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Winter L, Moriarty H, Robinson KM, Leiby BE, Schmidt K, Whitehouse CR, Swanson RL. Age Suppresses the Association Between Traumatic Brain Injury Severity and Functional Outcomes: A Study Using the NIDILRR TBIMS Dataset. J Head Trauma Rehabil 2024:00001199-990000000-00145. [PMID: 38652669 DOI: 10.1097/htr.0000000000000955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVES Recovery from traumatic brain injury (TBI) is extremely difficult to predict, with TBI severity usually demonstrating weak predictive validity for functional or other outcomes. A possible explanation may lie in the statistical phenomenon called suppression, according to which a third variable masks the true association between predictor and outcome, making it appear weaker than it actually is. Age at injury is a strong candidate as a suppressor because of its well-established main and moderating effects on TBI outcomes. We tested age at injury as a possible suppressor in the predictive chain of effects between TBI severity and functional disability, up to 10 years post-TBI. SETTING Follow-up interviews were conducted during telephone interviews. PARTICIPANTS We used data from the 2020 NDILRR Model Systems National Dataset for 4 successive follow-up interviews: year 1 (n = 10,734), year 2 (n = 9174), year 5 (n = 6,201), and year 10 (n = 3027). DESIGN Successive cross-sectional multiple regression analyses. MAIN MEASURES Injury severity was operationalized using a categorical variable representing duration of posttrauma amnesia. The Glasgow Outcomes Scale-Extended (GOS-E) operationally defined functioning. Sociodemographic characteristics having significant bivariate correlations with GOS-E were included. RESULTS Entry of age at injury into the regression models significantly increases the association between TBI severity and functioning up to 10 years post-TBI. CONCLUSIONS Age at injury is a suppressor variable, masking the true effect of injury severity on functional outcomes. Identifying the mediators of this suppression effect is an important direction for TBI rehabilitation research.
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Affiliation(s)
- Laraine Winter
- Author Affiliations: M. Louise Fitzpatrick College of Nursing (Drs Winter and Whitehouse), Villanova University, Villanova, Pennsylvania; Research Service (Dr Winter, Dr Moriarty, and Ms Schmidt), Nursing Service (Dr Moriarty), Physical Medicine and Rehabilitation/Rehabilitation Medicine Service (Dr Robinson and Dr Swanson), Center for Neurotrauma, Neurodegeneration and Restoration (Dr Swanson), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Department of Physical Medicine and Rehabilitation (Dr Robinson and Dr Swanson), Perelman School of Medicine, University of Pennsylvania, and Division of Biostatistics, Department of Pharmacology, Physiology, and Cancer Biology (Dr Leiby), Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
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Hauger SL, Borgen IMH, Forslund MV, Kleffelgård I, Andelic N, Løvstad M, Perrin PB, Røe C, Fure SCR. Participation in the Chronic Phase after Traumatic Brain Injury: Variations and Key Predictors. J Clin Med 2023; 12:5584. [PMID: 37685651 PMCID: PMC10488924 DOI: 10.3390/jcm12175584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Participation is of major importance for individuals with traumatic brain injury (TBI). This study evaluates participation over a period of one year among persons with TBI in the chronic phase and explores sociodemographic, psychological, and environmental predictors of levels and trajectories of participation. One hundred and twenty home-living survivors of TBI with persistent injury-related consequences at least two years post-injury who participated in a goal-oriented randomized trial were assessed at baseline and after four and twelve months. Linear mixed-effects model analysis was applied to evaluate height, trajectory slope, and predictors of the Participation Assessment with the Recombined Tools-Objective (PART-O) total score and the subscales Productivity, Social Relations, and Being Out and About. Being married, having a higher education, and having good global functioning predicted more frequent participation. Education, executive- and global functions predicted Productivity, while age and being married predicted Social Relations. Participating in the study during the COVID-19 pandemic had a negative impact on Productivity. Participation was relatively stable over 12 months, with a slight decline, but may be influenced by demographic factors and functional consequences. Rehabilitation services should particularly focus on people with TBI living alone with lower levels of global and executive function.
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Affiliation(s)
- Solveig L. Hauger
- Department of Research, Sunnaas Rehabilitation Hospital, 1453 Bjørnemyr, Norway;
- Department of Psychology, Faculty of Social Sciences, University of Oslo, 0316 Oslo, Norway
| | - Ida M. H. Borgen
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (I.M.H.B.); (M.V.F.); (I.K.); (N.A.); (C.R.); (S.C.R.F.)
| | - Marit V. Forslund
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (I.M.H.B.); (M.V.F.); (I.K.); (N.A.); (C.R.); (S.C.R.F.)
| | - Ingerid Kleffelgård
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (I.M.H.B.); (M.V.F.); (I.K.); (N.A.); (C.R.); (S.C.R.F.)
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (I.M.H.B.); (M.V.F.); (I.K.); (N.A.); (C.R.); (S.C.R.F.)
- Center for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, Faculty of Medicine, University of Oslo, 0316 Oslo, Norway
| | - Marianne Løvstad
- Department of Research, Sunnaas Rehabilitation Hospital, 1453 Bjørnemyr, Norway;
- Department of Psychology, Faculty of Social Sciences, University of Oslo, 0316 Oslo, Norway
| | - Paul B. Perrin
- Department of Psychology, School of Data Science, University of Virginia, Charlottesville, VA 22904, USA;
- Central Virginia Veterans Affairs Health Care System, Richmond, VA 23249, USA
| | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (I.M.H.B.); (M.V.F.); (I.K.); (N.A.); (C.R.); (S.C.R.F.)
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0316 Oslo, Norway
| | - Silje C. R. Fure
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (I.M.H.B.); (M.V.F.); (I.K.); (N.A.); (C.R.); (S.C.R.F.)
- Center for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, Faculty of Medicine, University of Oslo, 0316 Oslo, Norway
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Garcia-Rudolph A, Sauri J, Cisek K, Kelleher JD, Madai VI, Frey D, Opisso E, Tormos JM, Bernabeu M. Long-term trajectories of community integration: identification, characterization, and prediction using inpatient rehabilitation variables. Top Stroke Rehabil 2023:1-13. [PMID: 36934334 DOI: 10.1080/10749357.2023.2188756] [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: 03/20/2023]
Abstract
BACKGROUND Community integration (CI) is often regarded as the foundation of rehabilitation endeavors after stroke; nevertheless, few studies have investigated the relationship between inpatient rehabilitation (clinical and demographic) variables and long-term CI. OBJECTIVES To identify novel classes of patients having similar temporal patterns in CI and relate them to baseline features. METHODS Retrospective observational cohort study analyzing (n = 287) adult patients with stroke admitted to rehabilitation between 2003 and 2018, including baseline Functional Independence Measure (FIM) at discharge, follow-ups (m = 1264) of Community Integration Questionnaire (CIQ) between 2006 and 2022. Growth mixture models (GMMs) were fitted to identify CI trajectories, and baseline predictors were identified using multivariate logistic regression (reporting AUC) with 10-fold cross validation. RESULTS Each patient was assessed at 2.7 (2.2-3.7), 4.4 (3.7-5.6), and 6.2 (5.4-7.4) years after injury, 66% had a fourth assessment at 7.9 (6.8-8.9) years. GMM identified three classes of trajectories. Lowest CI (n=105, 36.6%): The lowest mean total CIQ; highest proportion of dysphagia (47.6%) and aphasia (46.7%), oldest at injury, largest length of stay (LOS), largest time to admission, and lowest FIM. Highest CI (n=63, 21.9%): The highest mean total CIQ, youngest, shortest LOS, highest education (27% university) highest FIM, and Intermediate CI (n=119, 41.5%): Intermediate mean total CIQ and FIM scores. Age at injury OR: 0.89 (0.85-0.93), FIM OR: 1.04 (1.02-1.07), hypertension OR: 2.86 (1.25-6.87), LOS OR: 0.98 (0.97-0.99), and high education OR: 3.05 (1.22-7.65) predicted highest CI, and AUC was 0.84 (0.76-0.93). CONCLUSION Novel clinical (e.g. hypertension) and demographic (e.g. education) variables characterized and predicted long-term CI trajectories.
