigating outpatient healthcare services for TBI remains complex and emphasised the need for ongoing care navigation support throughout the care continuum. They detailed the long-term financial burden of TBI including high treatment costs, limited insurance coverage, and the emotional toll that financial stress has on their ability to navigate healthcare services for ongoing TBI-related needs. They also discussed how ineffective patient-provider communication and lack of reliable, timely and comprehensive health information about TBI limited their engagement in and navigation of TBI health services. Findings suggest that persons with TBI and their caregivers need ongoing support to manage the long-term impacts of TBI. Efforts to provide care coordination and navigation to patients with TBI and their families are urgently needed to facilitate greater access to care, effective healthcare navigation and improved health outcomes.
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Affiliation(s)
- Johanne Eliacin
- Richard L. Roudebush Department of Veterans Affairs Medical Center, Center for Health Information and Communication, Health Services Research and Development, Indianapolis, IN, USA
- Departments of Psychology, Indiana University Purdue University at Indianapolis, Indianapolis, IN, USA
- Regenstrief Institute, Inc. Indianapolis, IN, USA
- Act Center of Indiana, Indianapolis, IN, USA
| | - Sarah K Fortney
- Departments of Psychology, Indiana University Purdue University at Indianapolis, Indianapolis, IN, USA
| | - Nicholas A Rattray
- Richard L. Roudebush Department of Veterans Affairs Medical Center, Center for Health Information and Communication, Health Services Research and Development, Indianapolis, IN, USA
- Department of Anthropology, Indiana University Purdue University at Indianapolis, Indianapolis, IN, USA
| | - Jacob Kean
- Informatics, Decision-Enhancement and Analytic Sciences Center, Health Services Research and Development, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Department of Population Health Sciences and Department of Communication Sciences and Disorders, University of Utah School of Medicine, Salt Lake City, UT, USA
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Kettlewell J, Radford K, Kendrick D, Patel P, Bridger K, Kellezi B, Das Nair R, Jones T, Timmons S. Qualitative study exploring factors affecting the implementation of a vocational rehabilitation intervention in the UK major trauma pathway. BMJ Open 2022; 12:e060294. [PMID: 35361654 PMCID: PMC8971801 DOI: 10.1136/bmjopen-2021-060294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This study aimed to: (1) understand the context for delivering a trauma vocational rehabilitation (VR) intervention; (2) identify potential barriers and enablers to the implementation of a VR intervention post-trauma. DESIGN Qualitative study. Data were collected in person or via phone using different methods: 38 semistructured interviews, 11 informal 'walk-through care pathways' interviews, 5 focus groups (n=25), 5 codesign workshops (n=43). Data were thematically analysed using the framework approach, informed by the Consolidated Framework for Implementation Research. SETTING Stakeholders recruited across five UK major trauma networks. PARTICIPANTS A variety of stakeholders were recruited (n=117) including trauma survivors, rehabilitation physicians, therapists, psychologists, trauma coordinators and general practitioners. We recruited 32 service users (trauma survivors or carers) and 85 service providers. RESULTS There were several issues associated with implementing a trauma VR intervention including: culture within healthcare/employing organisations; extent to which healthcare systems were networked with other organisations; poor transition between different organisations; failure to recognise VR as a priority; external policies and funding. Some barriers were typical implementation issues (eg, funding, policies, openness to change). This study further highlighted the challenges associated with implementing a complex intervention like VR (eg, inadequate networking/communication, poor service provision, perceived VR priority). Our intervention was developed to overcome these barriers through adapting a therapist training package, and by providing early contact with patient/employer, a psychological component alongside occupational therapy, case coordination/central point of contact, and support crossing sector boundaries (eg, between health/employment/welfare). CONCLUSIONS Findings informed the implementation of our VR intervention within the complex trauma pathway. Although we understand how to embed it within this context, the success of its implementation needs to be measured as part of a process evaluation in a future trial.
