Rural versus urban social support seeking as a moderating variable in traumatic brain injury outcome

Biopsychosocial factors of quality of life in individuals with moderate to severe traumatic brain injury: a scoping review

PURPOSE

Individuals with moderate to severe traumatic brain injury (TBI) experience changes in their quality-of-life (QOL) post-injury. Given the vast literature that exists about QOL after TBI, a scoping review was performed to identify the different biopsychosocial factors that affect a person's QOL after a moderate to severe TBI.

METHODS

A scoping review was conducted using the following electronic databases: MEDLINE, CINAHL, Embase, and PsycINFO. Terms relating to TBI and QOL were used.

RESULTS

There were 7576 articles obtained from the databases, resulting in 535 full-text articles. Ultimately, 52 articles were extracted, which consisted of biopsychosocial QOL factors after TBI. The biopsychosocial factors of QOL after TBI included 19 biological factors (i.e., sex, TBI severity, cognition), 16 psychological factors (i.e., depression, self-efficacy, coping styles), and 19 social factors (i.e., employment, social participation, social support). Factors such as fatigue, self-awareness, transition, and discharge from hospitals are known issues in TBI literature but were minimally reported in studies in this review, identifying them as potential gaps in research.

CONCLUSION

Identifying biopsychosocial factors relating to QOL after TBI can enable health services to develop targeted rehabilitation programs for individuals with TBI.

Physical Activity Preferences of People Living with Brain Injury: Formative Qualitative Research to Develop a Discrete Choice Experiment

BACKGROUND AND OBJECTIVE

The World Health Organization physical activity guidelines for people living with disability do not consider the needs of people living with moderate-to-severe traumatic brain injury. This paper describes the qualitative co-development of a discrete choice experiment survey to inform the adaption of these guidelines by identifying the physical activity preferences of people living with moderate-to-severe traumatic brain injury in Australia.

METHODS

The research team comprised researchers, people with lived experience of traumatic brain injury and health professionals with expertise in traumatic brain injury. We followed a four-stage process: (1) identification of key constructs and initial expression of attributes, (2) critique and refinement of attributes, (3) prioritisation of attributes and refinement of levels and (4) testing and refining language, format and comprehensibility. Data collection included deliberative dialogue, focus groups and think-aloud interviews with 22 purposively sampled people living with moderate-to-severe traumatic brain injury. Strategies were used to support inclusive participation. Analysis employed qualitative description and framework methods.

RESULTS

This formative process resulted in discarding, merging, renaming and reconceptualising attributes and levels. Attributes were reduced from an initial list of 17 to six: (1) Type of activity, (2) Out-of-pocket cost, (3) Travel time, (4) Who with, (5) Facilitated by and (6) Accessibility of setting. Confusing terminology and cumbersome features of the survey instrument were also revised. Challenges included purposive recruitment, reducing diverse stakeholder views to a few attributes, finding the right language and navigating the complexity of discrete choice experiment scenarios.

CONCLUSIONS

This formative co-development process significantly improved the relevance and comprehensibility of the discrete choice experiment survey tool. This process may be applicable in other discrete choice experiment studies.

The relationship among social support, experienced stigma, psychological distress, and quality of life among tuberculosis patients in China

The complex relationships among social support, experienced stigma, psychological distress, and quality of life (QOL) among tuberculosis (TB) patients are insufficiently understood. The purpose of this study was to explore the interrelationships among social support, experienced stigma, psychological distress, and QOL and to examine whether experienced stigma and psychological distress play a mediating role. A cross-sectional survey was conducted between November 2020 and March 2021 in Dalian, Liaoning Province, Northeast China. Data were obtained from 473 TB patients using a structured questionnaire. Structural equation modelling was used to examine the hypothetical model. The research model provided a good fit to the measured data. All research hypotheses were supported: (1) social support, experienced stigma and psychological distress were associated with QOL; (2) experienced stigma fully mediated the effect of social support on psychological distress; (3) psychological distress fully mediated the effect of experienced stigma on QOL; and (4) experienced stigma and psychological distress were sequential mediators between social support and QOL. This study elucidated the pathways linking social support, experienced stigma, and psychological distress to QOL and provides an empirical basis for improving the QOL of TB patients.

