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Arroyo P, Wilkie L, Davies E, Fisher Z, Kemp AH. Thriving in the wake of a storm: A systematic qualitative review & meta-synthesis on facilitating post-traumatic growth in patients living with Acquired Brain Injury. Neuropsychol Rehabil 2024:1-27. [PMID: 38870482 DOI: 10.1080/09602011.2024.2356891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 05/10/2024] [Indexed: 06/15/2024]
Abstract
Acquired Brain Injury (ABI) often results in significant challenges, yet it may also facilitate Post-Traumatic Growth (PTG). This review explores a critical question: "What are the main factors contributing to PTG following ABI, and what potential barriers to its development are perceived by ABI survivors?" Here we aim to systematically uncover these contributors and barriers to PTG through a meta-synthesis, involving a comprehensive review of previously published qualitative research on this topic. A literature search was conducted across PsycINFO, CINAHL, and MEDLINE up to December 2022 to identify studies for inclusion. From an initial pool of 1,946 records, eleven articles were selected for inclusion. Reflexive thematic analysis yielded three analytical themes including "Journey to Self-Rediscovery", "Strength in Connection" and "Overcoming Obstacles". Our findings also revealed facilitators and barriers across multiple levels of scale including personal (e.g., acceptance versus resignation), interpersonal (e.g., positive social ties versus difficulties making social connections), and systemic (e.g., new meaning and purpose versus financial constraints) scales. Our research extends existing knowledge in ABI rehabilitation, providing a more nuanced understanding of the dynamics influencing PTG with implications for clinicians seeking to promote wellbeing following brain injury.
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Affiliation(s)
- Pamela Arroyo
- School of Psychology, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, UK
| | - Lowri Wilkie
- School of Psychology, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, UK
- Regional Neuropsychology and Community Brain Injury Service, Morriston Hospital, Swansea, UK
| | - Elen Davies
- Swansea University Library, Swansea University, Swansea, UK
| | - Zoe Fisher
- Regional Neuropsychology and Community Brain Injury Service, Morriston Hospital, Swansea, UK
- Health and Wellbeing Academy, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, UK
| | - Andrew Haddon Kemp
- School of Psychology, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, UK
- Regional Neuropsychology and Community Brain Injury Service, Morriston Hospital, Swansea, UK
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De Dios Perez B, Morris RPG, Craven K, Radford KA. Peer mentoring for people with acquired brain injury - a systematic review. Brain Inj 2024; 38:316-329. [PMID: 38318794 DOI: 10.1080/02699052.2024.2310779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 01/23/2024] [Indexed: 02/07/2024]
Abstract
INTRODUCTION Over 100 million people worldwide live with disabilities resulting from an acquired brain injury (ABI). ABI survivors experience cognitive and physical problems and require support to resume an active life. They can benefit from support from someone who has been through the same issues (i.e. peer mentor). This review investigated the effectiveness of peer mentoring for ABI survivors. METHOD Eleven databases, two trial registers, and PROSPERO were searched for published studies. Two reviewers independently screened all titles, abstracts, and full texts, extracted data, and assessed quality. The PRISMA 2020 guidelines were followed to improve transparency in the reporting of the review. RESULTS The search returned 4,094 results; 2,557 records remained after the removal of duplicates and 2,419 were excluded based on titles and abstracts. Of the remaining 138, 12 studies met the inclusion criteria. Five were conducted in the United States, three in Canada, three in the UK, and one in New Zealand. Meta-analysis was inappropriate due to the heterogeneity of study designs. Therefore, a narrative synthesis of the data was undertaken. CONCLUSION Although peer mentoring has the potential to positively influence activity and participation among ABI survivors, further research is needed to understand the extent of the benefits.