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Affiliation(s)
- Alejandro Garcia-Rudolph
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain.,School of Computing and Digital Technology, Faculty of Computing, Engineering and the Built Environment, Birmingham City University, Birmingham, UK
| | - Joan Sauri
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Katryna Cisek
- School of Computing and Digital Technology, Faculty of Computing, Engineering and the Built Environment, Birmingham City University, Birmingham, UK
| | - John D Kelleher
- School of Computing and Digital Technology, Faculty of Computing, Engineering and the Built Environment, Birmingham City University, Birmingham, UK
| | - Vince Istvan Madai
- Information, Communication and Entertainment Research Institute, Technological University Dublin (TU Dublin), Dublin, Ireland.,CLAIM Charité Lab for AI in Medicine, Charité Universitätsmedizin, Berlin, Germany.,QUEST Center for Transforming Biomedical Research, Berlin Institute of Health (BIH), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Dietmar Frey
- Information, Communication and Entertainment Research Institute, Technological University Dublin (TU Dublin), Dublin, Ireland
| | - Eloy Opisso
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Josep María Tormos
- Universitat Autònoma de Barcelona, Barcelona, Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain.,Information, Communication and Entertainment Research Institute, Technological University Dublin (TU Dublin), Dublin, Ireland
| | - Montserrat Bernabeu
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
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Kersey J, Baum CM, Hammel J, Terhorst L, McCue M, Skidmore ER. Cut points and sensitivity to change of the Enfranchisement scale of the Community Participation Indicators in adults with traumatic brain injury. PM R 2023; 15:176-183. [PMID: 34865309 DOI: 10.1002/pmrj.12743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 11/09/2021] [Accepted: 11/30/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Community participation is an important outcome of rehabilitation following traumatic brain injury. Yet, few measures assess inclusion and belonging (enfranchisement) as a dimension of community participation. The Enfranchisement scale of the Community Participation Indicators addresses this need. However, research on its psychometric properties is lacking. OBJECTIVE To examine cut points and sensitivity to change of the Enfranchisement scale of the Community Participation Indicators in adults with traumatic brain injury. DESIGN This was a repeated measures study with assessments administered twice (3 months apart). SETTING Assessments were administered either over the phone, virtually (Zoom), or in person at the participant's home. PARTICIPANTS A total of 44 participants from community settings who had either experienced a traumatic brain injury within the previous year or were receiving rehabilitation interventions were recruited. MAIN OUTCOME MEASURE The Enfranchisement scale has two subscales: the Control subscale (range: 13-65) and the Importance subscale (range: 14-70). On both subscales, lower scores indicate better enfranchisement. METHODS The software SAS PROC Logistic and the macro %ROCPlot were used to examine cut points at varying levels of sensitivity and specificity. The area under the receiver operating characteristics curve was calculated to determine overall classification accuracy. Minimum detectable change and minimal clinically important difference were also calculated. RESULTS For the Control subscale, a cut point of 44 (area under the curve = .75), a minimum detectable change of 8, and a minimal clinically important difference of 5 were found. For the Importance subscale, a cut point of 39 (area under the curve = .81), a minimum detectable change of 8, and a minimal clinically important difference of 5 were found. CONCLUSIONS The cut points resulted in good classification accuracy, providing support for their reliability. The results provided evidence that both subscales are sensitive to change in adults with brain injury.
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Affiliation(s)
- Jessica Kersey
- OTR/L, Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, Pennsylvania, USA
| | - Carolyn M Baum
- OTR/L, Program in Occupational Therapy, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Joy Hammel
- OTR/L, Department of Occupational Therapy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Lauren Terhorst
- Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, Pennsylvania, USA
| | - Michael McCue
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Elizabeth R Skidmore
- OTR/L, Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, Pennsylvania, USA
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Community Integration and Associated Factors 10 Years after Moderate-to-Severe Traumatic Brain Injury. J Clin Med 2023; 12:jcm12020405. [PMID: 36675333 PMCID: PMC9866980 DOI: 10.3390/jcm12020405] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 12/29/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023] Open
Abstract
This study evaluated the impact of baseline injury characteristics and one-year functional level on the 10-year community integration outcomes for working-age patients with moderate-to-severe traumatic brain injury (TBI). Patients aged 16-55 and diagnosed with moderate-to-severe TBI within 24 h of injury were eligible for the study. Multivariable hierarchical linear regression was utilized to assess the impact of baseline characteristics and one-year functional measures on the mean Community Integration Questionnaire (CIQ) scores 10 years after injury. Of 133 original study participants, 97 survived 10 years, and 75 were available for this study. The mean total CIQ score changed positively from one to 10 years post-injury, from 18.7 (±5.5) to 19.8 (±4.8) (p = 0.04). The results suggested that age (β = -0.260, p = 0.013), FIM-Cognitive subscale (β = 0.608, p = 0.002), and the bodily pain subscale (BP) (β = 0.277, p = 0.017) of the SF-36 were significantly associated with the mean CIQ scores. In conclusion, this study demonstrated improved community integration from one to 10 years in a sample of working-age patients with moderate-to-severe TBI. The findings also showed that age, cognitive function, and bodily pain were significant predictors of long-term community integration, suggesting post-acute rehabilitation should focus on factors related to long-term risk and protective factors to improve long-term outcomes.
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Neuropsychological functioning predicts psychosocial adjustment after postacute rehabilitation for traumatic brain injury. J Int Neuropsychol Soc 2022; 29:410-414. [PMID: 36200316 DOI: 10.1017/s1355617722000352] [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: 11/07/2022]
Abstract
OBJECTIVES To examine neuropsychological functioning as a predictor of psychosocial adjustment difficulties at discharge from a postacute residential rehabilitation facility for traumatic brain injury (TBI) and depression as a potential mediator. METHODS A retrospective record review was conducted of 172 adults who received rehabilitation services for TBI. Individuals completed a full battery of neuropsychological tests, depression assessment, and functional assessments at admission. Functional assessments were also obtained at discharge. RESULTS A two-phase structural equation model analysis was performed. The first phase specified a good fitting model of a cognitive functioning (CF) latent construct with four indicators of cognitive domains measuring verbal fluency, cognitive flexibility, verbal learning, and working memory. Worse CF was associated with greater psychosocial adjustment impairment at discharge, but not related to depression. Psychosocial adjustment impairment at admission was positively associated with depression when controlling for CF, however depression did not predict psychosocial adjustment at discharge. Thus, depression was not found to be a significant mediator of psychosocial adjustment impairment at discharge. CONCLUSIONS Results provide support for neuropsychological functioning at the start of postacute rehabilitation for TBI as an important predictor of psychosocial functioning difficulties that remain upon discharge and highlights the need to examine mechanisms beyond depression.
