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Rioux M, Brasher PMA, McKeown G, Yeates KO, Vranceanu AM, Snell DL, Cairncross M, Panenka WJ, Iverson GL, Debert CT, Bayley MT, Hunt C, Burke MJ, Silverberg ND. Graded exposure therapy for adults with persistent symptoms after mTBI: A historical comparison study. Neuropsychol Rehabil 2024:1-17. [PMID: 39330946 DOI: 10.1080/09602011.2024.2403647] [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: 03/06/2024] [Accepted: 09/08/2024] [Indexed: 09/28/2024]
Abstract
Fear avoidance behaviour is associated with slow recovery from mild traumatic brain injury (mTBI). This study is a preliminary evaluation of graded exposure therapy (GET), which directly targets fear avoidance behaviour, for reducing post-concussion symptoms (PCS) and disability following mTBI. In a historical comparison design, we compared two groups from independent randomized trials. The GET + UC group (N = 34) received GET (delivered over 16 videoconference sessions) in addition to usual care (UC). The historical comparison group (N = 71) received UC only. PCS severity (Rivermead Post Concussion Symptoms Questionnaire; RPQ) and disability (World Health Organization Disability Assessment Schedule; WHODAS 2.0 12-item) were measured at clinic intake (M = 2.7, SD = 1.1 months after injury) and again at M = 4.9 (SD = 1.1) months after injury. Between-group differences were estimated using linear mixed effects regression, with a sensitivity analysis controlling for injury-to-assessment intervals. The estimated average change on the RPQ was -14.3 in the GET + UC group and -5.3 in the UC group. The estimated average change on the WHODAS was -5.3 in the GET + UC group and -3.2 in the UC group. Between-group differences post-treatment were -5.3 on the RPQ and -1.5 on the WHODAS. Treatment effects were larger in sensitivity analyses. Findings suggest that a randomized controlled trial is warranted.
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Affiliation(s)
- Mathilde Rioux
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Penelope M A Brasher
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Gabriel McKeown
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Ana-Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Deborah L Snell
- Concussion Clinic, Canterbury District Health Board, Christchurch, New Zealand
- Department of Orthopedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Molly Cairncross
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - William J Panenka
- British Columbia Neuropsychiatry Program, Vancouver, BC, Canada
- BC Mental Health and Substance Use Research Institute, Vancouver, BC, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Grant L Iverson
- Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
- Department of Physical Medicine and Rehabilitation, Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, MA, USA
- Mass General Brigham for Children Sports Concussion Program, Boston, MA, USA
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA, USA
| | - Chantel T Debert
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, Division of Physical Medicine and Rehabilitation, University of Calgary, Calgary, AB, Canada
| | - Mark T Bayley
- Hull-Ellis Concussion Research Clinic, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Cindy Hunt
- Head Injury Clinic, Trauma and Neurosurgery Program, St. Michael's Hospital, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Matthew J Burke
- Neuropsychiatry Program, Department of Psychiatry and Division of Neurology, Department of Medicine Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Noah D Silverberg
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
- Djavad Mowafaghian Center for Brain Health, University of British Columbia, Vancouver, BC, Canada
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Mikolic A, Klotz T, Brasher P, Yeates K, Vranceanu AM, Kendall KD, Snell DL, Debert CT, Bayley M, Panenka W, Cairncross M, Hunt C, Burke M, Tartaglia MC, Silverberg N. Graded Exposure Therapy for Fear Avoidance Behaviour After Concussion (GET FAB): protocol for a multisite Canadian randomised controlled trial. BMJ Open 2024; 14:e086602. [PMID: 38950993 PMCID: PMC11218021 DOI: 10.1136/bmjopen-2024-086602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 06/12/2024] [Indexed: 07/03/2024] Open
Abstract
INTRODUCTION Persistent symptoms after mild traumatic brain injury (mTBI) negatively affect daily functioning and quality of life. Fear avoidance behaviour, a coping style in which people avoid or escape from activities or situations that they expect will exacerbate their symptoms, maybe a particularly potent and modifiable risk factor for chronic disability after mTBI. This study will evaluate the efficacy of graded exposure therapy (GET) for reducing persistent symptoms following mTBI, with two primary aims: (1) To determine whether GET is more effective than usual care; (2) to identify for whom GET is the most effective treatment option, by evaluating whether baseline fear avoidance moderates differences between GET and an active comparator (prescribed aerobic exercise). Our findings will guide evidence-based care after mTBI and enable better matching of mTBI patients to treatments. METHODS AND ANALYSIS We will conduct a multisite randomised controlled trial with three arms. Participants (n=220) will be recruited from concussion clinics and emergency departments in three Canadian provinces and randomly assigned (1:2:2 ratio) to receive enhanced usual care, GET or prescribed aerobic exercise. The outcome assessment will occur remotely 14-18 weeks following baseline assessment, after completing the 12-week treatment phase. The primary outcome will be symptom severity (Rivermead Post-concussion Symptoms Questionnaire). ETHICS AND DISSEMINATION Informed consent will be obtained from all participants. All study procedures were approved by the local research ethics boards (University of British Columbia Clinical Research Ethics Board, University of Calgary Conjoint Health Research Ethics Board, University Health Network Research Ethics Board-Panel D). Operational approvals were obtained for Vancouver Coastal Health Research Institute and Provincial Health Services Authority. If GET proves effective, we will disseminate the GET treatment manual and present instructional workshops for clinicians. TRIAL REGISTRATION NUMBER ClinicalTrials.gov #NCT05365776.