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Affiliation(s)
- Blanca De Dios Perez
- Centre for Rehabilitation and Ageing Research, University of Nottingham, Nottingham, UK
| | - Richard P G Morris
- Centre for Rehabilitation and Ageing Research, University of Nottingham, Nottingham, UK
| | - Kristelle Craven
- Centre for Rehabilitation and Ageing Research, University of Nottingham, Nottingham, UK
| | - Kate A Radford
- Centre for Rehabilitation and Ageing Research, University of Nottingham, Nottingham, UK
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Wheeler S, Acord-Vira A. Occupational Therapy Practice Guidelines for Adults With Traumatic Brain Injury. Am J Occup Ther 2023; 77:7704397010. [PMID: 37624997 DOI: 10.5014/ajot.2023.077401] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
IMPORTANCE Occupational therapy practitioners are uniquely qualified to address the occupational needs of people with traumatic brain injury (TBI) and their caregivers to maximize participation, health, and well-being. OBJECTIVE These Practice Guidelines are informed by systematic reviews of the effectiveness of interventions that address impairments and skills to improve the occupational performance of people with TBI, as well as interventions for caregivers of people with TBI. The purpose of these guidelines is to summarize the current evidence available to assist clinicians' clinical decision-making in providing interventions for people with TBI and their caregivers. METHOD We reviewed six systematic reviews and synthesized the results into clinical recommendations to be used in occupational therapy clinical practice. RESULTS Sixty-two articles served as the basis for the clinical recommendations. CONCLUSIONS AND RECOMMENDATIONS Strong to moderate evidence supports multimodal sensory stimulation, unimodal auditory stimulation, physical activity, virtual reality, cognitive interventions, vision therapy, goal-focused interventions, individual and group training and education, and caregiver supports. Occupational therapy practitioners should incorporate these interventions into individual and group sessions to maximize recovery and promote occupational participation. Additional interventions are also available, based on emerging evidence and expert opinion, including prevention approaches, complexity of injury, and the use of occupation-based performance assessments. What This Article Adds: These Practice Guidelines provide a summary of evidence in clinical recommendations tables supporting occupational therapy interventions that address impairments resulting from and skills to improve occupational performance after TBI. The guidelines also include case study examples and evidence graphics for practitioners to use to support clinical reasoning when selecting interventions that address the goals of the person with TBI and their caregiver's needs.
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Affiliation(s)
- Steven Wheeler
- Steven Wheeler, PhD, OTR/L, FAOTA, CBIS, is Professor and Chair of Occupational Therapy, Division of Occupational Therapy, West Virginia University, Morgantown;
| | - Amanda Acord-Vira
- Amanda Acord-Vira, EdD, OTR/L, FAOTA, CBIS, is Associate Professor of Occupational Therapy, Division of Occupational Therapy, West Virginia University, Morgantown
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Quilico E, Sweet S, Duncan L, Wilkinson S, Bonnell K, Alarie C, Swaine B, Colantonio A. Exploring a peer-based physical activity program in the community for adults with moderate-to-severe traumatic brain injury. Brain Inj 2023:1-9. [PMID: 37157834 DOI: 10.1080/02699052.2023.2208375] [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: 05/10/2023]
Abstract
PRIMARY OBJECTIVE To explore the experiences of program mentors, participants, and employees involved in a peer-based physical activity (PA) program for adults with moderate-to-severe TBI, being piloted by a community fitness center, to develop the program as a measurable intervention. RESEARCH DESIGN We adopted an exploratory case study approach through an interpretivist paradigm, which focused on discovering realities about the peer-based PA program across the study participants' views, backgrounds, and experiences. METHODS AND PROCEDURES Semi-structured focus groups and individual interviews were conducted with nine adult program participants (3 peer mentors, 6 participants), and three program employees. Inductive content analysis was used to develop themes about their perceived experiences. MAIN OUTCOMES AND RESULTS 44 open-codes were grouped into 10 subthemes and three final themes: 1) program impacts identified the importance of the program in daily life and resulting psychological, physical, and social outcomes; 2) program characteristics highlighted program leaders, accessibility, and social inclusion; 3) program sustainability included program adherence, benefits for the center, and the program's future. CONCLUSIONS Perceptions of program experiences and outcomes identified how peer-based PA for adults with moderate-to-severe TBI can lead to meaningful activities, functioning better, and buy-in from all parties. Implications for research and practice related to supporting health-related behaviors after TBI through group-based, autonomy-supporting approaches are discussed.