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7
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Hart T, Rabinowitz A. Changes in social participation between 1 and 2 years following moderate-severe traumatic brain injury. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:945699. [PMID: 36189074 PMCID: PMC9397871 DOI: 10.3389/fresc.2022.945699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/27/2022] [Indexed: 11/23/2022]
Abstract
Objective To examine patterns of change in social participation in persons with moderate-severe traumatic brain injury (msTBI) between 1 and 2 years postinjury, and predictors of observed change. Participants 375 participants with msTBI enrolled in a single TBI Model System site. Measures and Methods The dependent variable in a linear regression was a reliable change score for the Social Relations subscale of the Participation Assessment with Recombined Tools-Objective, administered at 1- and 2-year follow-ups. Predictors of change included demographics, injury severity, social and functional status at Year 1, and changes in function and life circumstances between years 1 and 2. Results Social participation status did not change substantially for 34 of the sample, while approximately equal proportions of the remainder improved or declined. The regression model was significant (p < 0.001). Improvement was predicted by private vs. public insurance and decline was predicted by a reduction in the FIM functional outcome measure from year 1 to year 2. Marginal predictors included education (higher levels predicting improvement) and year 1 marital status (single status predicting decline). Conclusions Longitudinal change in social participation in the chronic phase of msTBI deserves further study, with attention to resource limitations and the impact of changes in functional status.
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Bystrup MR, Aadal L, Pallesen H, Larsen K, Hindhede AL. Who are relatives? Young adults, relatives and professionals' perceptions of relatives during the rehabilitation of young adults with a severe acquired brain injury. Disabil Rehabil 2022; 45:1655-1666. [PMID: 35559686 DOI: 10.1080/09638288.2022.2072959] [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: 11/03/2022]
Abstract
PURPOSE This paper explores the perception of "relatives" during the rehabilitation of young adults with severe acquired brain injury (SABI). METHODS This longitudinal qualitative study followed eight young adults with a SABI from hospital discharge to a year and a half after discharge. The design encompassed professional records, interviews, and surveys, including a name generator list completed by the young adults and focus group interviews with both their families and professionals. We apply a sociological theoretical framework concerning friendship, and we employ social network analysis (SNA) methodology to capture, visualise, and analyse the young adults' significant social relations. RESULTS Social relations engaged as relatives during rehabilitation are to a large extent determined by the perceptions of professionals and the parents of the young adult. These perceptions contain a limited number of social relations, with priority given to biological and juridical ties. This might reflect the reduced social support available for the young adult, who initially had a much larger social network. CONCLUSION The authors suggest a professional rethinking of who "relatives" are as well as considering these social ties as dynamic. Implications for rehabilitationRehabilitation professionals must be aware of and pay attention to differing perceptions that exist as to who qualifies as significant social relations in order to reconsider the practical implementation of relative involvement.The perception of who relatives are during the rehabilitation process should be reconsidered and extended to include who the young adult perceive as significant social relations.Relatives are not a fixed entity and should be considered dynamically throughout the rehabilitation process.Social relations of the young adult must to a larger extent be considered during rehabilitation to prevent social isolation in the long run.
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Affiliation(s)
- Mette Ryssel Bystrup
- Department of Culture and Learning, Aalborg University, Copenhagen SV, Denmark.,Department of Clinical Medicine, Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Hammel, Denmark
| | - Lena Aadal
- Department of Clinical Medicine, Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Hammel, Denmark
| | - Hanne Pallesen
- Department of Clinical Medicine, Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Hammel, Denmark
| | - Kristian Larsen
- The University Hospital Centre for Health Research (UCSF) & University of Copenhagen, Copenhagen, Denmark
| | - Anette L Hindhede
- The University Hospital Centre for Health Research (UCSF) & University of Copenhagen, Copenhagen, Denmark
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Lama S, Damkliang J, Kitrungrote L. Predictive factors for community integration among Nepalese persons after traumatic brain injury. TRAUMA-ENGLAND 2022. [DOI: 10.1177/14604086221088104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Various factors affect the community integration (CI) of persons experiencing traumatic brain injury (TBI). To ensure positive outcomes in terms of life at home, social activities, and productive work among persons suffering TBI, it is necessary to understand the factors that facilitate or impede CI. Purpose To compare CI by looking at demographic and clinical characteristics and determine significant predictors of CI among TBI Nepalese persons. Methods 120 participants were selected using a stratified random sampling technique. A questionnaire was used to identify the participants’ demographic and clinical characteristics, and the Community Integration Questionnaire was used to measure CI. Univariate and multivariate analyses were performed for demographic and clinical factors associated with community integration. Results Using univariate analysis, male, employed, living with family, and independence in performing activities of daily living had significantly higher CI scores than female (t = −4.18, p<.000), unemployed (t = −10.52, p<.000), living with friends (t = −3.30, p<.001), and those with moderate to slight dependence (t = −2.83, p<.005). The multivariate analysis revealed that employment status, living with family, and length of hospital stay were significant predictors of CI among TBI Nepalese persons. Conclusion Employment status, living with family, and length of hospital stay were significant predictors of CI. These findings suggest that rehabilitation efforts should focus on minimizing hospital stay and promoting both productive and social activities among people surviving TBI.
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Winter L, Mensinger JL, Moriarty HJ, Robinson KM, McKay M, Leiby BE. Age Moderates the Effect of Injury Severity on Functional Trajectories in Traumatic Brain Injury: A Study Using the NIDILRR Traumatic Brain Injury Model Systems National Dataset. J Clin Med 2022; 11:jcm11092477. [PMID: 35566607 PMCID: PMC9104127 DOI: 10.3390/jcm11092477] [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: 03/28/2022] [Revised: 04/18/2022] [Accepted: 04/25/2022] [Indexed: 12/04/2022] Open
Abstract
Age is a risk factor for a host of poor outcomes following traumatic brain injury (TBI), with some evidence suggesting that age is also a source of excess disability. We tested the extent to which age moderates the effect of injury severity on functional trajectories over 15 years post injury. Data from 11,442 participants from the 2020 National Institute of Disability and Independent Living Rehabiitation Research (NIDILRR) Traumatic Brain Injury Model Systems (TBIMS) National Dataset were analyzed using linear mixed effects models. Injury severity was operationally defined using a composite of Glasgow Coma Scale scores, structural imaging findings, and the number of days with post-trauma amnesia. Functioning was measured using the Glasgow Outcomes Scale-Extended. Age at injury was the hypothesized moderator. Race, ethnicity, sex, education, and marital status served as covariates. The results showed a significant confounder-adjusted effect of injury severity and age of injury on the linear slope in functioning. The age effect was strongest for those with mild TBI. Thus, the effects of injury severity on functional trajectory were found to be moderated by age. To optimize outcomes, TBI rehabilitation should be developed specifically for older patients. Age should also be a major focus in TBI research.