From Exposure to Family Violence During Childhood to Depression in Adulthood: A Path Analysis on the Mediating Effects of Intimate Partner Violence

Literature shows a link between adverse childhood experiences and subsequent depression, but there is a lack of concrete evidence on whether victimization of intimate partner violence (IPV) in adulthood plays significant roles in that link. This study aimed to test the mediating effect of adulthood IPV victimization in the associations between exposure to family violence in childhood and adulthood depression. Exposure to family violence in childhood was operationalized as one's experiences of child abuse and witnessing parental IPV in childhood. This study also tested the effects of other violence-related factors from the Personal and Relationships Profile, including one's antisocial personality, borderline personality, dominance, posttraumatic stress (PTS) symptoms, and violence approval, on the associations. A path analysis was conducted a cross-sectional survey study sample recruited between 2009 and 2010. The sample was 8,807 adults selected with a multistage stratified sampling procedure from six cities in China (43.4% male; M age = 40.61 years, SD = 8.93). The main outcome was participants' depressive symptoms during the past 2 weeks. As predicted, the path model suggests that IPV victimization significantly mediated the associations between exposure to family violence in childhood and adulthood depression. Violence approval and PTS symptoms, but not the other violence-related factors, significantly mediated the above associations. Findings warrant the need to identify individuals with exposure to family violence in early stages, and to provide them with suitable intervention programs to prevent subsequent IPV as well as to minimize the negative impacts of the exposure to family violence in childhood.

Principal components analysis of the Hesitation Scale: More than just social support seeking

The seeking of support from others during times of need is a critical strategy for overcoming challenging life events and ameliorating associated stress. The larger percentage of research examining help-seeking behaviour has been conducted with nonclinical samples, and conclusions remain somewhat unclear due to several limitations, including methodological inconsistencies across studies. The Hesitation Scale (HS) was developed to measure social support seeking in patients with traumatic brain injury but has not undergone thorough psychometric evaluation. The goal of this study primarily was to provide a clearer understanding of the specific aspects of support-seeking behaviour assessed by the HS, which is fundamental to the identification of factors that can be modified through targeted clinical interventions. A principal components analysis of the HS in an outpatient sample of 89 patients with spinal cord injury revealed that although the HS may provide an overall indication of respondents' attitudes and beliefs regarding social support seeking, the six significant extracted components of the scale appear to assess distinct aspects of support seeking behaviour. Results also suggested that the HS may have clinical utility in evaluating social support seeking in individuals with spinal cord injury.

Health-related stigma of noncommunicable neurological disease in rural adult populations: A scoping review

Stigma is a widely recognised public health issue. Many people with neurological disease and their families experience stigmatisation, adding to their burden of illness. Rural populations are typically small, lack anonymity, and often have a higher proportion of older adults with inadequate access to specialised services and resources. Although generally isolated, rural areas can offer benefits such as a sense of familiarity and interconnectedness. The purpose of this scoping review was to map the existing evidence on stigma associated with non-communicable neurological disease in rural adult populations and identify key findings and gaps in the literature. Our literature search of peer-reviewed English language articles published from 1 January 1992 to 22 June 2017 was conducted across five databases yielding 8,209 results. After duplicate removal, pairs of reviewers independently screened 6,436 studies according to inclusion criteria developed a priori; 36 articles were identified for inclusion in this review. Study characteristics were described and illustrated by frequency distribution, findings were grouped thematically, and each of the five types of stigma were identified (social, self, health professional, associative, structural). Four factors influencing stigma (knowledge, familiarity, beliefs, and rurality) and four overarching stigma-related themes (concealment; exclusion; disempowerment, discrimination, and unequal opportunities; and issues related to healthcare systems and providers) emerged. In urban-rural comparison studies, rural residents were generally less knowledgeable about the neurological disease and more stigmatised. The impact of other factors (i.e., gender, age, and education) on stigma varied and are stated where associations were reported. Three main gaps were identified including: low attention to stigma related to neurological diseases other than epilepsy, limited cross-cultural comparisons of stigma related to neurological disease, and inclusion of gender as a variable in the analysis of stigma-related outcomes in only half of the reviewed studies. Further research is recommended.