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Affiliation(s)
- E Quilico
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
- Applied Human Sciences, Concordia University, Montreal, QC, Canada
| | - S Sweet
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
- Kinesiology and Physical Education, McGill University, Montreal, QC, Canada
| | - L Duncan
- Kinesiology and Physical Education, McGill University, Montreal, QC, Canada
| | - S Wilkinson
- Applied Human Sciences, Concordia University, Montreal, QC, Canada
| | - K Bonnell
- Kinesiology and Physical Education, McGill University, Montreal, QC, Canada
| | | | - Bonnie Swaine
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
- School of Rehabilitation, University of Montreal, Montreal, QC, Canada
| | - Angela Colantonio
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
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Aterman S, Ghahari S, Kessler D. Characteristics of peer-based interventions for individuals with neurological conditions: a scoping review. Disabil Rehabil 2023; 45:344-375. [PMID: 35085058 DOI: 10.1080/09638288.2022.2028911] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE Peer-based interventions are increasingly popular and cost-effective therapeutic opportunities to support others experiencing similar life circumstances. However, little is known about the similarities and differences among peer-based interventions and their outcomes for people with neurological conditions. This scoping review aims to describe and compare the characteristics of existing peer-based interventions for adults with common neurological conditions. MATERIALS AND METHODS We searched MEDLINE, CINAHL, PsychInfo, and Embase for research on peer-based interventions for individuals with brain injury, Parkinson's, multiple sclerosis, spinal cord injury, and stroke up to June 2019. The search was updated in March 2021. Fifty-three of 2472 articles found were included. RESULTS Characteristics of peer-based intervention for this population vary significantly. They include individual and group-based formats delivered in-person, by telephone, or online. Content varied from structured education to tailored approaches. Participant outcomes included improved health, confidence, and self-management skills; however, these varied based on the intervention model. CONCLUSION Various peer-based interventions exist, each with its own definition of what it means to be a peer. Research using rigorous methodology is needed to determine the most effective interventions. Clear definitions of each program component are needed to better understand the outcomes and mechanism of action within each intervention.IMPLICATIONS FOR REHABILITATIONRehabilitation services can draw on various peer support interventions to add experiential knowledge and support based on shared experience to enhance outcomes.Fulfilling the role of peer mentor may be beneficial and could be encouraged as part of the rehabilitation process for people with SCI, TBI, Stroke, PD, or MS.In planning peer-based interventions for TBI, Stroke, SCI, PD, and MS populations, it is important to clearly define intervention components and evaluate outcomes to measure the impact of the intervention.
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Affiliation(s)
- Sarah Aterman
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Setareh Ghahari
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Dorothy Kessler
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
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Talbot KJ, Krüger E, Pillay BS. Experiences of acquired brain injury one-month post-discharge from acute hospitalisation. Afr J Disabil 2023; 12:1037. [PMID: 36876022 PMCID: PMC9982487 DOI: 10.4102/ajod.v12i0.1037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 12/12/2022] [Indexed: 02/24/2023] Open
Abstract
Background Healthcare professionals may have a preconceived idea about life after an acquired brain injury (ABI). Understanding lived experiences of individuals with ABI and their significant others, post-hospitalisation, may improve communication between healthcare professionals and individuals directly influenced by the ABI. Objective To describe perceived experiences of individuals with ABI, and their significant others, regarding rehabilitation services and returning to daily activities, one-month post-discharge from acute hospitalisation. Method Semi-structured interviews, via an online platform, expanded on the experiences of six dyads (individuals with an ABI and their significant others). Data were thematically analysed. Results Six main themes emerged that best described participants' experiences; two of which were shared between individuals with ABI and their significant others (SO). Individuals with an ABI acknowledged recovery as their priority and highlighted the importance of patience. The need for counselling and additional support from healthcare professionals and peers arose. The SO expressed a need for written information, improved communication from healthcare professionals, and education regarding the implications of an ABI. The coronavirus disease 2019 (COVID-19) pandemic negatively influenced all participants' overall experiences, mainly because of termination of visiting hours. Psychosocial intervention would have been beneficial to all participants. Faith influenced most participants' attitudes towards recovery and adapting post-ABI. Conclusion Most participants accepted their new reality but required additional support to cope emotionally. Individuals with an ABI would benefit from opportunities to share experiences with and learn from others in a similar situation. Streamlined services and improved communication may alleviate anxiety among families during this crucial transitional period. Contribution This article provides valuable information on the perspectives and experiences of individuals with ABI and their significant others during the transition from acute hospitalisation. The findings can assist with the continuity of care, integrative health and supportive strategies during the transition period post-ABI.