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Affiliation(s)
- Laraine Winter
- Nursing Service, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA 19104, USA;
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA 19085, USA;
- Correspondence:
| | - Janell L. Mensinger
- Department of Clinical and School Psychology, College of Psychology, Nova Southeastern University, Fort Lauderdale, FL 33314, USA; or
| | - Helene J. Moriarty
- Nursing Service, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA 19104, USA;
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA 19085, USA;
| | - Keith M. Robinson
- Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Michelle McKay
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA 19085, USA;
| | - Benjamin E. Leiby
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA;
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Kersey J, Terhorst L, Hammel J, Baum C, Toglia J, O'Dell MW, Heinemann AW, McCue M, Skidmore ER. Detecting change in community participation with the Enfranchisement scale of the community participation indicators. Clin Rehabil 2021; 36:251-262. [PMID: 34723687 DOI: 10.1177/02692155211052188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study determined the sensitivity to change of the Enfranchisement scale of the Community Participation Indicators in people with stroke. DATA SOURCES We analyzed data from two studies of participants with stroke: an intervention study and an observational study. MAIN MEASURES The Enfranchisement Scale contains two subscales: the Importance subscale (feeling valued by and contributing to the community; range: 14-70) and the Control subscale (choice and control: range: 13-64). DATA ANALYSIS Assessments were administered 6 months apart. We calculated minimum detectable change and minimal clinically important difference. RESULTS The Control subscale analysis included 121 participants with a mean age of 61.2 and mild-moderate disability (Functional Independence Measure, mean = 97.9, SD = 24.7). On the Control subscale, participants had a mean baseline score of 51.4 (SD = 10.4), and little mean change (1.3) but with large variation in change scores (SD = 11.5). We found a minimum detectable change of 9 and a minimum clinically important difference of 6. The Importance subscale analysis included 116 participants with a mean age of 60.7 and mild-moderate disability (Functional Independence Measure, mean = 98.9, SD = 24.5). On the Importance subscale, participants had a mean baseline score of 44.1 (SD = 12.7), and again demonstrated little mean change (1.08) but with large variation in change scores (SD = 12.6). We found a minimum detectable change of 11 and a minimum clinically important difference 7. CONCLUSIONS The Control subscale required 9 points of change, and the Importance subscale required 11 points of change, to achieve statistically and clinically meaningful changes, suggesting adequate sensitivity to change.
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Affiliation(s)
- Jessica Kersey
- OTR/L, Department of Occupational Therapy, 6614University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, PA, USA
| | - Lauren Terhorst
- Department of Occupational Therapy, 6614University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, PA, USA
| | - Joy Hammel
- OTR/L, Department of Occupational Therapy, 14681University of Illinois at Chicago, Chicago, IL, USA
| | - Carolyn Baum
- OTR/L, Program in Occupational Therapy and Departments of Neurology & Social Work, 7548Washington University in St Louis, St Louis, MO, USA
| | - Joan Toglia
- OTR/L, School of Health and Natural Sciences, 2986Mercy College, Dobbs Ferry, NY, USA
| | - Michael W O'Dell
- Department of Rehabilitation Medicine, 116366New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
| | - Allen W Heinemann
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael McCue
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Elizabeth R Skidmore
- OTR/L, Department of Occupational Therapy, 6614University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, PA, USA
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12
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A Scoping Review of Predictors of Community Integration Following Traumatic Brain Injury: A Search for Meaningful Associations. J Head Trauma Rehabil 2020; 34:E32-E41. [PMID: 30499925 DOI: 10.1097/htr.0000000000000442] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The purpose of this scoping review was to identify predictors of community integration for adults with traumatic brain injury. DATA SOURCES We searched the PubMed and PsycINFO databases and reviewed references of included studies. We selected studies exploring multiple components of community integration, including instrumental activities of daily living, leisure activities, and social activities. A total of 53 studies were included. DATA EXTRACTION We extracted data on sample size and sample characteristics (stage of injury and recovery, severity) and examined predictor variables, outcome measures for community integration, and significant findings, reported as correlations. DATA SYNTHESIS We found that the predictors of community integration fell into 4 categories: demographics, injury characteristics, disability and impairments, and environmental factors. There was large variability in reported relationships for demographics (r = 0.01-0.43), injury characteristics (r = 0.01-0.58), disability/functional impairments (r = 0.003-0.98) and environmental factors (r = 0.11-0.58). Cognition, disability, mobility/physical functioning, mood, social support, and length of posttraumatic amnesia had the strongest relationships with community integration outcomes. CONCLUSIONS Strategies for the management of cognitive, physical, and emotional functioning, and building and training a strong support system, may facilitate community integration outcomes. Additional work is warranted to further explore the discrepancies found among studies.
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13
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Perumparaichallai RK, Lewin RK, Klonoff PS. Community reintegration following holistic milieu-oriented neurorehabilitation up to 30 years post-discharge. NeuroRehabilitation 2020; 46:243-253. [PMID: 32083599 DOI: 10.3233/nre-192968] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The primary goal of neurorehabilitation for individuals with acquired brain injury (ABI) is successful community reintegration, which commonly focuses on home independence, productivity, and social engagement. Previous research has demonstrated that holistic treatment approaches have better long-term outcomes than other treatment approaches. Holistic approaches go beyond the fundamental components of neurorehabilitation and address metacognition and self-awareness, as well as interpersonal and functional skills. OBJECTIVES The present study aimed to examine community reintegration of individuals with ABI who completed holistic milieu-oriented neurorehabilitation at the Center for Transitional Neuro-Rehabilitation (CTN), Barrow Neurological Institute (BNI) at up to 30-years post-discharge. We evaluated (a) functional independence, (b) productivity and driving status, and (c) psychosocial profiles of the brain injury survivors. METHOD Participants included 107 individuals with ABI with heterogeneous etiologies who attended holistic milieu-oriented neurorehabilitation between 1986 and 2016. These participants completed the Mayo-Portland Adaptability Inventory-4 (MPAI-4) and a long-term outcome questionnaire (LOQ) specifically developed for this study. RESULTS The results demonstrate that 89% of participants were productive at up to 30 years post-discharge (73% engaged in competitive work and/or school) after excluding the retired participants. Almost all of the participants who were engaged in work and/or school reported using compensatory strategies on a long-term basis. Furthermore, only 14% out of 102 study participants were driving at the time of program admission; whereas 58% out of 96 were driving at the time of discharge; and impressively, 70% out of 107 participants were driving at the time of follow-up. Regression analyses revealed that older age at the time of injury, shorter duration between injury and treatment, and better functionality indicated by lower MPAI-4 Ability Index scores significantly predicted a return to driving status at the time of study participation. Psychosocial data from the LOQ revealed positive findings with respect to patients' marital status, living situation, income, and quality of social life. CONCLUSION The findings from this study suggest that functional gains made during holistic neurorehabilitation have enduring effects and that patients can benefit highly from holistic milieu therapy beyond the early post-acute phases of their recovery. Additionally, they provide evidence that there is potential to return to driving, years after treatment completion.Our holistic milieu treatment approach addressing metacognition, self-awareness, social and coping skills training, and actively transitioning to community settings, is thought to have contributed to the exceptional and long-lasting outcomes in this study.