"Mad Scared" versus "I Was Sad": Emotional expression and response in urban adolescent males

Decades of masculinity research have concluded that society places higher demands on males to adhere to norms for low emotional expression; yet, countless studies find that emotional expression is integral to well-being. Unfortunately, this contradiction places boys and men in a tenuous position as they must navigate a bombardment of societal messages about the importance of emotional stoicism and invincibility. For urban adolescents, the situation is more complicated as they encounter environmental stressors that place greater emphasis on projecting a tough façade. Thus, our primary aim was to assess to what degree dyads of close adolescent male friends from urban, low-income neighborhoods are able to engage in emotional expression and response and to explore some of the underlying mechanisms and interpersonal processes. Qualitative findings from our sample suggest that urban boys exhibit a wide range of behaviors when participating in dyadic emotional disclosure and response, including being highly emotionally expressive and supportive in the context of close male friendship.

Gout-related inpatient utilization: a study of predictors of outcomes and time trends

Background

To assess inpatient healthcare burden of gout in the USA after an Emergency Department (ED) visit and the predictors of gout-related hospitalizations.

Method

We used the 2009, 2010 and 2012 US National ED Sample (NEDS) data to examine the time trends in inpatient visits with gout as the primary diagnosis. We used the 2012 NEDS data to assess multivariable-adjusted predictors of length of hospital stay, discharge to home (versus other) and total charges for gout-related inpatient visits.

Results

Of the 205,152 ED visits for gout as the primary diagnosis in 2012, 7.7 % resulted in hospitalization. In 2009, 2010 and 2012, 63 %, 63 % and 64.5 % of hospitalized patients were discharged home; respective durations of hospital stay were 4.15, 4.00 and 3.86 days. Older age 50 to <65 years (ref <50), renal failure, heart failure, osteoarthritis and diabetes were associated with a longer hospital stay and self-pay/uninsured status, hospital location in the Midwest or Western USA with a shorter hospital stay for gout. Similar factors were associated with total charges for gout-related admissions. Older age (65 to <80 and ≥80, relative to <50 years), diabetes, self-pay/no charge insurance status, metropolitan area residence, and a longer length of hospital stay were associated with lower odds of discharge to home; and self-pay/no charge (uninsured) status was associated with higher odds of discharge to home, compared to Medicare coverage.

Conclusions

Using a national sample, we noted declining duration of hospital stay and identified factors associated with the length of hospital stay, discharge to home and charges for gout hospitalization following an ED visit. Future studies should examine whether better management of comorbidities in patients with gout can further reduce utilization and cost of gout-related hospitalizations.

Two-Year Outcome Following Traumatic Brain Injury and Rehabilitation: A Comparison of Patients From Metropolitan Melbourne and Those Residing in Regional Victoria

Background and Objective:Victoria's trauma management system provides acute care and rehabilitation following traumatic brain injury (TBI), with care of more complex injuries generally provided in specialist centres in metropolitan Melbourne. Little is known about how the outcomes of TBI survivors living in metropolitan Melbourne compare to those who reside in regional Victoria once they return to their community, where support services may be less available. The aim of the present study was to compare, in TBI individuals who have been treated at an inner-city rehabilitation centre in Melbourne, the long-term outcomes of those who live in metropolitan Melbourne (termed ‘Metro’) with those who reside in regional Victoria, termed ‘Regional.’Design and participants:Comparative study with quantitative outcome measures. A total of 959 patients, of whom 645 were designated ‘metro’ and 314 ‘regional’, were followed-up routinely at 2 years post-injury.Outcome measures:Structured Outcome Questionnaire, Glasgow Outcome Scale — Extended, Sickness Impact Profile, Craig Handicap Assessment and Reporting Technique, Hospital Anxiety and Depression Scale, Alcohol Use Disorders Identification Test and Drug Abuse Screening Test.Results:Few differences in outcomes were found between groups. However, after controlling for group differences in age and injury severity, some non-significant trends were suggestive of better outcomes in terms of less social isolation and anxiety and fewer dysexecutive behaviours in regional dwellers.Conclusions:These findings suggest that outcomes in patients from regional areas are at least as good as those from metropolitan Melbourne.