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Affiliation(s)
- Ana Mikolic
- Department of Psychology, The University of British Columbia, Vancouver, British Columbia, Canada
- Rehabilitation Research Program, Centre for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Tasha Klotz
- Department of Psychology, The University of British Columbia, Vancouver, British Columbia, Canada
- Rehabilitation Research Program, Centre for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Penelope Brasher
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Keith Yeates
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Univeristy of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Ana-Maria Vranceanu
- Department of Psychiatry, Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Karen D Kendall
- School of Kinesiology, Acadia University, Wolfville, Nova Scotia, Canada
| | - Deborah L Snell
- Department of Orthopedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Chantel T Debert
- Alberta Children's Hospital Research Institute, Univeristy of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, Univeristy of Calgary, Calgary, Alberta, Canada
| | - Mark Bayley
- Hull-Ellis Concussion Clinic, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, Temerty Medicine, University of Toronto, Toronto, Ontario, Canada
| | - William Panenka
- Department of Psychiatry, UBC, Vancouver, British Columbia, Canada
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada
- British Columbia Provincial Neuropsychiatry Program, Vancouver, British Columbia, Canada
| | - Molly Cairncross
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Cindy Hunt
- Head Injury Clinic, Department of Trauma and Neurosurgery, St Michael's Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Concussion Ontario Network: Neuroinformatics to Enhance Clinical Care and Translation, Toronto, British Columbia, Canada
| | - Matthew Burke
- Neuropsychiatry Program, Department of Psychiatry and Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program and Tory Trauma Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Maria Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Noah Silverberg
- Department of Psychology, The University of British Columbia, Vancouver, British Columbia, Canada
- Rehabilitation Research Program, Centre for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
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Theotokatos G, Escorpizo R, Angelopoulos TJ, Chrysagis NK, Venieri A, Bickenbach J, Karteroliotis K, Grammatopoulou E, Skordilis E. The Sociodemographic Factors Related to Disability of Applicants of Welfare Benefits in Greece: A Cross-Sectional Survey Based on the World Health Organization Disability Assessment Schedule (WHODAS) 2.0. Cureus 2024; 16:e55614. [PMID: 38586637 PMCID: PMC10995654 DOI: 10.7759/cureus.55614] [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] [Accepted: 03/05/2024] [Indexed: 04/09/2024] Open
Abstract
INTRODUCTION The aim of the present study was to report on the prevalence of disability and its association with sociodemographic factors among welfare benefit applicants in Greece. The study also compared the disability scores between different health conditions using the WHODAS 2.0 (12-item version), a biopsychosocial-model-based measure. METHODS The Greek WHODAS 2.0, 12-item version, was administered by interview. A three-member medical committee assessed the medical records of the applicants and assigned a disability percentage based on the biomedical measure of disability percentage determination (Barema scale). RESULTS The majority of the participants were female (56.65%). Certain health conditions were presented more frequently among welfare benefit applicants (mental health disorders and neoplasms). The domains with the highest rate of difficulty were the "participation" and "life activities" domains. Significant differences were found between WHODAS 2.0 and Barema scores for all eight different health condition categories. The factorial ANOVA (8x2) showed a significant interaction effect between health condition category and gender with respect to the WHODAS 2.0 score (F = 19.033, p <.001, η2 = 0.13). The WHODAS 2.0 score was negatively correlated to gender, years of studies, and marital status and positively correlated to age, working status, and the Barema score. The results revealed that male participants with a partner who were younger, had more studies, were actively working, and had a lower Barema score would have lower WHODAS scores. CONCLUSION Sociodemographic characteristics of welfare benefit applicants are associated with disability levels based on WHODAS 2.0. Certain health conditions, like mental health or neuromusculoskeletal conditions, are associated with higher disability scores. There are differences between the biopsychosocial and the biomedical approaches to disability assessment. The implementation of WHODAS 2.0 may contribute to a better understanding of the lived experience of patients and is a feasible and efficient tool. Combining biomedical and biopsychosocial approaches may enhance the procedures of disability assessment and help in the development of policies that support people with disabilities.
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Affiliation(s)
- Georgios Theotokatos
- School of Physical Education and Sport Science, National and Kapodistrian University of Athens, Athens, GRC
| | - Reuben Escorpizo
- Employment and Participation Unit, Swiss Paraplegic Research, Nottwil, CHE
- Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, USA
| | - Theodore J Angelopoulos
- Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, USA
| | - Nikolaos K Chrysagis
- Laboratory of Advanced Physiotherapy (LAdPhys) Physiotherapy, School of Health and Care Sciences, University of West Attica (UNIWA), Athens, GRC
| | - Aikaterini Venieri
- Sports Excellence, 1st Orthopedics Department, School of Health Sciences, National and Kapodistrian University of Athens, Athens, GRC
| | - Jerome Bickenbach
- Schweizer Paraplegiker Forschung (SPF), Swiss Paraplegic Research, Nottwil, CHE
- University of Lucerne, Faculty of Health Sciences and Medicine, Lucerne, CHE
| | | | - Eirini Grammatopoulou
- Laboratory of Advanced Physiotherapy (LAdPhys) Physiotherapy, School of Health and Care Sciences, University of West Attica (UNIWA), Athens, GRC
| | - Emmanouil Skordilis
- School of Physical Education and Sport Science, National and Kapodistrian University of Athens, Athens, GRC
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Tarvonen-Schröder S, Koivisto M. World Health Organization Disability Assessment Schedule versus Functional Independence Measure in Traumatic Brain Injury. J Rehabil Med 2023; 55:jrm16274. [PMID: 38032144 DOI: 10.2340/jrm.v55.16274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVE In patients with traumatic brain injury, to compare functioning measured using the 12-item patient and proxy World Health Organization Disability Assessment Schedule (WHODAS-12) with assessments made by professionals. PATIENTS AND METHODS At discharge from rehabilitation, 89 consecutive patients with traumatic brain injury (10 mild, 36 moderate, 43 severe) and their proxies completed the WHODAS-12. Professionals assessed functioning simultaneously using the WHO minimal generic set of domains of functioning and health and Functional Independence Measure (FIM). RESULTS From mild to severe traumatic brain injury, increasing disability was found in: sum, component and item scores of patient and proxy WHODAS, except for emotional functions in patients' ratings; in sum and item scores of the WHO minimal generic data-set, except for pain; and in FIM total score and sub-scores. The WHODAS participation component was more impaired than activities. Although proxies rated functioning more impaired than patients, the correlation between patient and proxy WHODAS was strong (0.74). The correlation between patient/proxy WHODAS and FIM was also strong (-0.56 and -0.78, respectively). Proxy WHODAS differentiated mild and moderate traumatic brain injury more accurately than the other assessments. CONCLUSION We recommend using the WHODAS-12 when planning patient- and family-oriented rehabilitation services after traumatic brain injury.