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Affiliation(s)
| | - Rivian K Lewin
- Center for Transitional Neuro-Rehabilitation, Barrow Neurological Institute/St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.,Department of Psychology, University of Memphis, Memphis, TN, USA
| | - Pamela S Klonoff
- Center for Transitional Neuro-Rehabilitation, Barrow Neurological Institute/St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
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14
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Arango-Lasprilla JC, Zeldovich M, Olabarrieta-Landa L, Forslund MV, Núñez-Fernández S, von Steinbuechel N, Howe EI, Røe C, Andelic N. Early Predictors of Employment Status One Year Post Injury in Individuals with Traumatic Brain Injury in Europe. J Clin Med 2020; 9:jcm9062007. [PMID: 32604823 PMCID: PMC7355447 DOI: 10.3390/jcm9062007] [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] [Received: 06/04/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 11/16/2022] Open
Abstract
Sustaining a traumatic brain injury (TBI) often affects the individual’s ability to work, reducing employment rates post-injury across all severities of TBI. The objective of this multi-country study was to assess the most relevant early predictors of employment status in individuals after TBI at one-year post-injury in European countries. Using a prospective longitudinal non-randomized observational cohort (The Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) project), data was collected between December 2014–2019 from 63 trauma centers in 18 European countries. The 1015 individuals who took part in this study were potential labor market participants, admitted to a hospital and enrolled within 24 h of injury with a clinical TBI diagnosis and indication for a computed tomography (CT) scan, and followed up at one year. Results from a binomial logistic regression showed that older age, status of part-time employment or unemployment at time of injury, premorbid psychiatric problems, and higher injury severity (as measured with higher Injury severity score (ISS), lower Glasgow Coma Scale (GCS), and longer length of stay (LOS) in hospital) were associated with higher unemployment probability at one-year after injury. The study strengthens evidence for age, employment at time of injury, premorbid psychiatric problems, ISS, GCS, and LOS as important predictors for employment status one-year post-TBI across Europe.
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Affiliation(s)
- Juan Carlos Arango-Lasprilla
- Biocruces Bizkaia Health Research Institute, 48903 Barakaldo, Spain;
- IKERBASQUE Basque Foundation for Science, 48013 Bilbao, Spain
- Department of Cell Biology and Histology, University of the Basque Country UPV/EHU, 48940 Leioa, Spain
- Correspondence: (J.C.A.-L.); (M.Z.); Tel.: +34-946-006-000 (J.C.A.-L.) (ext. 7963); +49-551-398-195 (M.Z.)
| | - Marina Zeldovich
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, 37073 Göttingen, Germany;
- Correspondence: (J.C.A.-L.); (M.Z.); Tel.: +34-946-006-000 (J.C.A.-L.) (ext. 7963); +49-551-398-195 (M.Z.)
| | | | - Marit Vindal Forslund
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (M.V.F.); (E.I.H.); (C.R.); (N.A.)
| | | | - Nicole von Steinbuechel
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, 37073 Göttingen, Germany;
| | - Emilie Isager Howe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (M.V.F.); (E.I.H.); (C.R.); (N.A.)
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
| | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (M.V.F.); (E.I.H.); (C.R.); (N.A.)
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (M.V.F.); (E.I.H.); (C.R.); (N.A.)
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
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15
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Kersey J, McCue M, Skidmore E. Domains and dimensions of community participation following traumatic brain injury. Brain Inj 2020; 34:708-712. [PMID: 32320307 DOI: 10.1080/02699052.2020.1757153] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PRIMARY OBJECTIVE To examine patterns of community participation, as well as the relationship among community participation outcomes and time since injury, impairments, environmental factors, and enfranchisement in adults with traumatic brain injury (TBI). RESEARCH DESIGN Cross-sectional study of a sample of 61 adults with TBI. METHODS AND PROCEDURES We administered the Participation Measure- 3 Domains 4 Dimensions to examine community participation in the three domains (productivity, community activities, and social participation) using four dimensions (diversity of activities, frequency, difficulty, and desire for change). MAIN RESULTS AND OUTCOMES All dimensions of community participation seem to be impaired following TBI, as evidenced by scores in the lower half of the available range. Most impaired was social participation (frequency: M = 10.0, SD = 3.4, possible range 0-24; difficulty: M= 11.3, SD = 3.2, possible range 4-16). Correlational analyses revealed that depression (r = 0.51), environmental factors (r = 0.51), and enfranchisement (r = 0.42), seem to play an important role in community participation outcomes, and may be potential targets for intervention. Results did not vary based on time since injury. CONCLUSION Our results suggest that depression, environmental factors, and enfranchisement may be important considerations for future interventions aiming to promote management of identified barriers.
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Affiliation(s)
- Jessica Kersey
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh , Pittsburgh, Pennsylvania, USA
| | - Michael McCue
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh , Pittsburgh, Pennsylvania, USA
| | - Elizabeth Skidmore
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh , Pittsburgh, Pennsylvania, USA
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16
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van Walsem MR, Howe EI, Perrin PB, Sigurdardottir S, Røe C, Sveen U, Lu J, Forslund MV, Andelic N. Trajectories of self-reported competency up to 10 years following moderate-to-severe traumatic brain injury. Brain Inj 2020; 34:335-342. [PMID: 31928233 DOI: 10.1080/02699052.2019.1704061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: To describe trajectories of self-reported functional competency up to 10 years following traumatic brain injury (TBI) and identify their predictors from baseline socio-demographic and injury severity characteristics.Design and methods: Data from 94 participants from a longitudinal cohort of patients with moderate-to-severe TBI were analyzed. Socio-demographic and injury severity data were recorded at baseline. Participants completed the Patient Competency Rating Scale (PCRS) at 1, 2, 5, and 10 years. Hierarchical linear modeling was used to examine PCRS trajectories over time and assess baseline predictors.Results: There was no significant change in average PCRS scores across the follow-up time points in the full sample. Emotional and cognitive competencies had the lowest mean scores. Gender, employment, and the interaction term between gender and time were significant predictors of PCRS trajectories. Females and those who were unemployed at the time of injury showed lower trajectories of self-reported competency.Conclusion: Self-reported competency remained stable from one-year post-injury for men only. Lower mean scores in the domains of emotional and cognitive competencies suggest a need for continued rehabilitation focus in the chronic phase after TBI. Special attention to women and individuals who are unemployed at the time of injury may be warranted.
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Affiliation(s)
- Marleen R van Walsem
- Department of Neurohabilitation, Oslo University Hospital, Oslo, Norway.,Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Emilie I Howe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Paul B Perrin
- Department of Psychology, Virginia Commonwealth University, Richmond, USA
| | | | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Unni Sveen
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Faculty of Health Sciences, Department of Occupational Therapy, Prosthetics and Orthotics, Oslo Metropolitan University, Oslo, Norway
| | - Juan Lu
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Family Medicine and Population Health, Division of Epidemiology, Virginia Commonwealth University, Richmond, USA
| | - Marit V Forslund
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Nada Andelic
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
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17
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Soendergaard PL, Wolffbrandt MM, Biering-Sørensen F, Nordin M, Schow T, Arango-Lasprilla JC, Norup A. A manual-based family intervention for families living with the consequences of traumatic injury to the brain or spinal cord: a study protocol of a randomized controlled trial. Trials 2019; 20:646. [PMID: 31775831 PMCID: PMC6880634 DOI: 10.1186/s13063-019-3794-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 10/10/2019] [Indexed: 01/07/2023] Open
Abstract
Background Acquiring a traumatic injury constitutes a severe life change for the survivor, but also for the surrounding family. The paradigm of helping the family has primarily been on psychosocial interventions targeting caregivers. However, interventions including both survivor and caregivers should be an essential part of treatment, as the whole family’s functional level and mental health can be affected. The current study protocol presents a manualized family intervention for families living with traumatic injury to the brain (TBI) or spinal cord (tSCI). The objectives are to investigate if the intervention improves quality of life (QoL) and decreases burden. It is hypothesized that the family intervention improves problem-solving strategies and family dynamics, which will reduce the burden. This may improve the caregivers’ mental health, which will improve the support to the survivor and QoL. Methods The study is an interventional, two-arm, randomized controlled trial. During a 2-year period, a total of 132 families will be included. Participants will be recruited from East-Denmark. Inclusion criteria are (1) TBI or tSCI, (2) ≥ 18 years of age, (3) ≥ 6 months to ≤ 2 years since discharge from hospital, (4) ability to understand and read Danish, (5) cognitive abilities that enable participation, and (6) a minimum of one family member actively involved in the survivor’s life. Exclusion criteria are (1) active substance abuse, (2) aphasia, (3) prior neurologic or psychiatric diagnose, and (4) history of violence. Within each disease group, families will be allocated randomly to participate in an intervention or a control group with a ratio 1:1. The intervention groups receive the family intervention consisting of eight sessions of 90 min duration. Families in the control groups receive 2 h of psychoeducation. All participants complete questionnaires on QoL, self-perceived burden, family dynamics, problem-solving strategies, mental health, and resilience at pre-intervention, post-intervention, and 6-month follow up. Conclusion If the intervention is found to have effect, the study will contribute with novel knowledge on the use of a manual-based intervention including the entire family. This would be of clinical interest and would help families living with the consequences of TBI or tSCI. Trials registration ClinicalTrials.gov, NCT03814876. Retrospectively registered on 24 January 2019.