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Affiliation(s)
- Kirsten J Talbot
- Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
| | - Esedra Krüger
- Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
| | - Bhavani S Pillay
- Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
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Quilico E, Wilkinson S, Duncan L, Sweet S, Bédard E, Trudel E, Colantonio A, Swaine B. Participatory co-creation of an adapted physical activity program for adults with moderate-to-severe traumatic brain injury. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:900178. [PMID: 36188895 PMCID: PMC9397937 DOI: 10.3389/fresc.2022.900178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022]
Abstract
Background Research about using physical activity (PA) to improve health, quality of life, and participation after moderate-to-severe traumatic brain injury (TBI) is receiving growing attention. However, best-practices for maintaining PA participation after TBI have yet to be defined. In this context, a team of researchers and stakeholders with a moderate-to-severe TBI (including program participants and peer mentors) participated in a co-creation process to optimize a 9-month, 3-phased, community-based, adapted PA program named TBI-Health. Purpose The study aimed to provide a detailed account of the participation in and co-creation of a new TBI-Health Program to enhance sport and exercise participation for adults with moderate-to-severe TBI. Specifically, we carried out an in-depth exploration of the perceived experiences and outcomes of users over one cycle of the program to assist the co-creation process. Methods An interpretive case study approach was used to explore the experiences and outcomes of the participatory co-creation within and across phases of the TBI-Health program. A purposeful sample of fourteen adults with moderate-to-severe TBI (program participants n = 10; peer mentors n = 4) were involved in audio-recorded focus groups after each program phase. Reflexive thematic analyses within and across the phases identified three higher-order themes. Results Program Participation included barriers, facilitators, sources of motivation and suggested modifications to optimize the program; Biopsychosocial Changes highlighted perceived physical, psychological, and social outcomes, by self and others, that resulted from program participation; PA Autonomy emphasized transitions in knowledge, sex- and gender-related beliefs, and abilities related to exercise and sport participation. Conclusions Study findings suggest the TBI-Health program can increase autonomy for and reduce barriers to PA for adults with moderate-to-severe TBI, which results in increased PA participation and important physical, psychological, and social benefits. More research is needed about the TBI-Health program with larger samples.
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Affiliation(s)
- Enrico Quilico
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centrefor Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
- Applied Human Sciences, Concordia University, Montreal, QC, Canada
- Correspondence: Enrico Quilico
| | - Shawn Wilkinson
- Applied Human Sciences, Concordia University, Montreal, QC, Canada
| | - Lindsay Duncan
- Kinesiology and Physical Education, McGill University, Montreal, QC, Canada
| | - Shane Sweet
- Centrefor Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
- Kinesiology and Physical Education, McGill University, Montreal, QC, Canada
| | - Evelyne Bédard
- Kinesiology and Physical Education, McGill University, Montreal, QC, Canada
| | | | - Angela Colantonio
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Bonnie Swaine
- Centrefor Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
- École de réadaptation, Faculté de Médecine, Université de Montréal, Montreal, ON, Canada
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Zwaiman A, da Luz LT, Perrier L, Hacker Teper M, Strauss R, Harth T, Haas B, Nathens AB, Gotlib Conn L. The involvement of trauma survivors in hospital-based injury prevention, violence intervention and peer support programs: A scoping review. Injury 2022; 53:2704-2716. [PMID: 35773023 DOI: 10.1016/j.injury.2022.06.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/26/2022] [Accepted: 06/20/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Despite decades-long involvement of trauma survivors in hospital-based program delivery, their roles and impact on trauma care have not been previously described. We aimed to characterize the literature on trauma survivor involvement in hospital-based injury prevention, violence intervention and peer support programs to map what is currently known and identify future research opportunities. METHODS A scoping review was conducted following the Joanna Briggs Institute (JBI) methodology. Articles were identified through electronic databases and gray literature. Included articles described hospital-based injury prevention programs, violence intervention programs and peer support programs that involved trauma survivors leveraging their injury experiences to counsel others. Studies were screened and data were abstracted in duplicate. Data were synthesized generally and by program type. RESULTS Thirty-six published articles and four program reports were included. Peer support programs were described in 21 articles, mainly involving trauma survivors as mentors or peer supporters. Peer support programs' most commonly reported outcome was participant satisfaction (n = 6), followed by participant self-efficacy (n = 5), depression (n = 4), and community integration (n = 3). Eleven injury prevention studies were included, all involving trauma survivors as speakers in youth targeted programs. Injury prevention studies commonly reported outcomes of participants' risk behaviors and awareness (n = 9). Violence intervention programs were included in four articles involving trauma survivors as intervention counsellors. Recidivism rate was the most commonly reported outcome (n = 3). Variability exists across and within program types when reporting on involved trauma survivors' gender, age, selection and training, duration of involvement and number of survivors involved. Outcomes related to trauma survivors' own experiences and the impacts to them of program involvement were under-studied. CONCLUSIONS Significant opportunity exists to fill current knowledge gaps in trauma survivors' involvement in trauma program delivery. There is a need to describe more fully who involved trauma survivors are to inform the development of effective future interventions.
