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Verhoeks C, Bus B, Tendolkar I, Rijnen S. Cognitive communication disorders after brain injury: A systematic COSMIN review of measurement instruments. Ann Phys Rehabil Med 2024; 67:101870. [PMID: 39098162 DOI: 10.1016/j.rehab.2024.101870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 04/08/2024] [Accepted: 05/25/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND There is a lack of consensus on standardized measurement instruments (MIs) for the assessment of cognitive communication disorders in individuals with acquired brain injury (ABI). OBJECTIVES To identify and describe the currently available MIs for the assessment of cognitive communication disorders in individuals with ABI and to evaluate the psychometric properties of MIs. METHODS A search was conducted in 6 databases on March 12, 2024 using a validated methodological search filter. We included studies that evaluated psychometric properties of MIs used to assess cognitive communication disorders in individuals with ABI. We applied the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) to evaluate the psychometric properties of the MIs. RESULTS We included 48 records reporting on 44 MIs. Of all MIs, the La Trobe Communication Questionnaire (LCQ) and the St Andrew's-Swansea Neurobehavioural Outcome Scale (SASNOS) were studied most extensively. No MIs had undergone exhaustive methodological evaluation. CONCLUSIONS Based on the COSMIN, only 1 of 44 MIs can be recommended as its results can be trusted. Most MIs have the potential to be recommended but require further research to assess their psychometric quality. The development of new tools is not necessary but further methodological studies should be conducted on promising tools. This review may help clinicians and researchers to select an MI for the assessment of cognitive communication disorders and may facilitate diagnosis and research. TRIAL REGISTRATION PROSPERO database (registration number: CRD42020196861). No funding.
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Affiliation(s)
- Carmen Verhoeks
- Multidisciplinary Specialist Center for Brain Injury and Neuropsychiatry, GGZ Oost Brabant. Kluisstraat 2 5427 EM Boekel, the Netherlands; Department of Psychiatry, Radboud University Medical Center, Post office box 9101 6500 HB Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behavior. P.O Box 9104 6500 HE Nijmegen, the Netherlands.
| | - Boudewijn Bus
- Multidisciplinary Specialist Center for Brain Injury and Neuropsychiatry, GGZ Oost Brabant. Kluisstraat 2 5427 EM Boekel, the Netherlands
| | - Indira Tendolkar
- Department of Psychiatry, Radboud University Medical Center, Post office box 9101 6500 HB Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behavior. P.O Box 9104 6500 HE Nijmegen, the Netherlands
| | - Sophie Rijnen
- Multidisciplinary Specialist Center for Brain Injury and Neuropsychiatry, GGZ Oost Brabant. Kluisstraat 2 5427 EM Boekel, the Netherlands; Limburg Brain Injury Centre, Maastricht, the Netherlands
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Alderman N, Williams C, Wood RL. Using the St Andrew's - Swansea Neurobehavioural Outcome Scale (SASNOS) to determine prevalence and predictors of neurobehavioural disability amongst survivors with traumatic brain injury in the community. Neuropsychol Rehabil 2022; 32:2342-2369. [PMID: 34180770 DOI: 10.1080/09602011.2021.1946092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Studies using the St Andrew's - Swansea Neurobehavioural Outcome Scale (SASNOS) confirm neurobehavioural disability (NBD) is highly prevalent in inpatient Neurobehavioural Rehabilitation and Stroke samples. However, a recent study amongst a Danish community sample of acquired brain injury survivors found a relative paucity of NBD symptoms; and when symptoms were present, they tended to be of mild severity. The current observational study employed the SASNOS to explore prevalence of NBD in survivors with traumatic brain injury (TBI) living in the community, the extent of survivors' self-awareness of NBD symptoms, and constructed prediction models of NBD. A de-identified data set was compiled, comprising data for 97 TBI survivors (74.2% men, mean time since injury 2.8 years). In addition to SASNOS self- and proxy-ratings, various demographic, clinical and injury-related characteristics were captured. NBD was found to be highly characteristic, although severity varied depending on subtype. Statistical comparison of self- and proxy-ratings did not support reduced self awareness regarding NBD, whereas treating the problem as one of inter-rater reliability suggested this was an issue. Executive impairment, depressed mood and sex were especially prognostic of NBD. Reasons accounting for differences in NBD between the community samples are discussed and recommendations for future research made.
