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Loflin C, Cheever CR, You H, Oyesanya TO. Feasibility of BrainSTORM, a Traumatic Brain Injury Transitional Care Intervention. J Head Trauma Rehabil 2024:00001199-990000000-00171. [PMID: 38916424 DOI: 10.1097/htr.0000000000000965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
OBJECTIVE To investigate the feasibility, acceptability, and clinical outcome measures of a transitional care intervention for patients with traumatic brain injury (TBI) and their family caregivers. SETTING Inpatient and outpatient rehabilitation at a level I trauma center in the Southeastern United States. PARTICIPANTS Patients (ages 18-75) diagnosed with moderate to severe TBI, receiving rehabilitation, and their family caregivers. DESIGN Quasi-experimental, single-arm, single-center feasibility study with pre- and post-test design. Participants completed a 4-month transitional care program involving monthly education and social support. MAIN MEASURES Feasibility of enrollment, data collection, intervention completion rates, and intervention acceptability. Clinical outcome measures included patient quality of life (QOL) (12-Item Short Form Health Survey (SF-12), primary outcome) and patient and caregiver self-efficacy (Self-Efficacy for Management of Chronic Conditions Scale). RESULTS Eleven dyads and 1 monad enrolled (N = 23, 12 patients, 11 caregivers). All completed baseline data; 91.3% (n = 21, 11 patients, 10 caregivers) completed 2-month (intervention midpoint) data; and 86% (n = 20, 11 patients, 9 caregivers) completed 4-month (intervention endpoint) data. The intervention completion rate was 91.67%. Participants engaged in a mean of 2.17 (SD = 1.34) monthly educational webinars and 2.42 (SD = 1.51) social support groups during the intervention period. Approximately 70% of participants (n = 16, 9 patients, 7 caregivers) completed acceptability data, indicating positive intervention experiences (patients: mean 9.44/10 [SD = 1.01]; caregivers: mean 9.57/10 [SD = 0.79]). Patient QOL scores did not statistically improve over time; however, patient self-efficacy scores did statistically significantly improve from baseline (mean = 7.03, SD = 1.53; P = .0197) to intervention end point (4 months) (mean = 8.35, SD = 1.71). CONCLUSION Brain Injury Support To Optimize Recovering Minds (BrainSTORM) is a promising new TBI transitional care intervention that has potential to enhance care standards for patients with TBI and their family caregivers. Further research is needed to determine its efficacy.
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Affiliation(s)
- Callan Loflin
- Author Affiliations: UNC School of Medicine, Chapel Hill, North Carolina (Ms Loflin and Mr Cheever); Duke University School of Nursing, Durham, North Carolina (Ms You and Dr Oyesanya)
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Wake E, Ranse J, Campbell D, Gabbe B, Marshall AP. Follow-up after major traumatic injury: a survey of services in Australian and New Zealand public hospitals. BMC Health Serv Res 2024; 24:630. [PMID: 38750458 PMCID: PMC11097478 DOI: 10.1186/s12913-024-11105-w] [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: 10/20/2023] [Accepted: 05/13/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Increased survival from traumatic injury has led to a higher demand for follow-up care when patients are discharged from hospital. It is currently unclear how follow-up care following major trauma is provided to patients, and how, when, and to whom follow-up services are delivered. The aim of this study was to describe the current follow-up care provided to patients and their families who have experienced major traumatic injury in Australia and New Zealand (ANZ). METHODS Informed by Donabedian's 'Evaluating the Quality of Medical Care' model and the Institute of Medicine's Six Domains of Healthcare Quality, a cross-sectional online survey was developed in conjunction with trauma experts. Their responses informed the final survey which was distributed to key personnel in 71 hospitals in Australia and New Zealand that (i) delivered trauma care to patients, (ii) provided data to the Australasian Trauma Registry, or (iii) were a Trauma Centre. RESULTS Data were received from 38/71 (53.5%) hospitals. Most were Level 1 trauma centres (n = 23, 60.5%); 76% (n = 16) follow-up services were permanently funded. Follow-up services were led by a range of health professionals with over 60% (n = 19) identifying as trauma specialists. Patient inclusion criteria varied; only one service allowed self-referral (3.3%). Follow-up was within two weeks of acute care discharge in 53% (n = 16) of services. Care activities focused on physical health; psychosocial assessments were the least common. Most services provided care for adults and paediatric trauma (60.5%, n = 23); no service incorporated follow-up for family members. Evaluation of follow-up care was largely as part of a health service initiative; only three sites stated evaluation was specific to trauma follow-up. CONCLUSION Follow-up care is provided by trauma specialists and predominantly focuses on the physical health of the patients affected by major traumatic injury. Variations exist in terms of patient selection, reason for follow-up and care activities delivered with gaps in the provision of psychosocial and family health services identified. Currently, evaluation of trauma follow-up care is limited, indicating a need for further development to ensure that the care delivered is safe, effective and beneficial to patients, families and healthcare organisations.