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Affiliation(s)
- Sinikka Tarvonen-Schröder
- Neurocenter, Turku University Hospital, Turku, Finland and Clinical Neurosciences, University of Turku, Turku, Finland; Finnish Institute for Health and Welfare, Finland.
| | - Mari Koivisto
- Department of Biostatistics, University of Turku, Turku, Finland
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Snell DL, Silverberg ND. Derivation of a minimal clinically important difference score for the WHODAS 2.0 in mild traumatic brain injury. NeuroRehabilitation 2022; 52:249-257. [PMID: 36565071 DOI: 10.3233/nre-220004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Mild traumatic brain injury (mTBI) treatment research is hindered by lack of clinically meaningful and responsive outcome measures. One promising measure is the World Health Organisation Disability Assessment Schedule 2.0 (WHODAS 2.0), although minimal clinically important differences (MCID) for have not been established. OBJECTIVE To estimate MCID for the WHODAS 2.0 for mTBI. METHODS We analysed two prospectively collected mTBI datasets (n = 225) attending adult outpatient clinics in British Columbia, Canada. Participants completed the 12-item WHODAS 2.0, Patient Global Impression of Change scale, and Rivermead Post-Concussion Symptoms Questionnaire. We used anchor- and distribution-based methods to explore MCIDs in WHODAS 2.0 scores. RESULTS For Study 1 (n = 131), the anchor and distribution-based approaches produced minimal change estimates ranging from 1.3 to 2.8 interval scores. For Study 2 (n = 94), the anchor and distribution-based approaches produced minimal change estimates from 2.2 to 3.2 interval scores. For certain subgroups based on age, sex, and post-concussion severity, minimal change estimates were slightly higher. CONCLUSION An MCID of 3.5 interval WHODAS 2.0 points would conservatively capture meaningful change in adults of varying age, sex, and post-concussion symptom severity. Such a uniform metric will assist future mTBI intervention studies to improve standards of care and evaluation of outcomes.
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Affiliation(s)
- Deborah L Snell
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Noah D Silverberg
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
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Silverberg ND, Otamendi T, Brasher PM, Brubacher JR, Li LC, Lizotte PP, Panenka WJ, Scheuermeyer FX, Archambault P. Effectiveness of a guideline implementation tool for supporting management of mental health complications after mild traumatic brain injury in primary care: protocol for a randomised controlled trial. BMJ Open 2022; 12:e062527. [PMID: 35728892 PMCID: PMC9214410 DOI: 10.1136/bmjopen-2022-062527] [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: 11/04/2022] Open
Abstract
INTRODUCTION Mental health problems frequently interfere with recovery from mild traumatic brain injury (mTBI) but are under-recognised and undertreated. Consistent implementation of clinical practice guidelines for proactive detection and treatment of mental health complications after mTBI will require evidence-based knowledge translation strategies. This study aims to determine if a guideline implementation tool can reduce the risk of mental health complications following mTBI. If effective, our guideline implementation tool could be readily scaled up and/or adapted to other healthcare settings. METHODS AND ANALYSIS We will conduct a triple-blind cluster randomised trial to evaluate a clinical practice guideline implementation tool designed to support proactive management of mental health complications after mTBI in primary care. We will recruit 535 adults (aged 18-69 years) with mTBI from six emergency departments and two urgent care centres in the Greater Vancouver Area, Canada. Upon enrolment at 2 weeks post-injury, they will complete mental health symptom screening tools and designate a general practitioner (GP) or primary care clinic where they plan to seek follow-up care. Primary care clinics will be randomised into one of two arms. In the guideline implementation tool arm, GPs will receive actionable mental health screening test results tailored to their patient and their patients will receive written education about mental health problems after mTBI and treatment options. In the usual care control arm, GPs and their patients will receive generic information about mTBI. Patient participants will complete outcome measures remotely at 2, 12 and 26 weeks post-injury. The primary outcome is rate of new or worsened mood, anxiety or trauma-related disorder on the Mini International Neuropsychiatric Interview at 26 weeks. ETHICS AND DISSEMINATION Study procedures were approved by the University of British Columbia's research ethics board (H20-00562). The primary report for the trial results will be published in a peer-reviewed journal. Our knowledge user team members (patients, GPs, policymakers) will co-create a plan for public dissemination. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT04704037).
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Affiliation(s)
- Noah D Silverberg
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Thalia Otamendi
- Rehabilitation Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Penelope Ma Brasher
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Jeffrey R Brubacher
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Linda C Li
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pierre-Paul Lizotte
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - William J Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Frank X Scheuermeyer
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Emergency Medicine, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Patrick Archambault
- Department of Family and Emergency Medicine, Université Laval, Québec, Québec, Canada
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Silverberg ND, Cairncross M, Brasher PMA, Vranceanu AM, Snell DL, Yeates KO, Panenka WJ, Iverson GL, Debert CT, Bayley MT, Hunt C, Baker A, Burke MJ. Feasibility of concussion rehabilitation approaches tailored to psychological coping styles: A randomized controlled trial. Arch Phys Med Rehabil 2021; 103:1565-1573.e2. [PMID: 34971596 DOI: 10.1016/j.apmr.2021.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/29/2021] [Accepted: 12/05/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the feasibility of a clinical trial involving participants with concussion randomized to treatments designed to address fear avoidance or endurance coping, which are risk factors for disability. A secondary objective was to evaluate whether each treatment could effect selective change on targeted coping outcomes. DESIGN Randomized controlled trial. SETTING Outpatient concussion clinics. PARTICIPANTS 73 adults (M=42.5 years old) who had persistent post-concussion symptoms and high avoidance or endurance behavior were enrolled at M=12.9 weeks post injury. 10 participants did not complete treatment. INTERVENTIONS Participants were randomized to an interdisciplinary rehabilitation program delivered via videoconferencing and tailored to avoidance coping (graded exposure therapy; GET) or endurance coping (operant condition-based pacing strategies plus mindfulness training; Pacing+). MAIN OUTCOME MEASURES Feasibility outcomes included screening efficiency, accrual, credibility, treatment fidelity, adherence, and retention. Avoidance was measured with the Fear Avoidance Behavior after Traumatic Brain Injury questionnaire and endurance behavior with the Behavioral Response to Illness Questionnaire. RESULTS Screening efficiency, or the proportion of clinic patients who were assessed for eligibility, was 44.5% (275/618). 65.8% (73/111) of eligible patients were randomized (n=37 to GET and n=36 to Pacing+), meeting accrual targets. 91.7% (55/60) of participants perceived treatment as credible. Therapists covered M=96.8% of essential prescribed elements, indicating excellent fidelity. The majority (71.2%; 47/66) of participants consistently attended treatment sessions and completed between-session homework. Retention was strong, with 65 of 73 (89%) randomized participants completing the outcome assessment. GET was associated with greater post-treatment reductions in avoidance behavior compared to Pacing+ (Cohen's drepeated measures = 0.81), whereas the treatment approach-specific effect of Pacing+ on endurance behavior was less pronounced (Cohen's drepeated measures = 0.39). CONCLUSIONS Findings support a future efficacy-focused clinical trial. GET has the potential to selectively reduce fear avoidance behavior after concussion, and, via this mechanism, to prevent or reduce disability.