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Affiliation(s)
- Nick Alderman
- Elysium Neurological Services, Elysium Healthcare, The Avalon Centre, Swindon, UK.,Department of Psychology, Swansea University, Swansea, UK
| | - Claire Williams
- Elysium Neurological Services, Elysium Healthcare, The Avalon Centre, Swindon, UK.,Department of Psychology, Swansea University, Swansea, UK
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Mahesh PKB, Gunathunga MW, Jayasinghe S, Arnold SM, Liyanage SN. Post-stroke Quality of Life Index: A quality of life tool for stroke survivors from Sri Lanka. Health Qual Life Outcomes 2020; 18:239. [PMID: 32690019 PMCID: PMC7370468 DOI: 10.1186/s12955-020-01436-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 06/04/2020] [Indexed: 01/29/2023] Open
Abstract
Background Burden of stroke is rising due to the demographic and epidemiological transitions in Sri Lanka. Assessment of success of stroke-management requires tools to assess the quality of life (QOL) of stroke survivors. Most of currently used QOL tools are developed in high-income countries and may not reflect characteristics relevant to resource-constrained countries. The aim was to develop and validate a new QOL tool for stroke survivors in Sri Lanka. Methods The COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist was referred. A conceptual framework was prepared. Item generation was done reviewing the existing QOL tools, inputs from experts and from stroke survivors. Non-statistical item reduction was done for the 36 generated items with modified-Delphi technique. Retained 21 items were included in the draft tool. A cross sectional study was done with 180 stroke survivors. Exploratory Factor Analysis was done and identified factors were subjected to varimax rotation. Further construct validity was tested with 6 a-priori hypothesis using already validated tools (SF-36, EQ-5D-3 L) and a formed construct. Internal consistency reliability was assessed with Cronbach alpha. Results Four factors identified with principal-component-analysis explained 72.02% of the total variance. All 21 items loaded with a level > 0.4. The developed tool was named as the Post-stroke QOL Index (PQOLI). Four domains were named as “physical and social function”, “environment”, “financial-independence” and “pain and emotional-wellbeing”. Four domain scores of PQOLI correlated as expected with the SF-36, EQ-5D Index and EQ-5D-VAS scores. Higher domain scores were obtained for ambulatory-group than the hospitalized-group. Higher scores for financial-independence domain were obtained for the group without financial-instability. Five a-priori hypothesis were completely proven to be true. Cronbach-alpha level ranged from 0.682 to 0.906 for the four domains. Conclusions There is first evidence for sufficient construct validity of the PQOLI as a valid QOL tool for measuring the QOL of stroke survivors with satisfactory internal consistency reliability.
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Affiliation(s)
- P K B Mahesh
- Office of Regional Director of Health Services, Colombo, Sri Lanka.
| | - M W Gunathunga
- Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - S Jayasinghe
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - S M Arnold
- Office of Regional Director of Health Services, Colombo, Sri Lanka
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Whitwham S, Jones KA. Assessing aggression following Acquired Brain Injury (ABI): a systematic review of assessment measures. Brain Inj 2019; 33:1491-1502. [PMID: 31449427 DOI: 10.1080/02699052.2019.1655795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To conduct a systematic review to identify and examine the reliability and validity of standardized measures used to assess aggression in people with ABI. Data sources: Systematic searches of PsychInfo, Medline, Embase, PubMed and CINAHL databases along with hand searching of gray literature and review articles. Study selection: Studies were included if the sample had an ABI, and the measure included assessment of aggression. Data extraction: Sample and measure characteristics and psychometric properties were extracted. Measure quality was assessed using the COSMIN checklist. Data synthesis: Of 5,100 abstracts screened, 78 were reviewed in full against the inclusion and exclusion criteria, and 25 articles met the criteria for analysis. Included articles assessed the psychometric properties of 17 different measures of aggression in adults with ABI. Quality of evidence was often low. Four measures (MBPC-1990R, NFI, SASNOS and KSMS) demonstrated positive evidence of at least one psychometric property with good quality evidence. Conclusions: Although a large number of general measures were available, there are few measures that only assess post-ABI aggression, and many are not well-validated. Future research should assess the psychometric properties of these measures.