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Affiliation(s)
- Jade Kettlewell
- Centre for Academic Primary Care, University of Nottingham School of Medicine, Nottingham, UK
| | - Kate Radford
- Centre for Rehabilitation & Ageing Research, University of Nottingham School of Medicine, Nottingham, UK
| | - Denise Kendrick
- Centre for Academic Primary Care, University of Nottingham School of Medicine, Nottingham, UK
| | - Priya Patel
- Institute of Mental Health, University of Nottingham School of Medicine, Nottingham, UK
| | - Kay Bridger
- Department of Psychology, Nottingham Trent University, Nottingham, UK
| | - Blerina Kellezi
- Centre for Academic Primary Care, University of Nottingham School of Medicine, Nottingham, UK
- Department of Psychology, Nottingham Trent University, Nottingham, UK
| | - Roshan Das Nair
- Institute of Mental Health, University of Nottingham School of Medicine, Nottingham, UK
| | - Trevor Jones
- Centre for Academic Primary Care, University of Nottingham School of Medicine, Nottingham, UK
| | - Stephen Timmons
- Centre for Health Innovation, Leadership & Learning, Nottingham University Business School, University of Nottingham, Nottingham, UK
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Pérez-de la Cruz S. Perceptions of recovery and rehabilitation in people with brain injury in Spain. A qualitative study. Health Expect 2022; 25:1168-1175. [PMID: 35289029 PMCID: PMC9122431 DOI: 10.1111/hex.13471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/28/2022] [Accepted: 02/23/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Acquired brain injury (ABI) is a condition that severely impairs the personal, family, social and professional lives of the individuals who experience it. The aim of this study was to gain insight into ABI patients' perceptions of their condition and rehabilitation process so that physiotherapists can approach their treatment in a more comprehensive, satisfactory manner. Methods A qualitative study was carried out with individual interviews, and focus group sessions (semi‐structured interviews) were held with 33 individuals from various associations. Results Four themes emerged in this study: physiotherapy treatment, changes in lifestyle, patients' feelings about their condition and aspirations for the future. The participants reported that their condition had led to multiple changes in their personal and family lives that were not always positive. Conclusions These findings may be useful for identifying ways to increase acceptance of their condition and design a comprehensive rehabilitation programme for these patients and their families. The psychosocial needs of ABI patients could be optimized by providing good physical care through effective communication within the rehabilitation environment where communication between professionals and patients prevails, to meet their real needs and expectations. Patient or Public Contribution This study was conducted based on interviews with adult ABI patients regarding their experiences concerning their rehabilitation process and daily life.
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Larsson-Lund M, Pettersson A, Strandberg T. Team-based rehabilitation after traumatic brain injury: a qualitative synthesis of evidence of experiences of the rehabilitation process. J Rehabil Med 2022; 54:jrm00253. [PMID: 35019996 PMCID: PMC8862657 DOI: 10.2340/jrm.v53.1409] [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] [Indexed: 12/04/2022] Open
Abstract
Objective To synthesize and explore experiences of the rehabilitation process for adults with traumatic brain injury receiving team-based rehabilitation. Data sources A qualitative evidence synthesis was conducted according to the “Enhancing transparency in reporting the synthesis of qualitative research” (ENTREQ) Guidelines, of qualitative studies published in 5 databases in 2000–21. Study selection and data extraction Screening, selection of relevant studies, assessment of methodological limitations, systematic qualitative content analysis and assessment of confidence with Grading of Recommendations Assessment, Development, and Evaluation-Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) were carried out by independent researchers. Data synthesis The 10 included studies revealed how people with traumatic brain injury perceived that they struggled on their own for a long time to adapt their daily life. They experienced that access to team-based rehabilitation was scarce and that the interventions offered were neither individually tailored nor coordinated. A respectful attitude from professionals and individually adapted information facilitated their rehabilitation process. Conclusion This qualitative evidence synthesis indicates areas for improvement and a need to develop person-centred team-based rehabilitation for adults with traumatic brain injury, in terms of accessibility, coordination, continuity, content and participation. Given the limited opportunities for team-based rehabilitation after hospital discharge, further research is needed to understand how rehabilitation can support the adaptation of everyday life.
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Affiliation(s)
- Maria Larsson-Lund
- Department of Health Science, Occupational Therapy, Luleå University of Technology, 971 87 Luleå, Sweden.
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Busch R, Cady RG. Discharge nurse intervention on a pediatric rehabilitation unit: Retrospective chart review to evaluate the Does it impact on number of unmet needs during the transition home following neurological injury. Dev Neurorehabil 2021; 24:561-568. [PMID: 33896361 DOI: 10.1080/17518423.2021.1915403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of this study is to describe the post-discharge needs of children and adolescents when transitioning home after an inpatient comprehensive rehabilitation stay following an acute neurological injury and to evaluate if trends in those needs changed with implementation of a discharge nurse intervention. DESIGN Retrospective medical record review was conducted 1-year prior (T1) and 1-year after (T2) a discharge nurse intervention. METHODS Medical charts of 80 pediatric patients with acute neurological injury (T1 = 39; T2 = 41) were reviewed. Post-discharge communication from the 8-week post-discharge period was reviewed to identify and categorize care coordination needs, using 18 pre-defined care coordination categories. T1 and T2 findings were compared using two sample proportion z-test. FINDINGS Patients discharged following inpatient rehabilitation for acute neurological injury have unmet care coordination needs. The proportion of unmet needs decreased significantly for 10/18 care coordination categories after implementation of the discharge nurse intervention. CONCLUSIONS Data from this study support proactive care coordination by inpatient rehabilitation nurses to reduce unmet post-discharge care coordination needs and provides preliminary evidence that the role of a discharge nurse may have a positive impact on the transition from inpatient rehabilitation to home.