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Affiliation(s)
- Ashley Zwaiman
- University of Toronto, 27 King's College Cir, Toronto, ON M5S 1A1 Canada
| | - Luis T da Luz
- Sunnybrook Research Institute, 2075 Bayview Ave, Toronto, ON M4N 3M5 Canada
| | - Laure Perrier
- University Health Network, 190 Elizabeth St, Toronto, ON M5G 2C4, Canada
| | | | - Rachel Strauss
- Sunnybrook Research Institute, 2075 Bayview Ave, Toronto, ON M4N 3M5 Canada
| | - Tamara Harth
- Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON M4N 3M5 Canada
| | - Barbara Haas
- Sunnybrook Research Institute, 2075 Bayview Ave, Toronto, ON M4N 3M5 Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, 5 College St 4th Floor, Toronto, ON M5T 3M6 Canada
| | - Avery B Nathens
- Sunnybrook Research Institute, 2075 Bayview Ave, Toronto, ON M4N 3M5 Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, 5 College St 4th Floor, Toronto, ON M5T 3M6 Canada
| | - Lesley Gotlib Conn
- Sunnybrook Research Institute, 2075 Bayview Ave, Toronto, ON M4N 3M5 Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, 5 College St 4th Floor, Toronto, ON M5T 3M6 Canada.
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Using an integrated knowledge translation approach to inform a pilot feasibility randomized controlled trial on peer support for individuals with traumatic brain injury: A qualitative descriptive study. PLoS One 2021; 16:e0256650. [PMID: 34428259 PMCID: PMC8384186 DOI: 10.1371/journal.pone.0256650] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 08/11/2021] [Indexed: 01/02/2023] Open
Abstract
Introduction Traumatic brain injury (TBI) is estimated to affect 10 million people annually, making it a leading cause of morbidity and mortality worldwide. One cost-effective intervention that has been shown to minimize some of the negative sequelae after TBI is peer support. However, the evidence supporting the benefits of peer support for individuals with TBI is sparse and of low quality. Integrated knowledge translation (iKT) may be one approach to optimizing the evaluation of peer support programs among individuals with TBI. Therefore, the objectives are: (1) To understand key informants’ perspectives of the barriers and facilitators of participating in peer support research and programs among individuals with TBI; (2) to understand key informants’ perspectives on the perceived impacts of peer support programs on individuals with TBI; and, (3) to demonstrate how an iKT approach can inform the development and implementation of a pilot feasibility randomized controlled trial (RCT). Methods A qualitative descriptive approach using one-on-one semi-structured interviews was used. Purposive sampling of 22 key informants included 8 peer support mentors, 4 individuals with TBI who received peer support, 3 caregivers of individuals with TBI, 4 peer support program staff, and 3 academics in peer support and/or TBI. Results There were five main themes related to the barriers and facilitators to participating in peer support research and programs: knowledge, awareness, and communication; logistics of participating; readiness and motivation to participate; need for clear expectations; and matching. There were three main themes related to the perceived impact of peer support: acceptance, community, social experiences; vicarious experience/learning through others: shared experiences, role-modelling, encouragement; and “I feel better.” Discussions with our Research Partner led to several significant adaptations to our trial protocol, including removing the twice/week intervention arm, shortening of the length of trial, and changing the measure for the community integration outcome. Discussion/Conclusion This is the first study to use an iKT approach to inform a trial protocol and the first to assess the barriers and facilitators to participating in peer support research.