Changes in the coping styles of spouses and the influence of these changes on their psychosocial functioning the first year after a patient's stroke

OBJECTIVE

The objective of this study was to examine the changes in spouses' coping styles that occur in the first year after a patient's stroke and the influence of these changes on the spouses' psychosocial functioning.

METHODS

A total of 211 spouses of patients with stroke were assessed at three different time points using self-reported questionnaires (at the time of the patient's admission to inpatient rehabilitation, 2 months after discharge and 1 year poststroke). We used linear mixed-model and multiple linear regression analyses to analyse the data.

RESULTS

Spouses' use of an active coping style decreased significantly in the first year poststroke. There were no significant overall changes in the use of a passive coping style. The use of a passive coping style at admission and increases in passive coping style in the first year poststroke predicted worse psychosocial functioning 1 year poststroke. The models explained between 32% and 50% of the variance in quality of life, depressive symptoms and strain.

CONCLUSION

The present study indicates that spouses' passive coping style is maladaptive poststroke when used in the acute as well as in the chronic phase. Use of an active coping style decreases in the first year poststroke, but these decreases do not predict psychosocial outcomes.

Does rurality affect quality of life following treatment for breast cancer?

PURPOSE

The present research examined the extent to which rural residence and social support seeking are associated with quality of life (QOL) among breast cancer patients following chemotherapy.

METHODS

Female breast cancer patients (n = 46) from communities of varying degrees of rurality in a Midwestern state completed psychological and QOL measures at 1-month postchemotherapy. Analyses assessed the relationships between QOL outcomes, rurality, and social support seeking.

FINDINGS

Using age and education as covariates, regression analyses were conducted to determine the extent to which QOL was related to social support seeking and rural/urban residence. Analyses revealed that social support seeking was associated with lower scores on multiple indices of QOL, and it was associated with higher self-reported symptoms of depression. Several significant associations with rural/urban residence were noted as well. Specifically, increasing rurality, as defined by USDA Rural-Urban continuum codes, was associated with lower overall QOL, lower functional well-being, and increased complaints of breast cancer specific symptoms.

CONCLUSIONS

These findings highlight the relevance of continued efforts to address social support needs among women with a history of breast cancer living in rural and urban communities. They also suggest that individuals in more rural communities may be at risk for lowered QOL in the early period following cancer treatment. Future research is needed to replicate these results with larger and more diverse samples of rural and urban dwelling individuals, and to determine whether these effects may be attributed to identifiable characteristics of rural communities (eg, fewer cancer-related resources).

Outcomes of participation objective, participation subjective (POPS) measure following traumatic brain injury

PRIMARY OBJECTIVE

To investigate the participation of adults living with traumatic brain injury in regional and rural NSW as measured by the Participation Objective Participation Subjective (POPS) measure.

RESEARCH DESIGN

A quantitative survey of a single cohort as the first of a two phase mixed methods study.

METHODS AND PROCEDURES

One hundred and thirty-one adults with a TBI were recruited through eight rural brain injury rehabilitation programmes in NSW. These adults completed a range of survey instruments, including the POPS.

MAIN OUTCOMES AND RESULTS

The POPS measure supported findings from other research that identified varying impacts of TBI. However, in contrast to other studies, there was no correlation between participation scores and age, gender, time since injury and severity of injury.

CONCLUSIONS

The findings from this study suggest that the issue of participation of adults with TBI living in non-metropolitan areas needs to be further researched.