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Affiliation(s)
- Rebecca Busch
- Gillette Children's Specialty Healthcare, St. Paul, MN, USA
| | - Rhonda G Cady
- Gillette Children's Specialty Healthcare, St. Paul, MN, USA
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Pictures and a thousand words: the experiences of significant others whose loved ones have a severe brain injury who are being discharged home. BRAIN IMPAIR 2021. [DOI: 10.1017/brimp.2021.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Purpose:
To investigate the experiences of significant others when their loved one with a severe acquired brain injury (ABI) is being discharged from an ABI-specific rehabilitation unit.
Participants:
Significant others of loved ones with an ABI participated in interviews close to their loved ones being discharged from inpatient ABI rehabilitation.
Methods:
Semi-structured interviews were conducted, and thematic analysis applied. Additionally, the drawing method was also used which involved participants drawing what it was like for them as their loved one was going home. Image analysis was then combined with the interview data.
Results:
Eight significant others participated in interviews on discharge and completed a drawing describing their experience. Five themes were identified (Change, Mixed feelings, Support of family and friends, Journey and Staff interactions).
Conclusion:
The experience of having a loved one with a severe ABI in rehabilitation is an emotional event. Compassionate communication, consistency of information and thorough discharge planning practices were cornerstones to enhancing the experience of significant others, empowering them to undertake their new role.
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The Experience of Caregivers Following a Moderate to Severe Traumatic Brain Injury Requiring ICU Admission. J Head Trauma Rehabil 2021; 35:E299-E309. [PMID: 31479080 DOI: 10.1097/htr.0000000000000525] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Survivors of moderate and severe traumatic brain injury (TBI) require substantial care, much of which is ultimately provided by friends and family. We sought to describe the unmet needs of informal caregivers. DESIGN Qualitative, semistructured interviews with informal caregivers of moderate and severe TBI survivors were conducted 72 hours, 1 month, 3 months, and 6 months after injury. SETTING Intensive care unit of a level 1 trauma center. PARTICIPANTS Informal caregivers were friends or family who planned to provide care for the patient. Patients were 18 years or older with a moderate to severe TBI, and not expected to imminently die of their injuries. MEASUREMENTS AND MAIN RESULTS Eighteen patient-caregiver dyads were enrolled. Fifty-three interviews with caregivers were completed and analyzed over the course of 6 months. Three themes were identified in the qualitative analysis: caregiver burden, caregiver health-related quality of life, and caregiver needs for information and support. CONCLUSIONS This study provides new information about the experience of informal caregivers during the 6 months after their friend or family member survived a moderate to severe TBI. Interventions to promote caregiving may be a substantial opportunity to improve patient-centered outcomes following TBI.
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Page TA, Gordon S, Balchin R, Tomlinson M. Caregivers' perspectives of the challenges faced with survivors of traumatic brain injury: A scoping review. NeuroRehabilitation 2021; 49:349-362. [PMID: 34308914 DOI: 10.3233/nre-210099] [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
INTRODUCTION Traumatic Brain Injury (TBI) has wide-ranging neuropsychological, physical, social and financial implications. The impact on caregivers of moderate to severe TBI survivors, particularly in low- and middle-income countries, is under-investigated. AIM Identify and describe the experiences of caregivers' of moderate to severe TBI survivors postdischarge from healthcare facilities. METHODS A scoping review was conducted utilising seven electronic databases. Two reviewers screened articles using eligibly criteria related to setting (postdischarge), caregiving (informal), age of TBI survivors (> 18 years) and injury severity (moderate-severe). Studies published in English between 1999 -2018 were included. RESULTS Fourteen articles met the inclusion criteria. Articles reporting on the same sample were merged during data charting. The final analyses included 11 articles comprised of qualitative, quantitative and mixed-methods studies. Ten themes were identified: psychological distress, social functioning, financial burden, family experiences, coping strategies, access to services, time burdens and physical, cognitive and behavioural difficulties. Characteristics of caregivers and TBI survivors were also reported. CONCLUSION Caregivers of moderate to severe TBI survivors experience challenges in various life domains, and there is limited research concerning caregivers in low- and middle-income countries. Future research should focus on understanding more nuanced experiences across various environments, which may increase comprehensive, flexible and long-term support.