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Affiliation(s)
- Stephanie Whitwham
- Division of Psychiatry and Applied Psychology, University of Nottingham , Nottingham , UK
| | - Katy A Jones
- Division of Psychiatry and Applied Psychology, University of Nottingham , Nottingham , UK
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Alderman N, Pink AE, Williams C, Ramos SDS, Oddy M, Knight C, Jenkins KG, Barnes MP, Hayward C. Optimizing measurement for neurobehavioural rehabilitation services: A multisite comparison study and response to UKROC. Neuropsychol Rehabil 2019; 30:1318-1347. [DOI: 10.1080/09602011.2019.1582432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Nick Alderman
- Elysium Neurological Services, Elysium Healthcare, Badby Park, Daventry, UK
- Department of Psychology, Swansea University, Swansea, UK
| | - Aimee E Pink
- Department of Psychology, Swansea University, Swansea, UK
- Independent Neurorehabilitation Providers Alliance, UK
| | | | | | - Michael Oddy
- Brain Injury Rehabilitation Trust, The Disabilities Trust, Burgess Hill, UK
| | - Caroline Knight
- The Oakleaf Group, Northampton, UK
- School of Psychology, University of Leicester, Leicester, UK
- Elysium Neurological Services, Elysium Healthcare, St Neots Hospital, Cambridge, UK
| | - Keith G Jenkins
- National Brain Injury Centre, St Andrew’s Healthcare, Northampton, UK
| | | | - Chloë Hayward
- Independent Neurorehabilitation Providers Alliance, UK
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Soendergaard PL, Siert L, Poulsen I, Wood RL, Norup A. Measuring Neurobehavioral Disabilities Among Severe Brain Injury Survivors: Reports of Survivors and Proxies in the Chronic Phase. Front Neurol 2019; 10:51. [PMID: 30804873 PMCID: PMC6370614 DOI: 10.3389/fneur.2019.00051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 01/15/2019] [Indexed: 11/28/2022] Open
Abstract
Background: Neurobehavioral disability (NBD) has a major influence on long-term psychosocial outcome following acquired brain injury, as it affects not only the survivor of the brain injury, but the whole family. Objectives: To investigate (1) the frequency of NBD among survivors of severe brain injury measured by the Danish version of the St Andrew's-Swansea Neurobehavioural Outcome Scale (SASNOS) rated by patients and proxies, (2) factors associated with NBD, and (3) concordance between reports of NBD completed by patients and proxies. Methods: SASNOS was administered at an outpatient unit as a part of a follow-up assessment after discharge from intensive neurorehabilitation. SASNOS consists of five factors describing the following domains: Interpersonal Behavior, Cognition, Aggression, Inhibition and Communication, and both the patient and a proxy were asked to complete the questionnaire. Data collection was conducted over a period of 2 years, and 32 patients and 31 proxies completed the questionnaire. Mean time since injury was 19.4 months (10.0 SD). Most patients were male (68.8%), and most proxies were female (58.1%). Most of the patients had suffered a traumatic brain injury (68.8%). Results: A fourth of this patient group reported themselves below the normal range on the major domains of Interpersonal Behavior and Cognition. Significant associations between proxies' reports and time since injury, cohabitant status, and the patient's score on the Extended Glasgow Outcome Scale were found. Furthermore, significant differences were found between patient and proxy ratings. Proxies rated patients as having fewer problems on the Interpersonal Behavior domain, and more problems in relation to Cognition. Cognition was the only domain, where patients rated themselves higher indicating fewer problems, compared with their proxies. On both the Aggression and Communication domains, proxies rated patients higher indicating fewer problems than the patients themselves. Conclusion: Danish brain injury survivors experienced NBD as measured by SASNOS. Differences were found between patient and proxy ratings in relation to Cognition and Interpersonal Behavior. The NBDs identified can affect the survivor's ability to reintegrate and participate in activities of daily living, emphasizing how a systematic assessment is required.