Social support and Quality of Life: a cross-sectional study on survivors eight months after the 2008 Wenchuan earthquake

Background

The 2008 Wenchuan earthquake resulted in extensive loss of life and physical and psychological injuries for survivors. This research examines the relationship between social support and health-related quality of life for the earthquake survivors.

Methods

A multistage cluster sampling strategy was employed to select participants from 11 shelters in nine counties exposed to different degrees of earthquake damage, for a questionnaire survey. The participants were asked to complete the Short Form 36 and the Social Support Rating Scale eight months after the earthquake struck. A total of 1617 participants returned the questionnaires. The quality of life of the survivors (in the four weeks preceding the survey) was compared with that of the general population in the region. Multivariate logistic regression analysis and canonical correlation analysis were performed to determine the association between social support and quality of life.

Results

The earthquake survivors reported poorer quality of life than the general population, with an average of 4.8% to 19.62% reduction in scores of the SF-36 (p < 0.001). The multivariate logistic regression analysis showed that those with stronger social support were more likely to have better quality of life. The canonical correlation analysis found that there was a discrepancy between actual social support received and perceived social support available, and the magnitude of this discrepancy was inversely related to perceived general health (rs = 0.467), and positively related to mental health (rs = 0.395).

Conclusion

Social support is associated with quality of life in the survivors of the earthquake. More attention needs to be paid to increasing social support for those with poorer mental health.

Neuropsychological functioning and quality of life during the first year after completing chemotherapy for breast cancer

OBJECTIVE

Research has documented modest cognitive difficulties among women treated for breast cancer. The present study was designed to evaluate the effects of these subtle cognitive changes on quality of life after treatment.

METHODS

Data are presented from women breast cancer patients who completed neuropsychological tests and questionnaires regarding quality of life 6 and 12 months post-chemotherapy (n's=39 and 33). Neuropsychological test scores were examined for evidence of cognitive difficulties at each time point; repeated measures ANOVAs were used to identify changes over time. Regression analyses assessed relationships of quality of life outcomes with cognitive functioning, social support seeking, and fatigue.

RESULTS

Small percentages of participants (<20% across tests) evidenced deficits in delayed memory, processing speed, response inhibition, and verbal fluency (VF) at each time point. Reliable change index analyses suggested statistically reliable improvements in each cognitive domain for a modest portion of participants. Regressions revealed hesitation to seek social support and fatigue as the most consistent predictors of quality of life at 6 and 12 months post-chemotherapy. Cognitive complaints and VF difficulties were also significantly related to quality of life at 12 months.

CONCLUSIONS

In addition to confirming the importance of fatigue and social support in quality of life, these data offer preliminary indications that weaker VF skills and self-reported cognitive complaints may be associated with poorer functional outcomes among cancer survivors. Further research is needed to validate these potential relationships, which suggest that cognitive difficulties among cancer survivors may warrant monitoring and possible intervention.

Traumatic brain injury, participation, and rural identity

In this article we focus on participation following traumatic brain injury (TBI) in rural and regional Australian contexts, asking how aspects of rurality, such as place identity and rural belonging, impact on participation for the individual living with TBI. We found a preference for country living, despite disadvantages including distance from services and lack of anonymity. A rural identity provides access to an enabling narrative, the "rural idyll," which allows people with TBI to inhabit the realm of social normality. A rural identity is enabling in this regard, because it cooperates with TBI-based preferences for social isolation and a relaxed pace that accommodates fatigue. Thus, people living in rural areas report satisfaction with their quality of life despite restricted access to resources and reduced social participation.