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Affiliation(s)
- Teneille A Page
- Department of Psychology, Faculty of Arts and Social Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sarah Gordon
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Ross Balchin
- University of Cambridge NIHR Global Health Research Group on Neurotrauma.,University of Cape Town (UCT) Neuroscience Institute and the Division of Neurosurgery, Groote Schuur Hospital, Cape Town, South Africa
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa.,School of Nursing and Midwifery, Queens University, Belfast, UK
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Xue M, Zhai X, Liu S, Xu N, Han J, Zhou M. The experience of family caregivers of patients receiving home nasogastric tube feeding in China: A descriptive qualitative study. J Hum Nutr Diet 2021; 35:14-22. [PMID: 33908101 PMCID: PMC9291130 DOI: 10.1111/jhn.12908] [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: 12/01/2020] [Revised: 03/18/2021] [Accepted: 04/20/2021] [Indexed: 11/30/2022]
Abstract
Background The value of caregivers with respect to ensuring safety during home nasogastric tube (NGT) feeding is increasingly acknowledged. However, little attention has been given to the experience of caregivers. Methods A qualitative descriptive design using semi‐structured interviews via purposive sampling at a comprehensive hospital in China was employed. Family caregivers of patients with home NGT feeding were recruited. Interviews were recorded, transcribed verbatim and analysed qualitatively using inductive content analysis. Results Thirteen family caregivers of patients with home NGT feeding were interviewed. Four main themes were generated: negative experience (uncertainty and ambivalence, transition gaps between hospitals and home care services), new role: adapting to the lifestyle (participating in decision‐making, being responsible for everything, adjusting own life to NGT feeding), perceived benefit of caregiving (personal growth, development of positive attitudes and achievements) and expectations (expectations from continuity health system services, expectations from social support). Conclusions The present study highlights the vulnerability and perceived benefits embedded in the role of a family caregiver. Improving communication and standardising practices between home and hospitals should be considered.
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Affiliation(s)
- Min Xue
- Qilu Hospital, Shandong University, Jinan, China.,Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | | | - Sihan Liu
- Qilu Hospital, Shandong University, Jinan, China
| | - Nana Xu
- Qilu Hospital, Shandong University, Jinan, China
| | - Jing Han
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Min Zhou
- Qilu Hospital, Shandong University, Jinan, China
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Collins J, Lizarondo L, Porritt K. Adult patient and/or carer experiences of planning for hospital discharge after major trauma: a qualitative systematic review protocol. JBI Evid Synth 2021; 18:341-347. [PMID: 31764434 DOI: 10.11124/jbisrir-d-19-00218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE To investigate patient and/or carer experiences of planning for discharge from an acute setting after a major trauma event. INTRODUCTION The experience of injury through major trauma is a worldwide issue that affects people of any age. These patients often experience long-lasting disability. During discharge from the acute setting, patients are at a high risk of experiencing an adverse event due to the complex nature of the process. This review aims to explore patient/carer opinion of their encounter with the discharge planning process following major trauma. INCLUSION CRITERIA This review will consider studies that include patients aged between 18 and 65 who had major traumatic central nervous system injury or were allocated an Injury Severity Score >12, with demonstrated possibility of having an ongoing disability at least one year post-injury. Qualitative studies exploring patient and/or carer experiences of their participation in discharge planning from a trauma unit, acute ward or inpatient rehabilitation to a community setting will be included. METHODS A three-stage search will be conducted and will include unpublished and gray literature. Databases to be searched include PubMed, Embase, PyscInfo, Scopus and CINAHL. Only studies published in English will be considered. Identified studies will be screened for inclusion in the review by two independent reviewers. Data will be extracted using a standardized tool and reviewers will discuss any disagreement. Data synthesis will adhere to the meta-aggregative approach to categorize findings. The categories will be synthesized into a set of findings that can be applied as evidence-based practice. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42019138431.