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Affiliation(s)
- Elizabeth Wake
- Trauma Service, Gold Coast University Hospital, Gold Coast, QLD, Australia.
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia.
- School of Nursing and Midwifery, Griffith University, Gold Coast, Australia.
| | - Jamie Ranse
- School of Nursing and Midwifery, Griffith University, Gold Coast, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Gold Coast, QLD, Australia
| | - Don Campbell
- Trauma Service, Gold Coast University Hospital, Gold Coast, QLD, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
| | - Belinda Gabbe
- School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Andrea P Marshall
- School of Nursing and Midwifery, Griffith University, Gold Coast, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Gold Coast, QLD, Australia
- Midwifery Education and Research Unit, Gold Coast University Hospital, Nursing, QLD, Australia
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Moore M, Kempthorne L, Fann JR, Shulein O, Dams-O'Connor K, Kajankova M, Conrick KM, Seeliger J, Hoffman JM. Patient and Caregiver Satisfaction With the Brain Injury Rehabilitation: Improving the Transition Experience (BRITE) Intervention. J Head Trauma Rehabil 2024:00001199-990000000-00154. [PMID: 38758094 DOI: 10.1097/htr.0000000000000949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
OBJECTIVE To ascertain patient and caregiver satisfaction with an individualized case management intervention to improve transition from inpatient rehabilitation care to the community after traumatic brain injury (TBI). SETTING Participants from 6 National Institute on Disability, Independent Living, and Rehabilitation Research-funded TBI Model Systems sites in the United States. PARTICIPANTS Adult, English-speaking patients with TBI who had moderate-to-severe TBI and were discharged from a TBI Model Systems site and who were in the intervention arm of the Brain Injury Rehabilitation: Improving the Transition Experience pragmatic clinical trial, as well as their caregivers. DESIGN A survey of participants in the intervention arm, which included an individualized case management program administered by a TBI Care Manager (TCM) who facilitated resource connection, education, and support. MAIN MEASURES Satisfaction with intervention was measured through Likert-scaled and open-ended questions. The survey was administered verbally through telephone, audio-recorded, and transcribed. Descriptive statistics were calculated for categorical variables, and content analysis was conducted for open-ended responses. RESULTS Patient and caregiver participants were satisfied with the intervention and highlighted the benefits of the interpersonal and practical support provided by the TCM. Participants identified the need for a more intensive intervention and clear expectations of the TCM role, as well as gaps in available medical and rehabilitation services in the community, as areas for improvement. CONCLUSION Patients with TBI and their caregivers reported satisfaction with the individualized case management program in supporting their transition from inpatient rehabilitation to the community. Further research is needed to understand the impact on outcomes.
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Affiliation(s)
- Megan Moore
- Author Affiliations: School of Social Work (Dr Moore and Dr Conrick), Harborview Injury Prevention and Research Center (Dr Moore), Department of Rehabilitation Medicine (Mss Kempthorne and Shulein and Dr Hoffman), Department of Psychiatry and Behavioral Sciences (Dr Fann), University of Washington, Seattle, Washington; Brain Injury Research Center, Department of Rehabilitation Medicine, Department of Neurology (Dr Dams-O'Connor), Department of Rehabilitation and Human Performance Brain Injury Research Center (Dr Kajankova), Icahn School of Medicine at Mount Sinai, New York, New York; and Physical Medicine and Rehabilitation (Ms Seeliger), North Shore Long Island Jewish Medical Group, Manhasset, New York
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Carrier SL, Ponsford J, McKay A. Family experiences of supporting a relative with agitation during early recovery after traumatic brain injury. Neuropsychol Rehabil 2024; 34:510-534. [PMID: 37332244 DOI: 10.1080/09602011.2023.2219064] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 05/23/2023] [Indexed: 06/20/2023]
Abstract
During the early recovery period after traumatic brain injury (TBI), referred to as post-traumatic amnesia (PTA), approximately 44% of individuals may exhibit agitated behaviours. Agitation can impede recovery and poses a significant management challenge for healthcare services. As families provide significant support for their injured relatives during this time, this study aimed to explore the family's experience during PTA to better understand their role in agitation management. There were 20 qualitative semi-structured interviews conducted with 24 family members of patients exhibiting agitation during early TBI recovery (75% female, aged 30-71 years), predominantly parents (n = 12), spouses (n = 7) and children (n = 3). The interviews explored the family's experience of supporting their relative exhibiting agitation during PTA. The interviews were analyzed using reflexive thematic analysis, which revealed three key themes: family contributions to patient care, expectations of the health care service and supporting families to support patients. This study emphasized the significant role of families in managing agitation during early TBI recovery and highlighted that families who are well-informed and well-supported have the potential to minimize their relative's agitation during PTA, which may reduce the burden on healthcare staff and promote patient recovery.