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Affiliation(s)
- Noah D Silverberg
- Department of Psychology, University of British Columbia, Rehabilitation Research Program, Vancouver Coastal Health Research Institute.
| | - Molly Cairncross
- Department of Psychology, University of British Columbia, Rehabilitation Research Program, Vancouver Coastal Health Research Institute
| | - Penelope M A Brasher
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute
| | - Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School
| | - Deborah L Snell
- Concussion Clinic, Canterbury District Health Board, Department of Orthopedic Surgery and Musculoskeletal Medicine, University of Otago
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Alberta Children's Hospital Research Institute, University of Calgary, Hotchkiss Brain Institute, University of Calgary
| | - William J Panenka
- British Columbia Neuropsychiatry Program, BC Mental Health and Substance Use Research Institute, Department of Psychiatry, University of British Columbia
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital and Spaulding Research Institute, MassGeneral Hospital for Children™ Sports Concussion Program, Home Base, A Red Sox Foundation and Massachusetts General Hospital Program
| | - Chantel T Debert
- Department of Clinical Neurosciences, Division of Physical Medicine and Rehabilitation, University of Calgary, Hotchhiss Brain Institute, Alberta Children's Hospital Research Institute
| | - Mark T Bayley
- Toronto Rehabilitation Institute, University Health Network
| | - Cindy Hunt
- Head Injury Clinic, Trauma and Neurosurgery Program, St. Michael's Hospital, Dalla Lana School of Public Health, University of Toronto
| | - Andrew Baker
- Head Injury Clinic, Trauma and Neurosurgery Program, St. Michael's Hospital
| | - Matthew J Burke
- Neuropsychiatry Program, Department of Psychiatry and Division of Neurology, Department of Medicine Sunnybrook Health Sciences Centre, University of Toronto, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School
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Exploratory and confirmatory factor analysis of the 12-item Arabic World Health Organization Disability Assessment Schedule (WHODAS 2.0) as a screening tool for Syrian refugees. BJPsych Open 2021. [PMCID: PMC8517853 DOI: 10.1192/bjo.2021.1017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is a generic measure of functional impairment and disability but to date no studies have reported its applicability in a population of Syrian refugees. Aims The aim of this study was to explore the psychometric properties and factor structure of the Arabic version of the WHODAS 2.0 among a population of Syrian refugees in a Jordanian refugee camp setting. The tool was used as part of a screening procedure for a randomised controlled trial assessing the effectiveness of a low-intensity psychological intervention. Method A representative sample of Syrian refugees (n = 650) were screened to assess levels of functional impairment and psychological distress. The screening results were used to explore the internal consistency and dimensionality of the WHODAS 2.0. We assessed level of convergence with the validated Kessler 10-item Psychological Distress Scale (K10), which assesses psychological distress. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted to explore the construct validity and factor structure of the WHODAS 2.0. Results The mean baseline WHODAS 2.0 score was 20.5 (s.d. = 7.6). The internal consistency was acceptable (Cronbach's alpha 0.74), with all 12-items appearing to be related to the same construct. The WHODAS 2.0 was positively correlated with the K10 (r = 0.57, P < 0.001). The results of the EFA identified a three-factor solution accounting for 51% of variation, corresponding with factors related to self-activities, external activities and self-care. CFA results indicated good fit of the three-factor solution. Conclusions The results indicated that the WHODAS 2.0 has a three-factor solution and is an acceptable screening tool for use among Syrian refugees.
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Psychological assessment of individuals with Mal de Débarquement Syndrome. J Neurol 2021; 269:2149-2161. [PMID: 34541614 DOI: 10.1007/s00415-021-10767-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To report on the psychological, personality, and behavioral profiles of individuals with persistent Mal de Débarquement Syndrome (MdDS). MATERIALS AND METHODS Individuals with MdDS who participated in neuromodulation clinical trials between May 2013 and June 2019 completed a series of standardized psychological questionnaires and underwent the Structural Clinical Interview for DSM-IV-TR (SCID) for specific psychiatric diagnoses. All data reported are from baseline assessments prior to any study interventions. Scores were compared to population norms for adult women. RESULTS Complete datasets were available for 55 women. Mean age of onset of MdDS was 49.0 ± 11.9 years (range 22-69 years) and median duration of illness of 22 months (6 months-20 years). SCID results were as follows: healthy (48.1%), any lifetime Major Depressive Disorder (35.2%, 7.4% current); any lifetime history of anxiety disorder (11.1%); any lifetime substance use disorders (18.5%, 0% current). Compared to population norms, the MdDS group scored significantly higher on the Patient Health Questionnaire-9 depression scale and the Generalized Anxiety Disorder 7 (GAD-7) anxiety scale, but only the GAD-7 correlated with symptom severity. The NEO-Five Factor Inventory for personality, Positive and Negative Affect Schedule, Behavioral Inhibition System/Behavioral Activation System Scale, and the Empathy Quotient metrics did not correlate with duration of illness. Disability assessed by the 12-item World Health Organization Disability Assessment Schedule 2.0 was 25.7 ± 6.7, comparable to reports for concussion. Disability correlated with severity of depression, anxiety, neuroticism, and affect but not to severity of MdDS. CONCLUSIONS Psychological profiles of MdDS relate to disability but not to duration of illness.