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Affiliation(s)
- Jeanette Collins
- Joanna Briggs Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
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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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40
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Christie L, Egan C, Wyborn J, Simpson GK. Evaluating client experience of rehabilitation following acquired brain injury: a cross-sectional study. Brain Inj 2021; 35:215-225. [PMID: 33459061 DOI: 10.1080/02699052.2020.1867768] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective: To implement a service-wide approach in the collection of data to evaluate client experience of brain injury rehabilitation.Methods: Mixed methods study. Clients with brain injury and family members of the Liverpool Brain Injury Rehabilitation Unit completed a purpose-designed Patient Experiences Survey for Brain Injury Rehabilitation (PES-BIR) which included closed and free-text responses, as well as the Client Services Questionnaire-8 (CSQ-8). The survey was completed by clients across the inpatient, community rehabilitation, vocational rehabilitation and community-based residential services.Results: 118 questionnaires were completed in relation to 102 clients. The majority of respondents were clients (n = 79, 66.9%) with a small proportion of family members represented (n = 39, 33.1%). High levels of satisfaction were reported (CSQ-8 28.4 ± 3.8) and positive patient experience (PES-BIR total, 37.2 ± 5.5) across all services. Themes identified from the free-text responses suggested that client experience was influenced by communication with the client about their progress and within the team, tailoring of rehabilitation, access to specialist services, integration of care across the rehabilitation continuum and the rehabilitation environment.Implications for practice: Routine collection and evaluation of client experience data in brain injury rehabilitation can be used to evaluate service delivery quality and guide further service improvements.
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Affiliation(s)
- Lauren Christie
- Liverpool Brain Injury Rehabilitation Unit, Liverpool Hospital, Sydney, Australia.,Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, Australia.,Allied Health Research Unit, St Vincent's Health Network, Sydney, Australia.,Nursing Research Institute, St Vincent's Health Network, Sydney, Australia
| | - Cara Egan
- Department of Occupational Therapy, Bankstown Hospital, Sydney, Australia
| | - Josephine Wyborn
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Grahame K Simpson
- Liverpool Brain Injury Rehabilitation Unit, Liverpool Hospital, Sydney, Australia.,Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, Australia.,John Walsh Centre for Rehabilitation Research, The University of Sydney, Sydney, Australia
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O’Donoghue C, Meixner C. A qualitative study of providers’ decision-making for cases involving neurobehavioral issues. COGENT PSYCHOLOGY 2020. [DOI: 10.1080/23311908.2020.1788330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Cynthia O’Donoghue
- Communication Sciences and Disorders, James Madison University, Harrisonburg, USA
| | - Cara Meixner
- Graduate Psychology, James Madison University, Harrisonburg, USA
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Lama S, Damkliang J, Kitrungrote L. Community Integration After Traumatic Brain Injury and Related Factors: A Study in the Nepalese Context. SAGE Open Nurs 2020; 6:2377960820981788. [PMID: 33912666 PMCID: PMC8047939 DOI: 10.1177/2377960820981788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 11/15/2020] [Accepted: 11/27/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction Community integration is an essential component for rehabilitation among traumatic brain injury (TBI) survivors, which yields positive outcomes in terms of social activities, community participation, and productive work. A factor that usually facilitates community integration among TBI survivors is social support, whereas physical environment and fatigue are most often found as barriers. Objectives This study aimed to (1) describe the level of community integration, fatigue, physical environment, and social support of persons after TBI, and (2) examine the relationship between community integration and these three factors. Methods This is a descriptive correlational study. One hundred and twenty TBI survivors living in the communities of Province Number Three, Nepal were enrolled using the stratified sampling technique. The data were collected using the Community Integration Questionnaire, Modified Fatigue Impact Scale, Craig Hospital Inventory of Environmental Factors, and the Multidimensional Scale of Perceived Social Support. Descriptive statistics and Pearson's correlation were used to analyze the data. Results Community integration, fatigue, and physical environment showed a moderate level, while social support revealed a high level. Fatigue was significantly correlated with overall community integration, whereas physical environment was found to correlate with two subscales of community integration, home integration and productive activities. Conclusion To enhance the level of community integration among TBI survivors, health care providers, in particular rehabilitation nurses and community nurses, should plan and implement strategies such as follow-up appointments or continued rehabilitation at home.
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Affiliation(s)
- Sumana Lama
- Nursing Science Program in Adult and Gerontological Nursing (International Program), Prince of Songkla University, Hat Yai, Thailand
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Kettlewell J, Timmons S, Bridger K, Kendrick D, Kellezi B, Holmes J, Patel P, Radford K. A study of mapping usual care and unmet need for vocational rehabilitation and psychological support following major trauma in five health districts in the UK. Clin Rehabil 2020; 35:750-764. [PMID: 33222497 PMCID: PMC8076839 DOI: 10.1177/0269215520971777] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective: To identify where and how trauma survivors’ rehabilitation needs are met after trauma, to map rehabilitation across five UK major trauma networks, and to compare with recommended pathways. Design: Qualitative study (interviews, focus groups, workshops) using soft-systems methodology to map usual care across trauma networks and explore service gaps. Publicly available documents were consulted. CATWOE (Customers, Actors, Transformation, Worldview, Owners, Environment) was used as an analytic framework to explore the relationship between stakeholders in the pathway. Setting: Five major trauma networks across the UK. Subjects: 106 key rehabilitation stakeholders (service providers, trauma survivors) were recruited to interviews (n = 46), focus groups (n = 4 groups, 17 participants) and workshops (n = 5 workshops, 43 participants). Interventions: None. Results: Mapping of rehabilitation pathways identified several issues: (1) lack of vocational/psychological support particularly for musculoskeletal injuries; (2) inconsistent service provision in areas located further from major trauma centres; (3) lack of communication between acute and community care; (4) long waiting lists (up to 12 months) for community rehabilitation; (5) most well-established pathways were neurologically focused. Conclusions: The trauma rehabilitation pathway is complex and varies across the UK with few, if any patients following the recommended pathway. Services have developed piecemeal to address specific issues, but rarely meet the needs of individuals with multiple impairments post-trauma, with a lack of vocational rehabilitation and psychological support for this population.