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Affiliation(s)
- Sarah L Carrier
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia
| | - Jennie Ponsford
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia
- Rehabilitation and Mental Health Division, Epworth Healthcare, Melbourne, Australia
| | - Adam McKay
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia
- Rehabilitation and Mental Health Division, Epworth Healthcare, Melbourne, Australia
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Hoepner JK, Dahl KA, Keegan LC, Proud DN. Healthcare perceptions of persons with traumatic brain injuries across providers: shortcomings in the chronic phase of care. Brain Inj 2024; 38:347-354. [PMID: 38354277 DOI: 10.1080/02699052.2024.2311332] [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: 04/17/2023] [Accepted: 01/24/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVE This investigation sought to examine the perceptions of individuals with mild, moderate, and severe traumatic brain injury (TBIs) toward healthcare providers across rehabilitation contexts (acute, rehabilitation, and chronic). METHODS The mCARE-TBI survey was distributed via Qualtrics throughout the US and Canada. Sixty-four survey responses met criteria for analysis. Participants were ≥18 years old, one-year post onset, reported no unrelated neurological deficits prior to the single TBI, and reported no prior diagnosed psychiatric disorders. The mCARE was the primary outcome measure. Comparisons were made between provider ratings on each question. RESULTS Significant differences were found between chronic-phase care, compared to acute care and rehabilitation. Group differences were found in transitioning home after discharge and in between each therapy discipline and both nurses and doctors, as well as for really listening and pairwise differences between therapy disciplines and both nurses and doctors. Group effects were found for showing compassion and care and being positive. CONCLUSIONS All disciplines need to improve communication, and transition care/discharge planning. Dismissal of ongoing impairments continues to be an area of perceived concern with doctors in particular. Communication training is needed, particularly for nurses and doctors.
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Affiliation(s)
- Jerry K Hoepner
- Department of Communication Sciences & Disorders, University of Wisconsin, Eau Claire, Wisconsin, USA
| | - Kathleen A Dahl
- Speech-Language Pathologist, North DuPage Special Education Cooperative, Roselle, Illinois, USA
| | - Louise C Keegan
- School of Rehabilitation Sciences, Moravian University, Bethlehem, Pennsylvania, USA
| | - Daniel N Proud
- Department of Biology, Moravian University, Bethlehem, Pennsylvania, USA
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Oyesanya TO, Ibemere SO, You H, Emerson MM, Pan W, Palipana A, Kandel M, Ingram D, Soto M, Pioppo A, Albert B, Walker-Atwater T, Hawes J, Komisarow J, Ramos K, Byom L, Gonzalez-Guarda R, Van Houtven CH, Agarwal S, Prvu Bettger J. Efficacy of BETTER transitional care intervention for diverse patients with traumatic brain injury and their families: Study protocol of a randomized controlled trial. PLoS One 2024; 19:e0296083. [PMID: 38394279 PMCID: PMC10890764 DOI: 10.1371/journal.pone.0296083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/08/2023] [Indexed: 02/25/2024] Open
Abstract
OBJECTIVE The purpose of this study is to examine the efficacy of BETTER (Brain Injury, Education, Training, and Therapy to Enhance Recovery) vs. usual transitional care management among diverse adults with traumatic brain injury (TBI) discharged home from acute hospital care and families. METHODS This will be a single-site, two-arm, randomized controlled trial (N = 436 people, 218 patient/family dyads, 109 dyads per arm) of BETTER, a culturally- and linguistically-tailored, patient- and family-centered, TBI transitional care intervention for adult patients with TBI and families. Skilled clinical interventionists will follow a manualized protocol to address patient/family needs. The interventionists will co-establish goals with participants; coordinate post-hospital care, services, and resources; and provide patient/family education and training on self- and family-management and coping skills for 16 weeks following hospital discharge. English- and Spanish-speaking adult patients with mild-to-severe TBI who are discharged directly home from the hospital without inpatient rehabilitation or transfer to other settings (community discharge) and associated family caregivers are eligible and will be randomized to treatment or usual transitional care management. We will use intention-to-treat analysis to determine if patients receiving BETTER have a higher quality of life (primary outcome, SF-36) at 16-weeks post-hospital discharge than those receiving usual transitional care management. We will conduct a descriptive, qualitative study with 45 dyads randomized to BETTER, using semi-structured interviews, to capture perspectives on barriers and facilitators to participation. Data will be analyzed using conventional content analysis. Finally, we will conduct a cost/budget impact analysis, evaluating differences in intervention costs and healthcare costs by arm. DISCUSSION Findings will guide our team in designing a future, multi-site trial to disseminate and implement BETTER into clinical practice to enhance the standard of care for adults with TBI and families. The new knowledge generated will drive advancements in health equity among diverse adults with TBI and families. TRIAL REGISTRATION NCT05929833.