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Tseng ES, Zolin SJ, Young BT, Claridge JA, Conrad-Schnetz KJ, Curfman ET, Wise NL, Lemaitre VC, Ho VP. Can educational videos reduce opioid consumption in trauma inpatients? A cluster-randomized pilot study. J Trauma Acute Care Surg 2021; 91:212-218. [PMID: 33797489 PMCID: PMC8487055 DOI: 10.1097/ta.0000000000003174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Opioids are often used to treat pain after traumatic injury, but patient education on safe use of opioids is not standard. To address this gap, we created a video-based opioid education program for patients. We hypothesized that video viewing would lead to a decrease in overall opioid use and morphine equivalent doses (MEDs) on their penultimate hospital day. Our secondary aim was to study barriers to video implementation. METHODS We performed a prospective pragmatic cluster-randomized pilot study of video education for trauma floor patients. One of two equivalent trauma floors was selected as the intervention group; patients were equally likely to be admitted to either floor. Nursing staff were to show videos to English-speaking or Spanish-literate patients within 1 day of floor arrival, excluding patients with Glasgow Coma Scale score less than 15. Opioid use and MEDs taken on the day before discharge were compared. Intention to treat (ITT) (intervention vs. control) and per-protocol groups (video viewers vs. nonviewers) were compared (α = 0.05). Protocol compliance was also assessed. RESULTS In intention to treat analysis, there was no difference in percent of patients using opioids or MEDs on the day before discharge. In per-protocol analysis, there was no different in percent of patients using opioids on the day before discharge. However, video viewers still on opioids took significantly fewer MEDs than patients who did not see the video (26 vs. 38, p < 0.05). Protocol compliance was poor; only 46% of the intervention group saw the videos. CONCLUSION Video-based education did not reduce inpatient opioid consumption, although there may be benefits in specific subgroups. Implementation was hindered by staffing and workflow limitations, and staff bias may have limited the effect of randomization. We must continue to establish effective methods to educate patients about safe pain management and translate these into standard practices. LEVEL OF EVIDENCE Therapeutic, Level IV.
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Affiliation(s)
- Esther S. Tseng
- Division of Trauma, Critical Care, Burns, and Emergency General Surgery, MetroHealth Medical Center, Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, OH
| | | | - Brian T. Young
- Division of Trauma, Critical Care, Burns, and Emergency General Surgery, MetroHealth Medical Center, Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Jeffrey A. Claridge
- Division of Trauma, Critical Care, Burns, and Emergency General Surgery, MetroHealth Medical Center, Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, OH
| | | | - Eric T. Curfman
- Division of Trauma, Critical Care, Burns, and Emergency General Surgery, MetroHealth Medical Center, Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Nicole L. Wise
- Division of Trauma, Critical Care, Burns, and Emergency General Surgery, MetroHealth Medical Center, Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Vetrica C. Lemaitre
- Division of Trauma, Critical Care, Burns, and Emergency General Surgery, MetroHealth Medical Center, Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Vanessa P. Ho
- Division of Trauma, Critical Care, Burns, and Emergency General Surgery, MetroHealth Medical Center, Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, OH
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH
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Panday J, Velikonja D, Moll SE, Harris JE. Experiences of inpatient rehabilitation from the perspective of persons with acquired brain injury. Disabil Rehabil 2021; 44:5539-5548. [PMID: 34166176 DOI: 10.1080/09638288.2021.1938706] [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] [Indexed: 10/21/2022]
Abstract
BACKGROUND Perspectives of individuals with acquired brain injury (ABI) regarding inpatient rehabilitation experiences can inform patient-centered care; however, these voices are under-represented in the literature. PURPOSE To explore the experiences, needs, and preferences of patients from an ABI inpatient rehabilitation program in Ontario. METHODS Using an interpretive description approach, we interviewed 12 participants and analyzed the transcripts inductively to generate themes. FINDINGS We identified three major themes: (1) Life Rerouted - participants felt their lives diverted due to ABI, with rehabilitation seen as a way to return to pre-injury life, (2) Autonomy within Rehab highlighted the perceived importance of personal autonomy in decision-making within rehabilitation, and (3) Life (and Recovery) Go On reflected an ongoing recovery process after discharge - leading to mixed emotions. An overall message, "re-establishing personal identity is important to the recovery process," reflected theories of biographical disruption and relational autonomy. IMPLICATIONS Our findings provide a patient perspective for clinicians and administrators to consider. We found that ABI was significantly disruptive to personal identity - resulting in tensions in autonomy while attempting to reclaim a sense of identity. We suggest counseling services and strategies supporting post-injury adjustment, along with ways for rehabilitation professionals to enhance patient autonomy where possible.Implications for rehabilitationSustaining an ABI can significantly disrupt personal identity and sense of autonomy - especially as persons occupy the role of "patient" while in inpatient rehabilitation.Psychological support is recommended to address the impacts of ABI on patients' sense of identity, as well as on family members.Strategies of support might include, providing formal psychotherapy, as well as creating opportunities for patients and family members to discuss the changes they are experiencing, and to establish their personal narratives (e.g., through writing or art) or peer mentorship programs between discharged and current patients.Clinicians can enhance patient autonomy by increasing opportunities for communication with patients about choice; educating patients and family members on the rehabilitation team's decision-making process, and other methods that increase communication and provide consistent up-to-date information to patients and their family members.