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Greenberg J, Singh T, Iverson GL, Silverberg ND, Macklin EA, Parker RA, Giacino JT, Yeh GY, Vranceanu AM. A Live Video Mind-Body Treatment to Prevent Persistent Symptoms Following Mild Traumatic Brain Injury: Protocol for a Mixed Methods Study. JMIR Res Protoc 2021; 10:e25746. [PMID: 33443484 PMCID: PMC7843203 DOI: 10.2196/25746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 11/23/2020] [Indexed: 12/12/2022] Open
Abstract
Background Every year, approximately 42 million people sustain a mild traumatic brain injury (mTBI, also known as concussion), with particularly high rates among college-aged individuals. A substantial proportion of these people (44%-64%) develop persistent symptoms that are challenging to treat, costly, and associated with significant disability. Anxiety has emerged as a risk factor for progression from acute to persistent mTBI symptoms. Objective This study aims to develop, adapt, and establish the feasibility of the Toolkit for Optimal Recovery after Concussions (TOR-C), an innovative mind-body program aimed at preventing persistent symptoms among young adults with mTBI and comorbid anxiety. Here, we describe the proposed study design, methodology, measurement, and treatment manuals. Methods In phase 1, we will conduct individual, live video qualitative interviews (up to n=20) with college-aged individuals with mTBI and comorbid anxiety to inform adaptation of the intervention and study procedures. In phase 2, an open pilot of the live video TOR-C (n=5) with exit interviews will be conducted to explore the initial feasibility, acceptability, and credibility of the program and to refine the study procedures. Phase 3 will involve conducting a feasibility randomized controlled trial (N=50) of the TOR-C versus a health education control (Health Enhancement for Concussions; HE-C), both delivered via live video, to establish feasibility of recruitment procedures (screening, eligibility, and enrollment) and data collection; feasibility, credibility, and acceptability of the live video TOR-C and HE-C (adherence, retention, fidelity, and satisfaction) following prespecified benchmarks; and a signal of improvement in outcomes. Results Phase 1 of the study has been approved by the Massachusetts General Hospital Institutional Review Board. Study completion is anticipated by early 2025. Conclusions We will develop and test the first mind-body intervention focused on prevention of persistent symptoms following mTBI in young adults with comorbid anxiety problems. This will allow us to establish feasibility markers in postconcussive symptoms, anxiety, disability, and fear avoidance to inform a future efficacy trial of the TOR-C versus HE-C. International Registered Report Identifier (IRRID) PRR1-10.2196/25746
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Affiliation(s)
- Jonathan Greenberg
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Tanya Singh
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Spaulding Research Institute, Harvard Medical School, Charlestown, MA, United States.,MassGeneral Hospital for Children Sports Concussion Program, Boston, MA, United States.,Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA, United States
| | - Noah D Silverberg
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada.,Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Eric A Macklin
- Harvard Medical School, Boston, MA, United States.,Biostatistics Center, Massachusetts General Hospital, Boston, MA, United States
| | - Robert A Parker
- Harvard Medical School, Boston, MA, United States.,Biostatistics Center, Massachusetts General Hospital, Boston, MA, United States
| | - Joseph T Giacino
- Spaulding Rehabilitation Hospital, Charlestown, MA, United States.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Gloria Y Yeh
- Harvard Medical School, Boston, MA, United States.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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11
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Silverberg ND, Panenka WJ, Lizotte PP, Bayley MT, Dance D, Li LC. Promoting early treatment for mild traumatic brain injury in primary care with a guideline implementation tool: a pilot cluster randomised trial. BMJ Open 2020; 10:e035527. [PMID: 33082178 PMCID: PMC7577038 DOI: 10.1136/bmjopen-2019-035527] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES New clinical practice guidelines for the management of mild traumatic brain injury (mTBI) emphasise that family physicians should proactively screen and initiate treatment for depression/anxiety, insomnia and headaches. This study aimed to evaluate the feasibility of delivering an implementation intervention to family physicians. DESIGN Pilot cluster randomised controlled trial. SETTING Specialty outpatient clinic (recruitment) and primary care (implementation). PARTICIPANTS 114 primary care clinics were randomised. These clinics were associated with 137 unique family physicians caring for 148 adult patients who sustained an mTBI within the previous 3 months and were seeking care for persistent symptoms. INTERVENTIONS Patients completed self-report screening measures for depression/anxiety, insomnia and headaches. A tailored letter that incorporates the patient's screening test results and associated treatment algorithms was sent to their family physician (or walk-in clinic). Physicians at clinics assigned to the control condition received a generic letter, without the screening test results. PRIMARY OUTCOME MEASURES Feasibility outcomes included the frequency of primary care follow-up, retention rates and reliability of patient recall of their physicians' actions (primary mechanistic outcome). The primary efficacy outcome was the Rivermead Post-Concussion Symptom Questionnaire (RPQ). RESULTS Most patients (97.8%; 128 of 131) followed up at the primary care clinic they planned to. Retention rates were 88% (131 of 148) and 78% (116 of 148) at the 1-month and 3-month assessments, respectively. Agreement between patient recall of their physicians' actions and medical chart audits was moderate (intraclass correlation coefficient=0.48-0.65). Patients in the experimental group reported fewer symptoms on the RPQ compared with those in the control group, whose physician received a general letter (B=-4.0, 95% CI: -7.3 to -0.7). CONCLUSIONS A larger trial will need to address minor feasibility challenges to evaluate the effectiveness of this guideline implementation tool for improving mTBI clinical outcomes and confirm the mechanism(s) of intervention benefit. TRIAL REGISTRATION NUMBER NCT03221218.
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Affiliation(s)
- Noah D Silverberg
- Department of Psychology, The University of British Columbia, Vancouver, British Columbia, Canada
- Division of Physical Medicine and Rehabilitation, The University of British Columbia, Vancouver, British Columbia, Canada
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - William J Panenka
- Department of Psychiatry, The University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada
- BC Neuropsychiatry Program, Vancouver, British Columbia, Canada
| | - Pierre-Paul Lizotte
- Department of Family Medicine, Providence Health Care, Vancouver, British Columbia, Canada
| | - Mark T Bayley
- Hull-Ellis Concussion Research Center, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - Derry Dance
- Division of Physical Medicine and Rehabilitation, The University of British Columbia, Vancouver, British Columbia, Canada
- Acquired Brain Injury Program, GF Strong Rehabilitation Hospital, Vancouver, British Columbia, Canada
| | - Linda C Li
- Arthritis Research Canada, Richmond, British Columbia, Canada
- Department of Physical Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
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12
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Ćwirlej-Sozańska A, Sozański B, Kotarski H, Wilmowska-Pietruszyńska A, Wiśniowska-Szurlej A. Psychometric properties and validation of the polish version of the 12-item WHODAS 2.0. BMC Public Health 2020; 20:1203. [PMID: 32758211 PMCID: PMC7409488 DOI: 10.1186/s12889-020-09305-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 07/27/2020] [Indexed: 12/12/2022] Open
Abstract
Background The assessment of disability in a population is an important part of public health management. In this article, we examine the psychometric properties and validation of the Polish version of the 12-item World Health Organization Disability Assessment Schedule 2.0. (12-item WHODAS 2.0). Methods A systematic random sample comprised 584 adult urban residents. The Polish version of the 12-item WHODAS 2.0 and the World Health Organization Quality of Life-BREF, Short Form (WHOQOL-BREF) questionnaire were used to assess disability and quality of life, respectively. Basic sociodemographic data and selected health-related data (e.g., pain and depressive moods) were also collected. Results Good scale score reliability for the entire tool was confirmed in the study population (Cronbach’s α = 0.90; Composite reliability = 0.95). In confirmatory factor analysis (CFA), satisfactory values of the fit indices were obtained (comparative fit index, CFI = 0.999; Tucker-Lewis Index, TLI = 0.999; root mean square error of approximation, RMSEA = 0.004; standardized root mean square residual, SRMR = 0.043, p = 0.454). Good consistency was noted over time (correlation coefficient = 0.88). The tool was found to have an appropriate level of validity. Conclusions We found that the 12-item WHODAS is short and easy to use, and it is suitable for use in the form of an interview during screening tests. This tool is appropriate for measuring the health status, functioning, and disability of an average population. It may be more relevant for studying populations with health problems. The 12-item WHODAS can be used to successfully obtain information about the general level of disability in a population.