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Affiliation(s)
- Tolu O. Oyesanya
- Duke University School of Nursing, Durham, NC, United States of America
| | - Stephanie O. Ibemere
- Duke University School of Nursing, Durham, NC, United States of America
- Duke Global Health Institute, Durham, NC, United States of America
| | - HyunBin You
- Duke University School of Nursing, Durham, NC, United States of America
| | | | - Wei Pan
- Duke University School of Nursing, Durham, NC, United States of America
- Duke University School of Medicine, Durham, NC, United States of America
| | - Anushka Palipana
- Duke University School of Nursing, Durham, NC, United States of America
| | - Melissa Kandel
- Department of Rehabilitation Services, Duke University Health System, Durham, NC, United States of America
| | - Darius Ingram
- Department of Rehabilitation Services, Duke University Health System, Durham, NC, United States of America
| | - Mayra Soto
- Department of Rehabilitation Services, Duke University Health System, Durham, NC, United States of America
| | - Anne Pioppo
- Department of Rehabilitation Services, Duke University Health System, Durham, NC, United States of America
| | - Brittany Albert
- Department of Rehabilitation Services, Duke University Health System, Durham, NC, United States of America
| | | | - Jodi Hawes
- Duke University School of Medicine, Durham, NC, United States of America
| | - Jordan Komisarow
- Duke University School of Medicine, Durham, NC, United States of America
| | - Katherine Ramos
- Duke University School of Medicine, Durham, NC, United States of America
| | - Lindsey Byom
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | | | - Courtney H. Van Houtven
- Duke University School of Medicine, Durham, NC, United States of America
- Durham VA Health Care System, Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham, NC, United States of America
| | - Suresh Agarwal
- Duke University School of Medicine, Durham, NC, United States of America
| | - Janet Prvu Bettger
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, PA, United States of America
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Roslin H, Muliira JK, Lazarus ER, Jacob D, Al-Habsi W, Al-Musallami F. Caregiving Preparedness and Caregiver Burden in Omani Family Caregivers for Patients with Acquired Brain Injury. Sultan Qaboos Univ Med J 2023; 23:493-501. [PMID: 38090237 PMCID: PMC10712375 DOI: 10.18295/squmj.6.2023.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 03/19/2023] [Accepted: 04/19/2023] [Indexed: 12/18/2023] Open
Abstract
Objectives This study aimed to explore the caregiving preparedness and caregiver burden among Omani family caregivers (FCs) of patients with acquired brain injury (ABI). Methods This prospective observational study was conducted at the neurology clinic at Khoula Hospital, Muscat, Oman, from April 2019 to December 2021. Data were collected from 119 FCs and their patients at the time of discharge from the hospital and 16 weeks post-discharge during follow-up care. The questionnaire comprised the Zarit Burden Index, the Preparedness for Caregiving Scale, the Short-Form-12 Health Survey, and a patient symptom scale. Results The FCs were predominantly female (53.8%), and the mean age was 38.27 ± 9.11 years. Most patients had moderate to severe ABI (95.8%) due to stroke (56.3%) and trauma (30.3%). The most common patient symptoms were loss of muscle strength, speech problems, mood problems, memory loss, and change in behaviour. Most FCs were found to have low caregiving preparedness (58%) at discharge, and 19.1% were found to have a high level of caregiver burden at 16 weeks post-discharge. The length of time post-injury (P <0.01), symptom severity (P <0.01) and the FCs' physical and mental health status (P <0.01 each) were found to be significant predictors of caregiving preparedness, whereas caregiver preparedness (P <0.01), symptom severity (P <0.01), and caregivers' mental health (P = 0.028) were seen as the predictors of caregiver burden. Conclusion Omani FCs of patients with ABI tend to commence the caregiver role with inadequate preparation, and shortly after, a significant number suffer high caregiver burden. Interventions focusing on the caregiver's health and training in symptom management may improve the outcomes of FCs and patients.