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Affiliation(s)
- Jade Kettlewell
- Centre for Health Innovation, Leadership and Learning, University of Nottingham Business School, Nottingham, UK.,Division of Primary Care, University of Nottingham School of Medicine, Nottingham, UK
| | - Stephen Timmons
- Centre for Health Innovation, Leadership and Learning, University of Nottingham Business School, Nottingham, UK
| | - Kay Bridger
- Division of Primary Care, University of Nottingham School of Medicine, Nottingham, UK.,Nottingham Trent University, School of Social Sciences, Division of Psychology, Nottingham, UK
| | - Denise Kendrick
- Division of Primary Care, University of Nottingham School of Medicine, Nottingham, UK
| | - Blerina Kellezi
- Division of Primary Care, University of Nottingham School of Medicine, Nottingham, UK.,Nottingham Trent University, School of Social Sciences, Division of Psychology, Nottingham, UK
| | - Jain Holmes
- Division of Primary Care, University of Nottingham School of Medicine, Nottingham, UK.,Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham School of Medicine, Nottingham, UK
| | - Priya Patel
- Centre for Neuroscience, Surgery and Trauma, Queen Mary University of London, London, UK
| | - Kate Radford
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham School of Medicine, Nottingham, UK
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Right people, right time? a qualitative study of service access experiences of adults with acquired brain injury following discharge from inpatient rehabilitation. BRAIN IMPAIR 2020. [DOI: 10.1017/brimp.2020.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AbstractPurpose:The intention of this paper is to develop the personal concept of appropriate access. We report on the service access experiences and opportunities of adults with an acquired brain injury after leaving inpatient rehabilitation. The benefits of appropriate access underpin standards in early and long-term recovery, though users’ access needs are highly personal.Methods:The study used a qualitative design involving 16 semi-structured interviews with Australian adults with an acquired brain injury after discharge from inpatient brain rehabilitation. Data were thematically analysed.Results:Three main themes were derived from the analysis. Theme 1 shows that participants valued being steered to services that providers thought appropriate for them early after discharge from inpatient rehabilitation. Theme 2 highlights the tensions between timing and personal recovery and perceived needs. Theme 3 captures participants’ insights into the challenges of gaining access vis-a-vis what the system offers and the enablers of actualising appropriate access.Conclusion:The positive experiences of being directed to specialist services early after discharge suggest that continuity of care constitutes appropriateness of access for participants in this study. However, it is also clear that continuity should not displace flexibility in the timing of services, to accord with individuals’ perceived needs. This, in addition to enablement of access opportunities, through funding and transport, are important in maintaining a personalised approach.
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Hawley L, Hammond FM, Cogan AM, Juengst S, Mumbower R, Pappadis MR, Waldman W, Dams-OʼConnor K. Ethical Considerations in Chronic Brain Injury. J Head Trauma Rehabil 2020; 34:433-436. [PMID: 31688380 PMCID: PMC6986275 DOI: 10.1097/htr.0000000000000538] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A growing number of individuals are living with chronic traumatic brain injury. As these individuals and their families attempt to reintegrate into their communities, several ethical questions arise for clinicians and researchers. These include issues around alignment of perspectives and priorities, as well as responsibilities for ongoing treatment, education, community outreach, and research. An action plan for addressing these questions is outlined.