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Affiliation(s)
- Agnieszka Ćwirlej-Sozańska
- Institute of Health Sciences, Medical College of Rzeszow University, Aleja Rejtana 16c, 35-959, Rzeszow, Poland.
| | - Bernard Sozański
- Institute of Health Sciences, Medical College of Rzeszow University, Aleja Rejtana 16c, 35-959, Rzeszow, Poland
| | - Hubert Kotarski
- Institute of Sociology, Social Sciences College of Rzeszow University, Aleja Rejtana 16c, 35-959, Rzeszow, Poland
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13
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Snell DL, Siegert RJ, Silverberg ND. Rasch analysis of the World Health Organization Disability Assessment Schedule 2.0 in a mild traumatic brain injury sample. Brain Inj 2020; 34:610-618. [PMID: 32078408 DOI: 10.1080/02699052.2020.1729417] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In this study we examined the psychometric properties of the World Health Organization Disability Assessment Schedule (WHODAS 2.0 12-item version) in a mild traumatic brain injury (MTBI) sample.Materials and Methods: Treatment-seeking adults (n = 131) with MTBI recruited from outpatient clinics in Vancouver Canada, were assessed 1- and 3-months following clinic intake. Dimensionality, reliability, and differential item functioning of the WHODAS 2.0 were examined with Rasch analysis. Associations between change in WHODAS 2.0 scores and symptom, work and perceived improvement outcomes were examined.Results: Adequate fit to the Rasch model was achieved for 1-month follow-up assessment WHODAS 2.0 scores without altering the response format or item content [X2 (24, n = 130) = 21.2, p = .6]. The best model fit for 3-month follow-up assessment scores was achieved when two items (problems with dressing and washing) were combined [X2 (22, n = 115) = 20.9, p = .5]. Associations were evident between changes in WHODAS total Rasch scores and other outcome indicators such as return to productivity and percieved improvement.Conclusions: The WHODAS 2.0 (12-item version) is a psychometrically sound measure of functional outcome for adults seeking treatment following MTBI. Our table of ordinal to interval score conversions is recommended for future research examining MTBI outcomes.
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Affiliation(s)
- Deborah L Snell
- Concussion Clinic, Canterbury District Health Board, Christchurch, New Zealand.,Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Richard J Siegert
- Faculty of Health and Environmental Studies, AUT University, Auckland, New Zealand
| | - Noah D Silverberg
- Division of Physical Medicine & Rehabilitation, University of British Columbia, Vancouver, Canada.,Rehabilitation Research Program, GF Strong Rehab Centre, Vancouver, Canada.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
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14
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Gertler P, Tate RL. Are single item mood scales (SIMS) valid for people with traumatic brain injury? Brain Inj 2020; 34:653-664. [DOI: 10.1080/02699052.2020.1733087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Paul Gertler
- John Walsh Centre for Rehabilitation Research, University of Sydney, St. Leonards, Australia
| | - Robyn L. Tate
- John Walsh Centre for Rehabilitation Research, University of Sydney, St. Leonards, Australia
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15
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Sousa AJDS, Silva MCD, Barreto MCA, Nunes BP, Coutinho BD, Castro SSD. Propriedades psicométricas do WHODAS para uso em pessoas com chikungunya no Brasil. FISIOTERAPIA E PESQUISA 2019. [DOI: 10.1590/1809-2950/18036226042019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO O objetivo deste estudo é validar um instrumento de aferição da funcionalidade segundo a proposta conceitual da Classificação Internacional de Funcionalidade, Incapacidade e Saúde, para uso em pessoas pós-chikungunya. Este é um estudo de validação com indivíduos >17 anos, de ambos os sexos, em atendimento para manejo clínico da chikungunya. A coleta de dados foi realizada por meio de entrevistas coletando informações sobre funcionalidade (WHODAS), qualidade de vida (WHOQOL-bref) e sociodemográficas. A análise estatística usou o coeficiente alfa de Cronbach (consistência interna) e coeficiente de correlação de Spearman (validade convergente), médias e desvios-padrão para a determinação do perfil de qualidade de vida, com nível de significância de 5%. A amostra foi composta por 68 indivíduos. Os valores médios das pontuações dos instrumentos foram: 45,4 (±16,38) para o WHODAS e 12,1 (±2,10) para o WHOQOL-bref. O alfa de Cronbach do valor total foi de α=0,93; todos os domínios do WHODAS apresentaram valores acima de 0,75. O valor total do WHODAS 2.0 apresentou forte correlação com o domínio físico (r=−0,74) e moderada correlação com os domínios psicológico (r=−0,68) e social (r=−0,42) do WHOQOL-bref. Os resultados indicam que o WHODAS 2.0 é um instrumento válido para a mensuração da autopercepção de alteração da funcionalidade em pacientes acometidos pela chikungunya, capaz de fornecer dados que podem ajudar a construir um perfil de impacto da doença no perfil de funcionalidade dessa população.
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16
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Ali JI, Mahoney P, Dance D, Silverberg ND. Outcomes of a brief coping skills group intervention for adults with severe postconcussion symptoms. Concussion 2019; 4:CNC67. [PMID: 31827884 PMCID: PMC6902311 DOI: 10.2217/cnc-2019-0011] [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] [Indexed: 11/21/2022] Open
Abstract
Aim: The aim of this study was to evaluate a brief psychologically informed coping skills group intervention for adults with severe prolonged symptoms following mild traumatic brain injury (mTBI). Methodology & results: Patients attended an education session about mTBI; 22 patients completed an additional coping skills group intervention, 16 declined/stopped the intervention early and 19 were not offered the intervention. At follow-up, patients who completed the intervention reported a similar degree of symptom improvement and disability as those who did not complete the intervention. The majority of patients who completed the intervention were satisfied with it and perceived it to be credible. Conclusion: The coping skills intervention was not associated with measurable clinical benefit. Recommendations for improving psychological interventions for mTBI are discussed.