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Affiliation(s)
- Pernille Langer Soendergaard
- Department of Neurorehabilitation, TBI Unit, Rigshospitalet, Kettegaard Allé 30, 2650, Hvidovre, Denmark. .,Department of Psychology, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark.
| | - Mia Moth Wolffbrandt
- Department of Neurorehabilitation, TBI Unit, Rigshospitalet, Kettegaard Allé 30, 2650, Hvidovre, Denmark
| | - Fin Biering-Sørensen
- Clinic for Spinal Cord Injuries, Rigshospitalet, University of Copenhagen, Havnevej 25, 3100, Hornbæk, Denmark.,Institute for Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
| | - Malin Nordin
- Department of Neurosurgery, Karolinska University Hospital, Eugeniavägen 3, 171 76, Stockholm, Sweden
| | - Trine Schow
- Research and Development, Brain Injury Center BOMI, Maglegaardsvej 15, 4000, Roskilde, Denmark
| | - Juan Carlos Arango-Lasprilla
- BioCruces Vizcaya Health Research Institute, Cruces University Hospital, Barakaldo, Spain.,IKERBASQUE, Basque Foundation for Science, Bilbao, Spain.,Department of Cell Biology, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Anne Norup
- Department of Neurorehabilitation, TBI Unit, Rigshospitalet, Kettegaard Allé 30, 2650, Hvidovre, Denmark.,Department of Psychology, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
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18
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Andelic N, Løvstad M, Norup A, Ponsford J, Røe C. Editorial: Impact of Traumatic Brain Injuries on Participation in Daily Life and Work: Recent Research and Future Directions. Front Neurol 2019; 10:1153. [PMID: 31736861 PMCID: PMC6838205 DOI: 10.3389/fneur.2019.01153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 10/14/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Research Centre for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Marianne Løvstad
- Research Department, Sunnaas Rehabilitation Hospital, Bjørnemyr, Norway.,Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Anne Norup
- Traumatic Brain Injury Unit, Department of Neurorehabilitation, Rigshospitalet, Copenhagen, Denmark.,Department of Psychology, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Jennie Ponsford
- Monash Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, VIC, Australia.,Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Research Centre for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
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19
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Predicting the Trajectory of Participation After Traumatic Brain Injury: A Longitudinal Analysis. J Head Trauma Rehabil 2019; 33:257-265. [PMID: 29385019 DOI: 10.1097/htr.0000000000000383] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify factors that predict trajectories of participation over the first 5 years after moderate to severe traumatic brain injury (TBI). SETTING TBI Model System Programs. PARTICIPANTS Community-dwelling individuals with TBI, 16 years of age or older (n = 1947). DESIGN Secondary analysis of a prospective, nonrandomly sampled, longitudinal data registry. MAIN MEASURES Participation Assessment with Recombined Tools-Objective (PART-O). RESULTS Age at injury and FIM Motor score predicted trajectory of participation over the first 5 years after moderate to severe TBI. Older age predicted generally worse participation overall as well as progressively worsening participation over time. Higher FIM Motor raised the predicted participation values, although it reduced the rate of improvement in participation scores over time. FIM Cognitive scores, race, depression, years of education, and living setting did not predict trajectory but did significantly influence participation consistently at all time points. CONCLUSION The trajectories of participation over the first 5 years after TBI can be predicted by age at injury and FIM Motor scores. These findings may enhance the ability of rehabilitation professionals to identify individuals at risk for poor participation after TBI and develop targeted interventions for optimizing involvement in life activities.
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20
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Forslund MV, Perrin PB, Røe C, Sigurdardottir S, Hellstrøm T, Berntsen SA, Lu J, Arango-Lasprilla JC, Andelic N. Global Outcome Trajectories up to 10 Years After Moderate to Severe Traumatic Brain Injury. Front Neurol 2019; 10:219. [PMID: 30923511 PMCID: PMC6426767 DOI: 10.3389/fneur.2019.00219] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 02/20/2019] [Indexed: 12/31/2022] Open
Abstract
Aims: Based on important predictors, global functional outcome after traumatic brain injury (TBI) may vary significantly over time. This study sought to: (1) describe changes in the Glasgow Outcome Scale-Extended (GOSE) score in survivors of moderate to severe TBI, (2) examine longitudinal GOSE trajectories up to 10 years after injury, and (3) investigate predictors of these trajectories based on socio-demographic and injury characteristics. Methods: Socio-demographic and injury characteristics of 97 TBI survivors aged 16-55 years were recorded at baseline. GOSE was used as a measure of TBI-related global outcome and assessed at 1-, 2-, 5-, and 10-year follow-ups. Hierarchical linear models were used to examine global outcomes over time and whether those outcomes could be predicted by: time, time*time, sex, age, partner relationship status, education, employment pre-injury, occupation, cause of injury, acute Glasgow Coma Scale score, length of post-traumatic amnesia (PTA), CT findings, and Injury Severity Score (ISS), as well as the interactions between each of the significant predictors and time*time. Results: Between 5- and 10-year follow-ups, 37% had deteriorated, 7% had improved, and 56% showed no change in global outcome. Better GOSE trajectories were predicted by male gender (p = 0.013), younger age (p = 0.012), employment at admission (p = 0.012), white collar occupation (p = 0.014), and shorter PTA length (p = 0.001). The time*time*occupation type interaction effect (p = 0.001) identified different trajectory slopes between survivors in white and blue collar occupations. The time*time*PTA interaction effect (p = 0.023) identified a more marked increase and subsequent decrease in functional level among survivors with longer PTA duration. Conclusion: A larger proportion of survivors experienced deterioration in GOSE scores over time, supporting the concept of TBI as a chronic health condition. Younger age, pre-injury employment, and shorter PTA duration are important prognostic factors for better long-term global outcomes, supporting the existing literature, whereas male gender and white collar occupation are vaguer as prognostic factors. This information suggests that more intensive and tailored rehabilitation programs may be required to counteract a negative global outcome development in survivors with predicted worse outcome and to meet their long-term changing needs.