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Affiliation(s)
- Pernille Langer Soendergaard
- Department of Neurology, Rigshospitalet, Glostrup, Denmark.,Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Lars Siert
- RUBRIC (Research Unit on Brain Injury Rehabilitation Copenhagen), Department of Neurorehabilitation, TBI Unit, Copenhagen University Hospital, Rigshospitalet, Hvidovre, Denmark
| | - Ingrid Poulsen
- RUBRIC (Research Unit on Brain Injury Rehabilitation Copenhagen), Department of Neurorehabilitation, TBI Unit, Copenhagen University Hospital, Rigshospitalet, Hvidovre, Denmark.,Health, Section of Nursing Science, Aarhus University, Aarhus, Denmark
| | - Rodger Ll Wood
- Swansea University, Institute of Life Sciences, College of Medicine, Swansea, United Kingdom
| | - Anne Norup
- Department of Neurology, Rigshospitalet, Glostrup, Denmark.,Department of Psychology, University of Southern Denmark, Odense, Denmark
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Alderman N. Challenges and importance of measuring neurobehavioural disability in acquired brain injury: the 'St Andrew's Swansea - Neurobehavioural Outcomes Scale' (SASNOS). Expert Rev Neurother 2018; 18:807-810. [PMID: 30277093 DOI: 10.1080/14737175.2018.1531705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Nick Alderman
- a Neurobehavioural Rehabilitation Services , Elysium Neurological , Badbury , Northants
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Stolwyk RJ, O'Connell E, Lawson DW, Thrift AG, New PW. Neurobehavioral disability in stroke patients during subacute inpatient rehabilitation: prevalence and biopsychosocial associations. Top Stroke Rehabil 2018; 25:1-8. [PMID: 30213238 DOI: 10.1080/10749357.2018.1499301] [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] [Received: 01/29/2018] [Accepted: 07/07/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND OBJECTIVES There are scarce data on post-stroke neurobehavioral disability (NBD). The aim of this study was to identify the prevalence of NBD in a subacute inpatient stroke population and examine potential associations with demographic, stroke-related, functional and psychosocial variables. METHODS 82 survivors of stroke were consecutively recruited during their inpatient rehabilitation admission. Nursing staff rated NBD in patients using the St Andrews -Swansea Neurobehavioral Outcome Scale (SASNOS). Measures of patient functional independence (FIM), cognition (MoCA), and mood symptoms (HADS) were collected in addition to nursing reports of whether observed NBD negatively impacted on the patient or those around them. RESULTS NBD relating to interpersonal relationships (44.4% of participants) and cognition (52.4%) were highly prevalent within the sample while NBD relating to inhibition (1.2%), aggression (3.6%), and communication (2.5%) were relatively rare. Presence of NBD was significantly associated with reduced functional independence (rs=0.39, p < 0.01) and associated with trends in cognitive impairment (rs=0.29, p = 0.03), increased anxiety (rs=-0.43, p = 0.02) and depressive symptoms (rs=-0.43, p = 0.02). Presence of NBD was significantly correlated with negative impact to the patient and those around them across all SASNOS domains (rs range 0.42 - 0.45, all p ≤ 0.01). CONCLUSIONS NBD is common within a subacute stroke inpatient population, particularly interpersonal and cognitive difficulties and preliminary analyses indicate associations with reduced functional ability, cognition and mood. There is a need to provide education and support to clinicians to facilitate routine assessment and management of NBD following stroke.
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Affiliation(s)
- Renerus J Stolwyk
- a Monash Institute of Cognitive and Clinical Neurosciences , School of Psychological Sciences, Monash University , Melbourne , Victoria , Australia
- b Monash-Epworth Rehabilitation Research Centre , Melbourne , Victoria , Australia
| | - Elissa O'Connell
- c Rehabilitation and Aged Care Services , Medicine Program, Monash Health , Melbourne , Australia
| | - David W Lawson
- a Monash Institute of Cognitive and Clinical Neurosciences , School of Psychological Sciences, Monash University , Melbourne , Victoria , Australia
- b Monash-Epworth Rehabilitation Research Centre , Melbourne , Victoria , Australia
| | - Amanda G Thrift
- d Department of Medicine, School of Clinical Sciences at Monash Health , Monash University , Melbourne , Victoria , Australia
| | - Peter W New
- e Epworth-Monash Rehabilitation Medicine Unit , Monash University , Melbourne , Victoria , Australia
- f Department of Epidemiology and Preventive Medicine , Monash University , Melbourne , Victoria , Australia
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Alderman N, Williams C, Wood RL. When normal scores don’t equate to independence: Recalibrating ratings of neurobehavioural disability from the ‘St Andrew’s – Swansea Neurobehavioural Outcome Scale’ to reflect context-dependent support. Brain Inj 2017; 32:218-229. [DOI: 10.1080/02699052.2017.1406989] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Nick Alderman
- Elysium Neurological, Badby Park, Daventry, Northants
- Department of Psychology, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Claire Williams
- Department of Psychology, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Rodger Ll. Wood
- Neuropsychology Clinic, College of Medicine, Swansea University, Swansea, UK
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