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Affiliation(s)
- Hema Roslin
- Department of Adult Health & Critical Care, College of Nursing, Sultan Qaboos University, Muscat, Oman
| | | | - Eilean R. Lazarus
- Department of Adult Health & Critical Care, College of Nursing, Sultan Qaboos University, Muscat, Oman
| | - Devakirubai Jacob
- Department of Adult Health & Critical Care, College of Nursing, Sultan Qaboos University, Muscat, Oman
| | - Warda Al-Habsi
- Directorate General of Khoula Hospital, Ministry of Health, Muscat, Oman
| | - Fatma Al-Musallami
- Directorate General of Khoula Hospital, Ministry of Health, Muscat, Oman
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Collins J, Lizarondo L, Taylor S, Porritt K. Adult patient and carer experiences of planning for hospital discharge after a major trauma event: a qualitative systematic review. Disabil Rehabil 2023; 45:3435-3455. [PMID: 36299236 DOI: 10.1080/09638288.2022.2133180] [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: 01/02/2021] [Accepted: 09/25/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To identify, evaluate and synthesize qualitative literature on adult patients and carer experiences of planning for discharge from an acute setting after a major trauma event. METHODS The JBI approach to meta-aggregation was followed. Qualitative studies exploring patient and carer discharge planning experiences of major trauma were included in the systematic review. A comprehensive search was conducted in five databases, supplemented by grey literature. Eligible studies were appraised for methodological quality by two reviewers and data extracted using standardized JBI tools. RESULTS Four synthesized findings emerged using 69 findings from sixteen papers. (i) Patients and carers feel generally unprepared to manage at home after discharge, (ii) early identification of patients' post discharge needs allows for appropriate referrals and supports to be organised prior to discharge, (iii) patients and carers value participation in the discharge planning process to facilitate a considered, organized and timely discharge from hospital (iv) the timely presentation, delivery, language used, format and relevancy of information impacts how patients and carers manage their discharge. CONCLUSION This meta-synthesis demonstrates that patients and carers predominantly have poor experiences of discharge planning after major trauma. Adoption of patient centered principles may improve patient and carer experiences of the discharge planning process. IMPLICATIONS FOR REHABILITATIONPatients and their carers benefit from a client-centred approach where their needs are recognised and their collaboration encouraged in important decisions, and if they are adequately prepared to reintegrate into their community.Patients can benefit from having a trauma pathway healthcare professional to provide support and advocacy services throughout their hospital admission and after discharge.Discharge planning that is organised, prepared and collaborative leads to a more positive patient experience.Discharge information should be individualised and presented in an easily accessible format for patients and carers.