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Affiliation(s)
- Janelle Panday
- School of Rehabilitation Science, McMaster University, Institute for Applied Health Sciences, Hamilton, Canada
| | - Diana Velikonja
- Hamilton Health Sciences, Regional Rehabilitation Centre, Hamilton, Canada.,Department of Psychology and Behavioural Neurosciences, DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Sandra E Moll
- School of Rehabilitation Science, McMaster University, Institute for Applied Health Sciences, Hamilton, Canada
| | - Jocelyn E Harris
- School of Rehabilitation Science, McMaster University, Institute for Applied Health Sciences, Hamilton, Canada
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Wilkie L, Arroyo P, Conibeer H, Kemp AH, Fisher Z. The Impact of Psycho-Social Interventions on the Wellbeing of Individuals With Acquired Brain Injury During the COVID-19 Pandemic. Front Psychol 2021; 12:648286. [PMID: 33841287 PMCID: PMC8027334 DOI: 10.3389/fpsyg.2021.648286] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/23/2021] [Indexed: 01/07/2023] Open
Abstract
Individuals with Acquired Brain Injury (ABI) suffer chronic impairment across cognitive, physical and psycho-social domains, and the experience of anxiety, isolation and apathy has been amplified by the COVID-19 pandemic. A qualitative evaluation was conducted of 14 individuals with ABI who had participated in series of COVID adapted group-based intervention(s) that had been designed to improve wellbeing. Eight themes were identified: Facilitating Safety, Fostering Positive Emotion, Managing and Accepting Difficult Emotions, Promoting Meaning, Finding Purpose and Accomplishment, Facilitating Social Ties, (Re)Connecting to Nature, and Barriers to Efficacy. Findings are discussed with respects to recent theoretical developments in positive psychology and wellbeing science and support the use of online and outdoor interventions to enhance wellbeing in individuals living with ABI during the COVID-19 pandemic. This paper makes a unique contribution to second wave positive psychology (PP2.0) through the application of recent advances in wellbeing science to an ABI population during the COVID-19 pandemic. In doing so, this paper lays the foundation for new interventions that not only reduce impairment and distress, but also create opportunities for meaning and enhanced wellbeing in people living with chronic conditions and those individuals living with ABI in particular.
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Affiliation(s)
- Lowri Wilkie
- Department of Psychology, College of Human and Health Sciences, Swansea University, Swansea, United Kingdom
- Community Brain Injury Service, Morriston Hospital, Swansea, United Kingdom
| | - Pamela Arroyo
- Department of Psychology, College of Human and Health Sciences, Swansea University, Swansea, United Kingdom
- Community Brain Injury Service, Morriston Hospital, Swansea, United Kingdom
| | - Harley Conibeer
- Department of Psychology, College of Human and Health Sciences, Swansea University, Swansea, United Kingdom
- Community Brain Injury Service, Morriston Hospital, Swansea, United Kingdom
| | - Andrew Haddon Kemp
- Department of Psychology, College of Human and Health Sciences, Swansea University, Swansea, United Kingdom
- Community Brain Injury Service, Morriston Hospital, Swansea, United Kingdom
| | - Zoe Fisher
- Community Brain Injury Service, Morriston Hospital, Swansea, United Kingdom
- Health and Wellbeing Academy, College of Human and Health Sciences, Swansea University, Swansea, United Kingdom
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Lefkovits AM, Hicks AJ, Downing M, Ponsford J. Surviving the "silent epidemic": A qualitative exploration of the long-term journey after traumatic brain injury. Neuropsychol Rehabil 2020; 31:1582-1606. [PMID: 32660336 DOI: 10.1080/09602011.2020.1787849] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Previous studies examining life after traumatic brain injury (TBI) have taken a predominantly short-term and quantitative perspective, with generally narrow focus, and have not specifically investigated changes in experience over time post-injury to gain a uniquely long-term perspective. This study therefore aimed to qualitatively explore the broad long-term experience of living for 10 years or more with TBI. Thirty participants completed semi-structured interviews investigating the impact of TBI on various life domains, the rehabilitation experience and support received, and overall perspectives of the long-term journey after TBI. Results demonstrated that: (a) although some participants reported full recovery, several experienced persistent physical, cognitive and emotional problems that impacted their independence, employment and interpersonal relationships; (b) early rehabilitation was very helpful, but some participants experienced difficulties accessing ongoing services; (c) family and social support were important to recovery; (d) most participants drew upon inner strength to find positives in their experience. These findings have identified factors that facilitate and impede long-term recovery from TBI, which may inform better support and care for injured individuals over the years after injury to improve their quality of life.