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Affiliation(s)
- Jordan I Ali
- Department of Psychology, University of Victoria, Victoria, BC, V8W 2Y2, Canada
| | - Patricia Mahoney
- Acquired Brain Injury Program, GF Strong Rehabilitation Centre, Vancouver, BC, V5Z 2G9, Canada
| | - Derry Dance
- Acquired Brain Injury Program, GF Strong Rehabilitation Centre, Vancouver, BC, V5Z 2G9, Canada.,Division of Physical Medicine & Rehabilitation, University of British Columbia, Vancouver, BC, V5Z 2G9, Canada
| | - Noah D Silverberg
- Acquired Brain Injury Program, GF Strong Rehabilitation Centre, Vancouver, BC, V5Z 2G9, Canada.,Division of Physical Medicine & Rehabilitation, University of British Columbia, Vancouver, BC, V5Z 2G9, Canada.,Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, BC, V5Z 2G9, Canada
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17
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Herrold AA, Kletzel SL, Mallinson T, Pape TLB, Weaver JA, Guernon A, Smith B, Babcock-Parziale J, High WM, Sesso-Osburn F, Vis L. Psychometric measurement properties of the world health organization disability assessment schedule 2.0 (WHODAS) evaluated among veterans with mild traumatic brain injury and behavioral health conditions. Disabil Rehabil 2019; 43:1313-1322. [PMID: 31549869 DOI: 10.1080/09638288.2019.1660914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE Examine the psychometric properties of the World Health Organization Disability Assessment Schedule 2.0 among U.S. Iraq/Afghanistan Veterans with a combination of mild traumatic brain injury and behavioral health conditions using Rasch analysis. METHODS 307 Veterans were classified as either combat control (n = 141), or one of three clinical groups: mild traumatic brain injury (n = 10), behavioral health conditions (n = 24), or both (n = 128). Data from the three clinical groups were used to establish step and item calibrations serving as anchors when including the control group. RESULTS Measurement precision was excellent (person separation reliability = 0.93). Ordering of item calibrations formed a logical hierarchy. Test items were off-target (too easy) for the clinical groups. Principal component analysis indicated unidimensionality although 4/36 items misfit the measurement model. No meaningful differential item functioning was detected. There was a moderate effect size (Hedge's g = 1.64) between the control and clinical groups. CONCLUSIONS The World Health Organization Disability Assessment Schedule was suitable for our study sample, distinguishing 4 levels of functional ability. Although items may be easy for some Veterans with mild traumatic brain injury and/or behavioral health conditions, the World Health Organization Disability Assessment Schedule can be used to capture disability information for those with moderate to severe disability.Implications for rehabilitationPersistent functional disability is seen in military and civilian populations with mild traumatic brain injury which often co-occurs with behavioral health conditions.A comprehensive measure of disability is needed to distinguish between levels of disability to inform clinical decisions for individual patients and to detect treatment effects between groups in research.Results of this analysis indicate the World Health Organization Disability Assessment Schedule items are sufficiently unidimensional to evaluate level of disability in the moderate and severe range among persons with mild traumatic brain injury with and without behavioral health conditions.Further examination of the psychometric properties of the World Health Organization.Disability Assessment Schedule is necessary before measurement of disability is recommended for those with less than moderate levels of disability.
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Affiliation(s)
- Amy A Herrold
- Research Service and Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr., VA Hospital, Hines, IL, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Sandra L Kletzel
- Research Service and Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr., VA Hospital, Hines, IL, USA
| | - Trudy Mallinson
- Department of Clinical Research and Leadership, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Theresa L Bender Pape
- Research Service and Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr., VA Hospital, Hines, IL, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Jennifer A Weaver
- Department of Clinical Research and Leadership, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Ann Guernon
- Research Service and Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr., VA Hospital, Hines, IL, USA.,Department of Research, Marianjoy Rehabilitation Hospital/Northwestern Medicine, Wheaton, IL, USA
| | - Bridget Smith
- Research Service and Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr., VA Hospital, Hines, IL, USA.,Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | | | - Walter M High
- New Mexico VA Health Care System, Albuquerque, NM, USA
| | | | - Lynnea Vis
- Medical Service Corps, United States Navy
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18
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Elias DA, MacLaren VV, Brien EK, Metcalfe AWS. Exaggerated Functional Impairment due to Malingered Neurocognitive Dysfunction Following Mild Traumatic Brain Injury. Arch Clin Neuropsychol 2018; 34:648-656. [DOI: 10.1093/arclin/acy086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 09/09/2018] [Accepted: 10/26/2018] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
Functional impairment associated with Neurocognitive Disorder is often claimed in medico-legal settings after mild Traumatic Brain Injury (mTBI). This case–control study examined self-reported functional impairment and the plausibility of chronic disability claims following uncomplicated mTBI.
Method
Independent Medical Evaluations included a battery of performance and symptom validity tests, along with self-reports of physical or emotional complaints and functional impairment. Slick and colleagues’ (Slick, D. J., Sherman, E. M., & Iverson, G. L. (1999). Diagnostic criteria for malingered neurocognitive dysfunction: Proposed standards for clinical practice and research. The Clinical Neuropsychologist, 13, 545–561.) criteria ruled out probable malingering in 21 mTBI cases without psychiatric comorbidity and their self-reports were compared to those of seven non-malingering cases with a psychiatric comorbidity, 17 who were probable malingerers, and 31 orthopedic pain sufferers. Coherence Analysis of medical documentation corroborated assignment of mTBI cases to non-malingering versus probable malingering groups.
Results
Probable malingerers reported more postconcussion symptoms than non-malingerers (d = 0.79) but they did not differ significantly on tests of neurocognitive performance. Probable malingerers and orthopedic pain patients gave significantly higher ratings of functional impairment (d = 1.28 and 1.26) than non-malingerers. Orthopedic pain patients reported more disability due to pain than non-malingerers (d = 1.03), but pain catastrophizing was rated more highly by the probable malingerers (d = 1.21) as well as by the orthopedic pain patients (d = 0.98). The non-malingerers reported lower emotional distress than the other three groups, but only the probable malingerers reported elevated depression symptoms compared to the non-malingerers (d = 1.01).
Conclusions
The combined evaluation of performance validity, function, and coherence analysis would appear to enhance the difficult clinical evaluation of postconcussion symptoms in the medical-legal setting.