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Affiliation(s)
- Marit V Forslund
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Paul B Perrin
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States
| | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Torgeir Hellstrøm
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Svein A Berntsen
- Department of Physical Medicine and Rehabilitation, Sørlandet Hospital, Kristiansand, Norway
| | - Juan Lu
- Department of Family Medicine and Population Health, Division of Epidemiology, Virginia Commonwealth University, Richmond, VA, United States.,Faculty of Medicine, Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), University of Oslo, Oslo, Norway
| | - Juan Carlos Arango-Lasprilla
- Ikerbasque, Basque Foundation for Science, Bilbao, Spain.,BioCruces Health Research Institute, Cruces University Hospital Barakaldo, Barakaldo, Spain
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), University of Oslo, Oslo, Norway
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21
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Roberts CM, Spitz G, Mundy M, Ponsford JL. Prospective evaluation of first and last memory reports following moderate to severe traumatic brain injury. J Clin Exp Neuropsychol 2018; 41:109-117. [DOI: 10.1080/13803395.2018.1490392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Caroline M. Roberts
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- Monash-Epworth Rehabilitation Research Centre, Richmond, VIC, Australia
| | - Gershon Spitz
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- Monash-Epworth Rehabilitation Research Centre, Richmond, VIC, Australia
| | - Matthew Mundy
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Jennie L. Ponsford
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- Monash-Epworth Rehabilitation Research Centre, Richmond, VIC, Australia
- Epworth Healthcare, Richmond, VIC, Australia
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22
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Andelic N, Howe EI, Hellstrøm T, Sanchez MF, Lu J, Løvstad M, Røe C. Disability and quality of life 20 years after traumatic brain injury. Brain Behav 2018; 8:e01018. [PMID: 29888869 PMCID: PMC6043714 DOI: 10.1002/brb3.1018] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 03/19/2018] [Accepted: 05/06/2018] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES The study describes functional outcomes and health-related quality of life (HRQL) in patients with traumatic brain injury (TBI) 20 years postinjury. MATERIALS AND METHODS Forty-four survivors who acquired moderate and severe TBI during 1995-1996 were followed 10 and 20 years postinjury. Outcomes were Glasgow Outcome Scale Extended (GOSE), Community Integration Questionnaire (CIQ), and SF-36 questionnaire (SF-36). Multiple regressions were performed to examine the relationship between follow-up measurements, controlling for baseline demographics and injury severity. RESULTS There were no significant differences in baseline age and civil status between moderate and severe TBI, but patients with severe injury had significantly lower employment rates (p = 0.05). Mean age at 20-years follow-up was 50.8 (SD 11.4) years, and 73% were males. Most patients showed good recovery (52%) or moderate disability (43%). Disability levels remained stable between and within severity groups from 10 to 20 years. Community integration including social integration improved from 10 to 20 years (p = 0.01 and p = 0.005, respectively). HRQL remained stable, except for subscales Bodily Pain and Role Emotional (p = 0.02 and p = 0.06). Depression at 10 years and females were associated with poorer mental health, while productive activity at 10 years indicated better physical and mental health at 20 years postinjury, respectively. CONCLUSIONS Functional limitations persist even decades after moderate and severe TBI, with poorer prognosis for females and persons who were depressed at the 10-year follow-up. Development and evaluation of targeted long-term follow-up programs and access to rehabilitation services for these groups should be highlighted. Improved community integration despite stable functional limitations draws attention to long-term adaptation to adversity and illness.
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Affiliation(s)
- Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Ulleval, Norway.,Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Emilie I Howe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Ulleval, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Torgeir Hellstrøm
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Ulleval, Norway
| | - Maria Fernandez Sanchez
- Institute on Community Integration (INICO), Faculty of Psychology, University of Salamanca, Salamanca, Spain
| | - Juan Lu
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - Marianne Løvstad
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Ulleval, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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23
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Shaikh NM, Kersten P, Siegert RJ, Theadom A. Developing a comprehensive framework of community integration for people with acquired brain injury: a conceptual analysis. Disabil Rehabil 2018; 41:1615-1631. [PMID: 29509028 DOI: 10.1080/09638288.2018.1443163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE Despite increasing emphasis on the importance of community integration as an outcome for acquired brain injury (ABI), there is still no consensus on the definition of community integration. The aim of this study was to complete a concept analysis of community integration in people with ABI. MATERIALS AND METHODS The method of concept clarification was used to guide concept analysis of community integration based on a literature review. Articles were included if they explored community integration in people with ABI. Data extraction was performed by the initial coding of (1) the definition of community integration used in the articles, (2) attributes of community integration recognized in the articles' findings, and (3) the process of community integration. This information was synthesized to develop a model of community integration. RESULTS Thirty-three articles were identified that met the inclusion criteria. The construct of community integration was found to be a non-linear process reflecting recovery over time, sequential goals, and transitions. Community integration was found to encompass six components including: independence, sense of belonging, adjustment, having a place to live, involved in a meaningful occupational activity, and being socially connected into the community. Antecedents to community integration included individual, injury-related, environmental, and societal factors. CONCLUSION The findings of this concept analysis suggest that the concept of community integration is more diverse than previously recognized. New measures and rehabilitation plans capturing all attributes of community integration are needed in clinical practice. Implications for rehabilitation Understanding of perceptions and lived experiences of people with acquired brain injury through this analysis provides basis to ensure rehabilitation meets patients' needs. This model highlights the need for clinicians to be aware and assess the role of antecedents as well as the attributes of community integration itself to ensure all aspects are addressed in in a manner that will enhance the recovery and improve the level of integration into the community. The finding that community integration is a non-linear process also highlights the need for rehabilitation professionals to review and revise plans over time in response to a person's changing circumstances and recovery journey. This analysis provides the groundwork for an operational model of community integration for the development of a measure of community integration that assesses all six attributes revealed in this review not recognized in previous frameworks.
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Affiliation(s)
- Nusratnaaz M Shaikh
- a School of Clinical Sciences , Auckland University of Technology , Auckland , New Zealand
| | - Paula Kersten
- b School of Health Sciences , University of Brighton , Brighton , UK
| | - Richard J Siegert
- c School of Clinical Sciences/School of Public Health and Psychosocial Studies , Auckland University of Technology , Auckland , New Zealand
| | - Alice Theadom
- d National Institute for Stroke and Applied Neurosciences , Auckland University of Technology , Auckland , New Zealand
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24
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Mollayeva T, El-Khechen-Richandi G, Colantonio A. Sex & gender considerations in concussion research. Concussion 2018; 3:CNC51. [PMID: 30202593 PMCID: PMC6094024 DOI: 10.2217/cnc-2017-0015] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 07/27/2017] [Indexed: 02/01/2023] Open
Abstract
The study of concussion, a common form of mild traumatic brain injury, has received increased notice over the last decade. Recently, more researchers have been addressing the historic paucity of attention over sex and gender influences on recovery outcomes after concussion. This development has led to exciting progress in our understanding of concussion incidence and outcomes. In this review, we will report on new findings from varying studies on sex differences in the epidemiology of concussion and clinical manifestations of mild traumatic brain injury/concussion, further discussing some key issues related to the integration of sex and gender in concussion research in a broad range of contexts, with recommendations to guide future research, along with sex- and gender-sensitive policy considerations.