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Affiliation(s)
- Jeanette Collins
- JBI, University of Adelaide, Adelaide, Australia
- Jeanette Collins, Rehabilitation in the Home (RITH), Perth, Australia
| | | | - Susan Taylor
- School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
- Occupational Therapy Department, Perth Children's Hospital, Child and Adolescent Health Service, Perth, Australia
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Oyesanya TO, Loflin C, You H, Myers J, Kandel M, Johnson K, Strauman T, Hawes J, Byom L, Gonzalez-Guarda R, Houtven CV, Agarwal S, Bettger JP. The BETTER Traumatic Brain Injury Transitional Care Intervention: A Feasibility Study. West J Nurs Res 2023; 45:902-912. [PMID: 37542381 PMCID: PMC10947151 DOI: 10.1177/01939459231189786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
This study aimed to investigate the feasibility, acceptability, and clinical outcome measures of BETTER (Brain Injury Education, Training, and Therapy to Enhance Recovery), a culturally tailored traumatic brain injury (TBI) transitional care intervention, among diverse younger adult patients with TBI (age 18-64) and their caregivers. Trained clinical interventionists addressed patient/family needs; established goals; coordinated post-hospital care and resources; and provided patient/family training on self- and family-management coping skills. Fifteen dyads enrolled (N = 31, 15 patients, 16 caregivers). All completed baseline data; 74.2% (n = 23; 10 patients, 13 caregivers) completed 8-week data; 83.8% (n = 26; 13 each) completed 16-week data. Approximately 38% (n = 12, 3 patients, 9 caregivers) completed acceptability data, showing positive experiences (mean = 9.25, range 0-10; SD = 2.01). Overall and mental quality of life (QOL) scores did not differ over time but physical QOL scores did improve over time (baseline: 30.3, 8 weeks: 46.5, 16 weeks: 61.6; p = 0.0056), which was considered to be a suitable outcome measure for a future trial. BETTER is a promising intervention with implications to improve TBI care standards. Research is needed to determine efficacy in a randomized trial.
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Affiliation(s)
| | - Callan Loflin
- Duke University School of Nursing
- Duke University School of Medicine
| | | | | | - Melissa Kandel
- Duke University Health System, Department of Physical and Occupational Therapy
| | - Karen Johnson
- Duke University Health System, Department of Physical and Occupational Therapy
| | | | | | - Lindsey Byom
- University of North Carolina at Chapel Hill, Department of Allied Health Sciences
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Oyesanya TO, Ibemere SO, Loflin C, McReynolds V, Anaya B, Huang M, Gonzalez-Guarda R, Strauman TJ, Prvu Bettger J. "If you respect me, you are respecting my culture": methods and recommendations for personalizing a TBI transitional care intervention. Brain Inj 2023; 37:746-757. [PMID: 37144496 PMCID: PMC10330302 DOI: 10.1080/02699052.2023.2208881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 02/02/2023] [Accepted: 03/20/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Despite research, national legislation, and clinical guidelines supporting transitional care, there is minimal benefit from existing transitional care interventions for racial/ethnic minorities with traumatic brain injury (TBI) discharged home from acute hospital care. Existing TBI transitional care interventions are not tailored to address the needs/preferences of patients from various racial/ethnic minority groups. The purpose of this study was to describe use of personalization to tailor a TBI transitional care intervention for various racial/ethnic groups. DESIGN Following preliminary intervention manual development, a qualitative descriptive study was conducted using eight focus groups with 40 English-and Spanish-speaking participants (12 patients, 12 caregivers, and 16 providers). RESULTS Three personalization-related themes emerged: 1) what is important to me, 2) finding someone to deliver the intervention who can adapt to my needs, and 3) respect over culture. Findings informed personalization strategies within our final manual. CONCLUSIONS We recommend researchers who wish to use personalization to tailor interventions to consider: 1) allowing stakeholders to dictate what is most important and 2) implementing an iterative intervention development process with input from diverse stakeholders. Findings have implications for informing the development of transitional care interventions to increase the likelihood that interventions are inclusive of needs and preferences of various races/ethnicities.