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Affiliation(s)
- David A Elias
- Canadian Health Solutions Inc. and Dalhousie University School of Medicine, Saint John, New Brunswick, Canada
| | - Vance V MacLaren
- Canadian Health Solutions Inc., Saint John, New Brunswick, Canada
| | - Erin K Brien
- Canadian Health Solutions Inc., Saint John, New Brunswick, Canada
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19
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Fear Avoidance and Clinical Outcomes from Mild Traumatic Brain Injury. J Neurotrauma 2018; 35:1864-1873. [DOI: 10.1089/neu.2018.5662] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Disability in amyotrophic lateral sclerosis compared with traumatic brain injury using the World Health Organization Disability Assessment Schedule 2.0 and the International Classification of Functioning minimal generic set. Int J Rehabil Res 2018; 41:224-229. [PMID: 30095553 DOI: 10.1097/mrr.0000000000000292] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We compared the functioning of two neurological patient groups, amyotrophic lateral sclerosis (ALS) and traumatic brain injury (TBI), using brief and validated International Classification of Functioning (ICF)-based tools. A 12-item World Health Organization Disability Assessment Schedule (WHODAS 2.0) questionnaire was mailed to ALS and TBI patients and their significant others 2 weeks before their appointment at an outpatient clinic of a university hospital. In addition, a neurologist filled in the ICF minimal generic set. Two years after diagnosis, no significant differences between the two diagnosis groups were found in overall functioning or in working ability using either patient or proxy WHODAS or physician-rated minimal generic set. In single items, however, clear differences were found. Patients and significant others rated household activities, mobility, and self-care as more impaired in the group with ALS, and learning, concentrating, and maintaining friendships in the group with TBI. There were no differences between the two diagnosis groups in the WHODAS items emotional functions, engaging in community, relating with strangers, or in working ability. Both brief ICF-based generic scales, WHODAS and the ICF generic set, could show differences between these patient groups with severe disability. The results of this study should promote assessment of disability with WHODAS 2.0 in ALS and TBI.
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Comparing disability between traumatic brain injury and spinal cord injury using the 12-item WHODAS 2.0 and the WHO minimal generic data set covering functioning and health. Clin Rehabil 2018; 32:1676-1683. [DOI: 10.1177/0269215518785945] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To compare disability between two patient groups using short validated tools based on International Classification of Functioning, Disability and Health (ICF). Design: Cross-sectional study. Setting: University hospital specialist outpatient clinic. Subjects: A total of 94 patients with traumatic brain injury and 59 with spinal cord injury. Main measures: Disability evaluated using self-reported and proxy 12-item WHODAS 2.0 (World Health Organization Disability Assessment Schedule), and physician-rated WHO minimal generic data set covering functioning and health. Results: The two measures used showed severe but very different disabilities in these patient groups. Disability was assessed worse by physicians in the spinal cord injury population (sum 15.8 vs. 12.7, P = 0.0001), whereas disability assessed by the patients did not differ significantly between the two groups (sum 18.4 vs. 21.2). Further analysis revealed that in patients with “high disability” (the minimal generic data set score ⩾15), self-reported functioning was more severely impaired in the traumatic brain injury group compared to the spinal cord injury group (29.7 vs. 21.4, P < 0.0001), with no difference between these two diagnostic groups in patients with “low disability” (the minimal generic data set below 15). Patients with traumatic brain injury perceived more difficulties in cognition, getting along and participation, patients with spinal cord injury in mobility and self-care. Conclusion: Both generic measures were able to detect severe disability but also to detect differences between two patient populations with different underlying diagnoses.
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Terry DP, Iverson GL, Panenka W, Colantonio A, Silverberg ND. Workplace and non-workplace mild traumatic brain injuries in an outpatient clinic sample: A case-control study. PLoS One 2018; 13:e0198128. [PMID: 29856799 PMCID: PMC5983513 DOI: 10.1371/journal.pone.0198128] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 05/14/2018] [Indexed: 11/29/2022] Open
Abstract
Individuals who are injured in the workplace typically have a greater risk of delayed return to work (RTW) and other poor health outcomes compared to those not injured at work. It is not known whether these differences hold true for mild traumatic brain injuries (MTBI). The present study examined differences associated with workplace and non-workplace MTBI upon intake to a specialty MTBI clinic, their outcomes, and risk factors that influence RTW. Slow-to-recover participants were recruited from consecutive referrals to four outpatient MTBI clinics from March 2015 to February 2017. Two clinics treat Worker’s Compensation claimants and two clinics serve patients with non-work related injuries in the publically funded health care system. Of 273 eligible patients, 102 completed an initial study assessment (M age = 41.2 years, SD age = 11.7; 54% women) at an average of 2–3 months post injury. Participants were interviewed about their MTBI and completed a battery of standardized questionnaires and performance validity testing. Outcomes, including RTW, were assessed via telephone follow-up 4–5 months later. Workplace injuries comprised 45.1% of the sample. The workplace MTBI group had a greater proportion of men and lower education levels compared to the non-workplace MTBI group. The two groups had a comparable post-concussion symptom burden and performance validity test failure rate. Workplace MTBI was associated with greater post-traumatic stress symptoms. Fifteen patients (14.7%) were lost to follow-up. There were no workplace/non-workplace MTBI differences in RTW outcome at 6–7 months post injury. Of the entire sample, 42.5% of patients had full RTW, 18.4% had partial RTW, and 39.1% had no RTW. Greater post-concussion symptom burden was most predictive of no RTW at follow-up. There was no evidence that the workplace and non-workplace MTBI groups had different risk factors associated with prolonged work absence. Despite systemic differences in compensation and health care access, the workplace and non-workplace MTBI groups were similar at clinic intake and indistinguishable at follow-up, 6–7 months post injury.
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Affiliation(s)
- Douglas P Terry
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, United States of America.,Spaulding Rehabilitation Hospital, Boston, Massachusetts, United States of America.,MassGeneral Hospital for Children™ Sports Concussion Program, Boston, Massachusetts, United States of America.,Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, Massachusetts, United States of America
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, United States of America.,Spaulding Rehabilitation Hospital, Boston, Massachusetts, United States of America.,MassGeneral Hospital for Children™ Sports Concussion Program, Boston, Massachusetts, United States of America.,Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, Massachusetts, United States of America
| | - William Panenka
- British Columbia Neuropsychiatry Program, Vancouver, British Columbia, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Angela Colantonio
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Noah D Silverberg
- Division of Physical Medicine & Rehabilitation, University of British Columbia, Vancouver, British Columbia, Canada.,Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
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