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Affiliation(s)
- Tatyana Mollayeva
- Acquired Brain Injury Lab, University of Toronto, Toronto, ON, M5G 1V7, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, M5G 1V7, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, M5G 2A2, Canada
| | - Graziella El-Khechen-Richandi
- Acquired Brain Injury Lab, University of Toronto, Toronto, ON, M5G 1V7, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, M5G 1V7, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, M5G 2A2, Canada
| | - Angela Colantonio
- Acquired Brain Injury Lab, University of Toronto, Toronto, ON, M5G 1V7, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, M5G 1V7, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, M5G 2A2, Canada
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25
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Honan CA, McDonald S, Tate R, Ownsworth T, Togher L, Fleming J, Anderson V, Morgan A, Catroppa C, Douglas J, Francis H, Wearne T, Sigmundsdottir L, Ponsford J. Outcome instruments in moderate-to-severe adult traumatic brain injury: recommendations for use in psychosocial research. Neuropsychol Rehabil 2017; 29:896-916. [DOI: 10.1080/09602011.2017.1339616] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Cynthia A. Honan
- Department of Psychology, School of Medicine, University of Tasmania, Newnham, Australia
- Moving Ahead Centre for Research Excellence in Brain Recovery, Australia
| | - Skye McDonald
- Moving Ahead Centre for Research Excellence in Brain Recovery, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Robyn Tate
- Moving Ahead Centre for Research Excellence in Brain Recovery, Australia
- Sydney Medical School, Northern Clinical School, The University of Sydney, Sydney, Australia
- John Walsh Centre for Rehabilitation Studies, Sydney, Australia
| | - Tamara Ownsworth
- Moving Ahead Centre for Research Excellence in Brain Recovery, Australia
- School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Leanne Togher
- Moving Ahead Centre for Research Excellence in Brain Recovery, Australia
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Jennifer Fleming
- Moving Ahead Centre for Research Excellence in Brain Recovery, Australia
- School of Health and Rehabilitation Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia
| | - Vicki Anderson
- Moving Ahead Centre for Research Excellence in Brain Recovery, Australia
- Murdoch Childrens Research Institute, Psychological Sciences & Paediatrics, University of Melbourne, Melbourne, Australia
| | - Angela Morgan
- Moving Ahead Centre for Research Excellence in Brain Recovery, Australia
- Murdoch Childrens Research Institute, Centre for Neuroscience of Speech, University of Melbourne, Melbourne, Australia
| | - Cathy Catroppa
- Moving Ahead Centre for Research Excellence in Brain Recovery, Australia
- Murdoch Childrens Research Institute, Psychological Sciences & Paediatrics, University of Melbourne, Melbourne, Australia
| | - Jacinta Douglas
- Moving Ahead Centre for Research Excellence in Brain Recovery, Australia
- School of Allied Health, Department of Community and Clinical Allied Health, LaTrobe University, Melbourne, Australia
| | - Heather Francis
- Moving Ahead Centre for Research Excellence in Brain Recovery, Australia
- Department of Psychology, Faculty of Human Sciences, Macquarie University, Sydney, Australia
| | - Travis Wearne
- Moving Ahead Centre for Research Excellence in Brain Recovery, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Linda Sigmundsdottir
- Moving Ahead Centre for Research Excellence in Brain Recovery, Australia
- Sydney Medical School, Northern Clinical School, The University of Sydney, Sydney, Australia
- John Walsh Centre for Rehabilitation Studies, Sydney, Australia
| | - Jennie Ponsford
- Moving Ahead Centre for Research Excellence in Brain Recovery, Australia
- School of Psychological Sciences, Monash University, Melbourne, Australia
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26
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Forslund MV, Roe C, Perrin PB, Sigurdardottir S, Lu J, Berntsen S, Andelic N. The trajectories of overall disability in the first 5 years after moderate and severe traumatic brain injury. Brain Inj 2017; 31:329-335. [PMID: 28095032 DOI: 10.1080/02699052.2016.1255778] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PRIMARY OBJECTIVES To assess longitudinal trajectories of overall disability after moderate-to-severe traumatic brain injury (TBI) and to examine whether those trajectories could be predicted by socio-demographic and injury characteristics. METHODS Demographics and injury characteristics of 105 individuals with moderate-to-severe TBI were extracted from medical records. At the 1-, 2-, and 5-year follow-ups, TBI-related disability was assessed by the GOSE. A hierarchical linear model (HLM) was used to examine functional outcomes up to 5 years following injury and whether those outcomes could be predicted by: time, gender, age, relationship, education, employment pre-injury, occupation, GCS, cause of injury, length of post-traumatic amnesia (PTA), CT findings and injury severity score, as well as the interactions between each of these predictors and time. RESULTS Higher GOSE trajectories (lower disability) were predicted by younger age at injury and shorter PTA, as well as by the interaction terms of time*PTA and time*employment. Those who had been employed at injury decreased in disability over time, while those who had been unemployed increased in disability. CONCLUSION The study results support the view that individual factors generally outweigh injury-related factors as predictors of disability after TBI, except for PTA.
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Affiliation(s)
- Marit V Forslund
- a Department of Physical Medicine and Rehabilitation , Oslo University Hospital , Oslo , Norway
| | - Cecilie Roe
- a Department of Physical Medicine and Rehabilitation , Oslo University Hospital , Oslo , Norway.,b Faculty of Medicine , University of Oslo , Oslo , Norway
| | - Paul B Perrin
- c Department of Psychology , Virginia Commonwealth University , Richmond , VA , USA
| | - Solrun Sigurdardottir
- d CHARM (Research Centre for Habilitation and Rehabilitation Models and Services), Faculty of Medicine , University of Oslo , Oslo , Norway.,e Department of Research , Sunnaas Rehabilitation Hospital , Nesoddtangen , Norway
| | - Juan Lu
- f Department of Epidemiology and Community Health , Virginia Commonwealth University , Richmond , VA , USA
| | - Svein Berntsen
- g Department of Physical Medicine and Rehabilitation , Sørlandet Hospital , Kristiansand , Norway
| | - Nada Andelic
- a Department of Physical Medicine and Rehabilitation , Oslo University Hospital , Oslo , Norway.,d CHARM (Research Centre for Habilitation and Rehabilitation Models and Services), Faculty of Medicine , University of Oslo , Oslo , Norway
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27
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Long-Term Functional and Psychosocial Consequences and Health Care Provision after Traumatic Brain Injury. Behav Neurol 2016; 2016:2678081. [PMID: 27034584 PMCID: PMC4806268 DOI: 10.1155/2016/2678081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 02/07/2016] [Indexed: 11/17/2022] Open
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28
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Traumatic Brain Injury Rehabilitation in Hong Kong: A Review of Practice and Research. Behav Neurol 2015; 2015:274326. [PMID: 26557738 PMCID: PMC4617702 DOI: 10.1155/2015/274326] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 08/21/2015] [Accepted: 09/03/2015] [Indexed: 11/21/2022] Open
Abstract
Background. The rising public health concern regarding traumatic brain injury (TBI) implies a growing need for rehabilitation services for patients surviving TBI. Methods. To this end, this paper reviews the practices and research on TBI rehabilitation in Hong Kong so as to inform future developments in this area. This paper begins by introducing the general situation of TBI patients in Hong Kong and the need for rehabilitation. Next, the trauma system in Hong Kong is introduced. Following that is a detailed description of the rehabilitation services for TBI patients in Hong Kong, as exemplified by a rehabilitation hospital in Hong Kong. This paper will also review intervention studies on rehabilitating brain-injured populations in Hong Kong with respect to various rehabilitation goals. Lastly, the implications of culture-related issues will be discussed in relation to TBI. Results/Conclusions. The intervention studies conducted in Hong Kong are generally successful in achieving various rehabilitative outcomes. Additionally, certain cultural-related issues, such as the stigma associated with TBI, may impede the rehabilitative process and lead to various psychosocial problems.
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