Cognitive and psychological factors associated with early posttreatment functional outcomes in breast cancer survivors

Breast cancer survivors experience cognitive difficulties following chemotherapy, yet the effects of these deficits on functional outcomes have not been systematically evaluated. This study assessed the relationships between postchemotherapy cognitive difficulties and functional outcomes. Forty-six women with breast cancer were seen at 1-month postchemotherapy; data were collected on cognitive functioning, psychological variables, and physical symptoms. Wilcoxon signed-rank analyses revealed cognitive deficits in executive functioning and verbal fluency. Subsequent regression analyses demonstrated that poorer executive functioning was associated with decreased productivity, community involvement, and social role functioning. Poorer quality of life was predicted by depression and reluctance to seek social support, but not cognitive functioning. These findings indicate that executive functioning deficits are associated with important functional outcomes among breast cancer survivors 1-month postchemotherapy. Thus, treatment efforts should focus on addressing cognitive, as well as psychological and physical, issues among cancer survivors.

Traumatic brain injury state planning grant: Preparing for change in a rural state

PURPOSE

The overarching purpose of this work was to generate a framework on which to build a traumatic brain injury (TBI) system-support action plan for individuals with a TBI living in a rural state.

METHODS

Four research questions were posed aimed at describing rural service/support needs and service satisfaction among persons with a TBI, as well as rural service/support availability as defined by providers. One hundred and ninety-four providers/agencies and 250 individuals/family members completed one of two versions (provider/agency, individual/family member) of a Needs and Resources Assessment.

RESULTS

Data analyses indicated that the majority of individual respondents lived at an impoverished income level and lived with a TBI for approximately 12 years. Quality of life was perceived as significantly lower after the TBI than before. Employment decreased significantly following a TBI. Reasons for unemployment included a perceived inability to work, problems regarding proper accommodation and/or perceptions regarding being chosen as suitable job candidates.

CONCLUSIONS

Provider data confirmed that many important services are rarely available or specific to TBIs. Basic assistance with employment, cognitive training and occupational therapy were among those most needed. Paradoxically, a high proportion of individuals reported feeling satisfied with most services. Applications of these data along with recommendations for other rural states are described.

Effect of urbanicity of residence on TBI outcome at one year post-injury

OBJECTIVE

To determine the impact of urbanicity of residence and occurrence of medical complications on outcome after traumatic brain injury (TBI).

STUDY DESIGN

A consecutive series of persons admitted for inpatient TBI rehabilitation followed for 1 year post-injury.

SETTING

Inpatient brain injury rehabilitation programme in the southeastern US.

PARTICIPANTS

One hundred and eleven persons with severe (67%), moderate (18%) or mild (15%) TBI.

OUTCOME MEASURE

Functional status at 2 year post-injury as measured by the Disability Rating Scale (DRS).

RESULTS

Functional status at follow-up was predicted by age, DRS at admission for rehabilitation, injury severity, alcohol use, continued need for medications and medical complications (validated R2 = 0.57; p < 0.0001). Urbanicity of residence was not predictive of functional status.

CONCLUSIONS

As expected, participants who experienced more medical complications and required continued use of medications had poorer functional outcomes. Contrary to expectation, more rural residents did not have poorer outcomes than persons residing in more urban areas.

Holistic neuro-rehabilitation in the community: is identity a key issue?

Many people experience identity change after brain injury. Impaired self-awareness after acquired brain injury is also common and can, along with other factors, affect the identity change a person may experience. Holistic rehabilitation programmes attempt to address both cognitive and emotional difficulties and specifically problems of self-awareness after brain injury. Does identity change require longer-term rehabilitation interventions? This paper describes a community-based neuro-rehabilitation service that has incorporated some principles from more traditional holistic programmes with a view to providing long-term, low-intensity brain injury rehabilitation. Specific reference is made to problems of identity and how these may be addressed during long-term psychotherapeutic follow-up. The potential relevance of the total duration of rehabilitation input rather than simply the number of sessions when working with adjustment and identity change after brain injury in community settings is discussed. The service model is compared to more traditional holistic rehabilitation programmes. A case study and early outcome data are presented to illustrate some of these points and to provide more information about the nature of the programme.

Neighborhood characteristics and outcomes after traumatic brain injury

OBJECTIVE

To determine the extent to which characteristics of a person's neighborhood contribute to outcomes after traumatic brain injury (TBI).

DESIGN

Prospective cohort.

SETTING

A specialized brain injury unit providing acute rehabilitation care.