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Affiliation(s)
- Aviva Margaret Lefkovits
- Monash Epworth Rehabilitation Research Centre (MERRC), Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Amelia J Hicks
- Monash Epworth Rehabilitation Research Centre (MERRC), Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Marina Downing
- Monash Epworth Rehabilitation Research Centre (MERRC), Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Jennie Ponsford
- Monash Epworth Rehabilitation Research Centre (MERRC), Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
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Kita H, Mallory KD, Hickling A, Wilson KE, Kroshus E, Reed N. Social support during youth concussion recovery. Brain Inj 2020; 34:782-790. [PMID: 32315217 DOI: 10.1080/02699052.2020.1753243] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE We explored the lived experience of high-school aged girls receiving social support during concussion recovery to better understand (1) how they define meaningful social support and barriers/facilitators to receiving it; (2) who provides that support; and (3) the role of peers. METHODS In person, semi-structured interviews were conducted with 10 girls (aged 14-19 years) with a personal history of concussion. RESULTS Close friends, youth with personal history of concussion, and parents were identified as key providers of meaningful social support during concussion recovery. Participants identified specific examples of support provided by each group. Close friends built a sense of social inclusion that mitigated feelings of social isolation. Youth with a personal history of concussion used their lived experiences to communicate empathy and validate the participant's challenges. Parents assisted with practical challenges (e.g. accessing accommodations) by leveraging their "adult power". Participants identified that lack of understanding of their lived experiences was a key barrier to receiving support. They proposed solutions focused on education initiatives highlighting personal accounts from youth with concussion, and specific examples of how peers can help. CONCLUSIONS Fostering social support may require strategies tailored to each group of key providers as they mitigate different challenges in recovery.
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Affiliation(s)
- Helena Kita
- Concussion Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
| | - Kylie D Mallory
- Concussion Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto , Toronto, Canada
| | - Andrea Hickling
- Concussion Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada.,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto , Toronto, Canada
| | - Katherine E Wilson
- Concussion Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
| | - Emily Kroshus
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute , Seattle, Washington, USA.,Department of Pediatrics, University of Washington , Seattle, Washington, USA
| | - Nick Reed
- Concussion Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto , Toronto, Canada.,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto , Toronto, Canada
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D’Cruz K, Douglas J, Serry T. Narrative storytelling as both an advocacy tool and a therapeutic process: Perspectives of adult storytellers with acquired brain injury. Neuropsychol Rehabil 2019; 30:1409-1429. [DOI: 10.1080/09602011.2019.1586733] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Kate D’Cruz
- Department of Community and Clinical Allied Health, Discipline of Occupational Therapy, La Trobe University, Melbourne, Australia
| | - Jacinta Douglas
- Department of Community and Clinical Allied Health, Discipline of Speech Pathology, La Trobe University, Melbourne, Australia
- Living with Disability Research Centre, La Trobe University, Melbourne, Australia
- Summer Foundation, Melbourne, Australia
| | - Tanya Serry
- Department of Community and Clinical Allied Health, Discipline of Speech Pathology, La Trobe University, Melbourne, Australia
- Living with Disability Research Centre, La Trobe University, Melbourne, Australia
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