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Affiliation(s)
- Tolu O Oyesanya
- Department of School of Nursing, Duke University, Durham, North Carolina, USA
| | - Stephanie O Ibemere
- Department of School of Nursing, Duke University, Durham, North Carolina, USA
| | - Callan Loflin
- Department of School of Nursing, Duke University, Durham, North Carolina, USA
- Department is Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Victoria McReynolds
- Department of School of Nursing, Duke University, Durham, North Carolina, USA
| | - Brian Anaya
- Department of School of Nursing, Duke University, Durham, North Carolina, USA
| | - Michelle Huang
- Department of School of Nursing, Duke University, Durham, North Carolina, USA
| | | | - Timothy J Strauman
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, USA
| | - Janet Prvu Bettger
- Department of School of Nursing, Duke University, Durham, North Carolina, USA
- Department is Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
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11
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Bohan JK, Nielsen M, Watter K, Kennedy A. "It gave her that soft landing": Consumer perspectives on a transitional rehabilitation service for adults with acquired brain injury. Neuropsychol Rehabil 2023; 33:1144-1173. [PMID: 35543026 DOI: 10.1080/09602011.2022.2070222] [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: 10/20/2021] [Accepted: 04/20/2022] [Indexed: 10/18/2022]
Abstract
Transitional rehabilitation service models for people with acquired brain injury (ABI) may address sub-optimal support for individuals returning home after hospitalization for ABI. This study investigated perspectives of people with ABI and close others who received transitional rehabilitation. A qualitative study involving semi-structured interviews with 10 individuals with ABI and 12 associated close others was conducted as part of a mixed-method evaluation of an Australian transitional rehabilitation service (TRS) pilot project. Thematic analysis based on the Framework method was conducted independently by two researchers. Three broad themes illustrated participants' experience of the TRS: (1) structure after hospital discharge; (2) a "soft landing"; and (3) equipped for community living. Findings suggest that home-based, interdisciplinary transitional rehabilitation after hospital discharge was perceived as an important stage of rehabilitation by participants. Valued features relate to post-hospital rehabilitation structure: a single point of contact to facilitate organization and information exchange, a known discharge destination, and consistent communication; support and therapy within a familiar home environment; and being equipped with relevant knowledge and strategies to manage ongoing challenges. Further research exploring the experiences of individuals with ABI without close family or social support, and research capturing longitudinal outcomes from transitional rehabilitation is recommended.
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Affiliation(s)
- Jaycie K Bohan
- Acquired Brain Injury Transitional Rehabilitation Service, Division of Rehabilitation,Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- School of Health and Rehabilitation Services, The University of Queensland, Brisbane, Australia
| | - Mandy Nielsen
- Acquired Brain Injury Transitional Rehabilitation Service, Division of Rehabilitation,Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Kerrin Watter
- Acquired Brain Injury Transitional Rehabilitation Service, Division of Rehabilitation,Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Areti Kennedy
- Acquired Brain Injury Transitional Rehabilitation Service, Division of Rehabilitation,Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
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Guldager R, Nordentoft S, Poulsen I, Aadal L, Loft MI. Wants and needs for involvement experienced by relatives of patients with an acquired brain injury: a scoping review. JBI Evid Synth 2022; 21:886-912. [PMID: 36729839 DOI: 10.11124/jbies-22-00022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This scoping review identifies and maps the breadth of available evidence on relatives' wants and needs for involvement in the care of patients with an acquired brain injury. INTRODUCTION Acquired brain injuries often occur suddenly and unexpectedly. Suffering from an acquired brain injury has major consequences, not only for the patients, due to the devastating impact on their physical, cognitive, social, and psychological well-being, but also for the relatives who may need to take on a lifelong role as carers. Research has cited some benefits of involving relatives in the care of patients, including positive effects on the patients' health outcomes; however, there are few studies showing how relatives can be involved. INCLUSION CRITERIA Studies that defined or assessed relatives' wants and needs for involvement with the care of patients with an acquired brain injury in all settings were included. Studies were included if they described any kind of wants and needs for involvement experienced from the perspective of relatives. The review considered all study designs, except for literature reviews. METHODS The JBI methodology for conducting a scoping review was employed in accordance with an a priori published protocol. An extensive search was conducted in MEDLINE (PubMed), CINAHL (EBSCO), and Embase (Ovid). Gray literature was searched using Grey Matters and BASE. The initial search was conducted in February 2020 and updated in September 2021. This review was limited to studies published in English, German, or Scandinavian languages since January 2010. The data were extracted using a data extraction tool (authors, year of publication, country of origin, setting, study methods, and findings related to wants and needs for involvement) created by the authors. The review findings are reported as a descriptive summary, with tables and figures supporting the data. RESULTS The search identified 3854 studies, 31 of which were included. The studies were published between 2010 and 2021 and were conducted across 9 countries. In total, 16 studies applied a qualitative study design, 4 studies used a descriptive approach, 4 studies used a quantitative research design, 4 studies reported using a mixed methods design, and 3 studies employed a multi-methods design. The studies were conducted across a variety of settings, ranging from acute care to home. The international literature on the involvement of relatives with patients with acquired brain injuries comprises multiple published studies on different aspects of the topic and within various care contexts. The findings identified few studies describing wants and needs experienced by relatives in relation to involvement in the patient's disease trajectory. CONCLUSIONS The findings show that relatives' wants and needs are primarily related to information and communication, but are also related to collaboration with health care professionals. The findings illustrate that the complexity of involvement is comprehensive, with multiple aspects to consider.