PARTICIPANTS

A consecutive sample of participants (N=200) in the Traumatic Brain Injury Model Systems (TBIMS) longitudinal study: 100 participants were 2 years postinjury, and 100 participants were 5 years postinjury.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

U.S. Census Bureau block group descriptors of economic and social characteristics and initial and follow-up data from the TBIMS national dataset including the Glasgow Outcome Scale-Extended (GOS-E) and Satisfaction With Life Scale (SWLS).

RESULTS

Economic and social characteristics of a person's neighborhood accounted for additional variance in outcomes beyond what could be accounted for by individual characteristics, including demographic, premorbid, and injury-related measures; concurrent measures of functioning; and the persons's perception of environmental influences. Individual characteristics predicted a substantial proportion of the variance in the GOS-E (69%); neighborhood characteristics contributed an additional 1.5%. Individual characteristics predicted 33.3% of the variance in SWLS, with neighborhood characteristics accounting for an additional 6.9%.

CONCLUSIONS

For both outcomes, a small but important proportion of the variance accounted for by neighborhood indices was unique to these environmental influences and was not accounted for by individual indices, including concurrent measures of functioning and the individual's perception of environmental influences. Further investigations of how neighborhood factors affect outcomes after TBI are warranted.

Outcomes in TBI with violent versus nonviolent etiology in a predominantly rural setting

OBJECTIVE

To evaluate differences in outcome in persons with violent versus nonviolent traumatic brain injury (TBI) etiology.

DESIGN

Two-group (violent vs nonviolent) 1-year follow-up study.

SETTING

Midwestern medical center TBI Model System serving a predominantly rural catchment area.

PARTICIPANTS

Forty-five (n = 19 violent TBI etiology; n = 26 nonviolent TBI etiology) inpatients with primary diagnosis of TBI followed up as outpatients 1 year after injury.

MAIN OUTCOME MEASURES

Substance use, income source, employment status, Wechsler Adult Intelligence Scale--Revised (abbreviated version), Logical Memory I and II from the Wechsler Memory Scale--Revised, Wide Range Achievement Test--Third Edition Reading subtest, Trail-Making Tests A and B, Rey Auditory Verbal Learning Test, Community Integration Questionnaire, Neurobehavioral Functioning Inventory.

RESULTS

Members of the violent group were more likely to be men, of a racial minority, unemployed, and have low income. Substance abuse was common among both groups prior to injury, with significant declines at 1 year. Follow-up also revealed significant group differences in verbal intelligence, social integration, productivity, and source of income, but nonsignificant difference in employment. In all comparisons, more favorable outcomes were found for the nonviolent group.

CONCLUSIONS

Persons with violent injury etiology have poorer premorbid functioning and are likely to have less favorable outcomes than the general population with TBI. Therefore, persons with violent TBI etiology may require more intensive aftercare programming to promote improved rehabilitation outcomes.

Severe traumatic brain injury in New South Wales: comparable outcomes for rural and urban residents

OBJECTIVE

To compare differences in functional outcomes between urban and rural patients with traumatic brain injury (TBI).

DESIGN

A longitudinal, prospective, multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program (BIRP) for New South Wales, with follow-up at 18 months after injury.

PARTICIPANTS

198 patients (147 urban, 51 rural) with severe TBI from the 11 participating rehabilitation units.

MAIN OUTCOME MEASURES

Demographic and injury details collected prospectively using a standardised questionnaire, and measures from five validated instruments (Disability Rating Scale, Mayo-Portland Adaptability Inventory, Sydney Psychosocial Reintegration Scale, Medical Outcomes Study Short Form and the General Health Questionnaire--28-item version) administered at follow-up to document functional, psychosocial, emotional and vocational outcomes.

RESULTS

Demographic details, injury severity, lengths of stay in intensive and acute care wards were similar for both rural and urban groups. There were no significant group differences in functional outcomes, including return to work, at follow-up.

CONCLUSIONS

Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents, and suggest that the integrated network of inpatient, outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live.