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Affiliation(s)
- Lenore Hawley
- Craig Hospital, Englewood, Colorado (Ms Hawley); Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine and Rehabilitation Hospital of Indiana, Indianapolis (Dr Hammond); Washington DC VA Medical Center, Washington, District of Columbia (Dr Cogan); Physical Medicine & Rehabilitation, UT Southwestern Medical Center, Dallas, Texas (Dr Juengst); Capstone College of Nursing, The University of Alabama, Tuscaloosa (Dr Mumbower); Division of Rehabilitation Sciences, School of Health Professions, The University of Texas Medical Branch, Galveston and Brain Injury Research Center, TIRR Memorial Hermann, Houston (Dr Pappadis); Resource Facilitation Program, RHI-Neuro Rehab Center, Indianapolis, Indiana (Ms Waldman); and Brain Injury Research Center, Department of Rehabilitation Medicine, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (Dr Dams-O'Connor)
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Carroll NW, Hall AG, Feldman S, Thirumalai M, Wade JT, Rimmer JH. Enhancing Transitions From Rehabilitation Patient to Wellness Participant for People With Disabilities: An Opportunity for Hospital Community Benefit. Front Public Health 2020; 8:105. [PMID: 32322569 PMCID: PMC7156537 DOI: 10.3389/fpubh.2020.00105] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/17/2020] [Indexed: 11/13/2022] Open
Abstract
Pressure is increasing on not-for-profit hospitals to demonstrate that they provide sufficient benefit to the community to justify their tax-exempt status. Many industry observers have suggested that this community benefit should address unmet medical needs within the community, deficits in the social determinants of health, or health disparities within communities. We argue that one area of clear unmet need is assistance in helping bridge the transition that people with disabilities (PWD) must make from rehabilitation patient to wellness participant. Programs to bridge this transition are necessary because many PWD struggle to identify strategies to maintain and maximize their own well-being after discharge from the healthcare system. As a result, PWD have worse health outcomes than non-disabled individuals. To address these needs, we propose hospitals take a leading role in establishing new, community-based efforts to provide PWD with benefits that will support their effort to self-manage health. Hospitals are well-suited to lead the creation of these programs because of the important role they play in providing services to PWD and because of their ability to bring together multiple stakeholders required to make supportive programs sustainable.
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Affiliation(s)
- Nathan W Carroll
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States.,School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Allyson G Hall
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States.,School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Sue Feldman
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States.,School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Mohanraj Thirumalai
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States.,School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jamie Tinker Wade
- Spain Rehabilitation Center, University of Alabama at Birmingham Hospital, Birmingham, AL, United States
| | - James H Rimmer
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
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Pettemeridou E, Kennedy MR, Constantinidou F. Executive functions, self-awareness and quality of life in chronic moderate-to-severe TBI. NeuroRehabilitation 2020; 46:109-118. [DOI: 10.3233/nre-192963] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Eva Pettemeridou
- Center for Applied Neuroscience, University of Cyprus, Nicosia, Cyprus
- KIOS Innovation & Research Center of Excellence, University of Cyprus, Nicosia, Cyprus
| | - Mary R.T. Kennedy
- Communication Sciences and Disorders, Chapman University, Irvine, CA, USA
| | - Fofi Constantinidou
- Center for Applied Neuroscience, University of Cyprus, Nicosia, Cyprus
- Department of Psychology, University of Cyprus, Nicosia, Cyprus
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Minimum Competency Recommendations for Programs That Provide Rehabilitation Services for Persons With Disorders of Consciousness: A Position Statement of the American Congress of Rehabilitation Medicine and the National Institute on Disability, Independent Living and Rehabilitation Research Traumatic Brain Injury Model Systems. Arch Phys Med Rehabil 2020; 101:1072-1089. [PMID: 32087109 DOI: 10.1016/j.apmr.2020.01.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 11/24/2022]
Abstract
Persons who have disorders of consciousness (DoC) require care from multidisciplinary teams with specialized training and expertise in management of the complex needs of this clinical population. The recent promulgation of practice guidelines for patients with prolonged DoC by the American Academy of Neurology, American Congress of Rehabilitation Medicine (ACRM), and National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) represents a major advance in the development of care standards in this area of brain injury rehabilitation. Implementation of these practice guidelines requires explication of the minimum competencies of clinical programs providing services to persons who have DoC. The Brain Injury Interdisciplinary Special Interest Group of the ACRM, in collaboration with the Disorders of Consciousness Special Interest Group of the NIDILRR-Traumatic Brain Injury Model Systems convened a multidisciplinary panel of experts to address this need through the present position statement. Content area-specific workgroups reviewed relevant peer-reviewed literature and drafted recommendations which were then evaluated by the expert panel using a modified Delphi voting process. The process yielded 21 recommendations on the structure and process of essential services required for effective DoC-focused rehabilitation, organized into 4 categories: diagnostic and prognostic assessment (4 recommendations), treatment (11 recommendations), transitioning care/long-term care needs (5 recommendations), and management of ethical issues (1 recommendation). With few exceptions, these recommendations focus on infrastructure requirements and operating procedures for the provision of DoC-focused neurorehabilitation services across subacute and postacute settings.
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Donnelly KZ, Baker K, Pierce R, St Ivany AR, Barr PJ, Bruce ML. A retrospective study on the acceptability, feasibility, and effectiveness of LoveYourBrain Yoga for people with traumatic brain injury and caregivers. Disabil Rehabil 2019; 43:1764-1775. [PMID: 31577456 DOI: 10.1080/09638288.2019.1672109] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE To conduct a mixed methods, pre-post, retrospective study on the feasibility, acceptability, and effectiveness of the LoveYourBrain Yoga program. MATERIALS AND METHODS People were eligible if they were a traumatic brain injury survivor or caregiver, age 15-70, ambulatory, and capable of gentle exercise and group discussion. We analyzed attendance, satisfaction, and mean differences in scores on Quality of Life After Brain Injury Overall scale (QOLIBRI-OS) and four TBI-QOL/Neuro-QOL scales. Content analysis explored perceptions of benefits and areas of improvement. RESULTS 1563 people (82.0%) participated ≥1 class in 156 programs across 18 states and 3 Canadian provinces. Mean satisfaction was 9.3 out of 10 (SD 1.0). Mixed effects linear regression found significant improvements in QOLIBRI-OS (B 9.70, 95% CI: 8.51, 10.90), Resilience (B 1.30, 95% CI: 0.60, 2.06), Positive Affect and Well-being (B 1.49, 95% CI: 1.14, 1.84), and Cognition (B 1.48, 95% CI: 0.78, 2.18) among traumatic brain injury survivors (n = 705). No improvement was found in Emotional and Behavioral Dysregulation, however, content analysis revealed better ability to regulate anxiety, anger, stress, and impulsivity. Caregivers perceived improvements in physical and psychological health. CONCLUSIONS LoveYourBrain Yoga is feasible and acceptable and may be an effective mode of community-based rehabilitation.IMPLICATIONS FOR REHABILITATIONPeople with traumatic brain injury and their caregivers often experience poor quality of life and difficulty accessing community-based rehabilitation services.Yoga is a holistic, mind-body therapy with many benefits to quality of life, yet is largely inaccessible to people affected by traumatic brain injury in community settings.Participants in LoveYourBrain Yoga, a six-session, community-based yoga with psychoeducation program in 18 states and 3 Canadian provinces, experienced significant improvements in quality of life, resilience, cognition, and positive affect.LoveYourBrain Yoga is feasible and acceptable when implemented on a large scale and may be an effective mode of, or adjunct to, community-based rehabilitation.
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Affiliation(s)
- Kyla Z Donnelly
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA.,The LoveYourBrain Foundation, Windsor, VT, USA
| | - Kim Baker
- The LoveYourBrain Foundation, Windsor, VT, USA
| | | | - Amanda R St Ivany
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
| | - Paul J Barr
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
| | - Martha L Bruce
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
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50
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A Qualitative Study on the Transition Support Needs of Indigenous Australians Following Traumatic Brain Injury. BRAIN IMPAIR 2019. [DOI: 10.1017/brimp.2019.24] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjective:A growing body of qualitative literature globally describes post-hospital experiences during early recovery from a traumatic brain injury. For Indigenous Australians, however, little published information is available. This study aimed to understand the lived experiences of Indigenous Australians during the 6 months post-discharge, identify the help and supports accessed during transition and understand the gaps in service provision or difficulties experienced.Methods and Procedure:Semi-structured interviews were conducted at 6 months after hospital discharge to gain an understanding of the needs and lived experiences of 11 Aboriginal and Torres Strait Islander Australians who had suffered traumatic brain injury in Queensland and Northern Territory, Australia. Data were analysed using thematic analysis.Results:Five major themes were identified within the data. These were labelled ‘hospital experiences’, ‘engaging with medical and community-based supports’, ‘health and wellbeing impacts from the injury’, ‘everyday living’ and ‘family adjustments post-injury’.Conclusions:While some of the transition experiences for Indigenous Australians were similar to those found in other populations, the transition period for Indigenous Australians is influenced by additional factors in hospital and during their recovery process. Lack of meaningful interaction with treating clinicians in hospital, challenges managing direct contact with multiple service providers and the injury-related psychological impacts are some of the factors that could prevent Indigenous Australians from receiving the supports they require to achieve their best possible health outcomes in the long term. A holistic approach to care, with an individualised, coordinated transition support, may reduce the risks for re-admission with further head injuries.
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