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Affiliation(s)
- Rikke Guldager
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
| | - Sara Nordentoft
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
| | - Ingrid Poulsen
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre Hospital Hvidovre, Denmark.,Research Unit Nursing and Health Care, Aarhus University, Aarhus, Denmark
| | - Lena Aadal
- Hammel Neurorehabilitation and Research Centre, Hammel, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mia Ingerslev Loft
- Research Unit Nursing and Health Care, Aarhus University, Aarhus, Denmark.,Department of Neurology, Rigshospitalet, Copenhagen, Denmark
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Oyesanya TO, Loflin C, You H, Kandel M, Johnson K, Strauman T, Yang Q, Hawes J, Byom L, Gonzalez-Guarda R, Van Houtven C, Agarwal S, Bettger JP. Design, methods, and baseline characteristics of the Brain Injury Education, Training, and Therapy to Enhance Recovery (BETTER) feasibility study: a transitional care intervention for younger adult patients with traumatic brain injury and caregivers. Curr Med Res Opin 2022; 38:697-710. [PMID: 35174756 PMCID: PMC9131748 DOI: 10.1080/03007995.2022.2043657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES We developed a patient- and family-centered traumatic brain injury (TBI) transitional care intervention, called BETTER (Brain Injury Education, Training, and Therapy to Enhance Recovery), to improve quality of life (via SF-36) of younger TBI patients of different racial groups discharged home from acute hospital care and caregivers. We describe our design, methods, and baseline characteristics for our feasibility study. METHODS We co-developed BETTER with input from key stakeholders (TBI patients and caregivers, healthcare providers, and interdisciplinary research team members). BETTER is guided by the Individual and Family Self-Management Theory, our team's prior research, as well as literature used to support, educate, and train patients and families recovering from TBI and other conditions. The intervention is delivered by trained clinical interventionists (transitional care managers), beginning 24-72 h pre-discharge to 16 weeks post-discharge. BETTER offers tailored transitional care support to patient/family dyads, including assessing needs; establishing goals; coordinating post-hospital care, services, and resources; and providing patient/family education and training on brain injury coping skills. The majority of the intervention is delivered remotely via phone and remote video conferencing platform (Clinicaltrials.gov: NCT04584554). RESULTS We enrolled 15 dyads (N = 31, 15 patients, 16 caregivers) in this single arm, single center feasibility study. Most patients were men (n = 11, 73.33%), had a mean age of 39.07 (SD: 15.15), and were Black (n = 9, 60%), White (n = 5, 33.3%), or American Indian (n = 1, 0.66%). Injury severities were mild (n = 6, 40%), moderate (n = 4, 26.6%) or severe (n = 5, 33.33%). Most patients were insured (n = 10; 66.7%), had a high school education (n = 6; 40%); and earned $30,000 or less per year (n = 11; 73.3%). Most caregivers were married (n = 9, 56.25%) women (n = 14, 87.5%) with a mean age of 43.38 (SD: 10.45) and were Black (n = 8, 50%), White (n = 7, 43.75%), or American Indian (n = 1, 0.62%). Most caregivers identified as the spouse (n = 7; 43.75%) or parent (n = 6; 37.5%) of the patient. CONCLUSIONS BETTER is among the first TBI transitional care intervention to address needs/preferences for younger TBI patients of different racial groups after discharge home from acute hospital care and families. Findings can be used to inform future work.
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Affiliation(s)
| | - Callan Loflin
- Duke University School of Nursing
- Duke University School of Medicine
| | | | - Melissa Kandel
- Duke University Health System, Department of Physical and Occupational Therapy
| | - Karen Johnson
- Duke University Health System, Department of Physical and Occupational Therapy
| | | | | | | | - Lindsey Byom
- University of North Carolina at Chapel Hill, Department of Allied Health Sciences
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Ahmed S, Archambault P, Auger C, Durand A, Fung J, Kehayia E, Lamontagne A, Majnemer A, Nadeau S, Pineau J, Ptito A, Swaine B. Biomedical Research & Informatics Living Laboratory for Innovative Advances of New Technologies in Community Mobility Rehabilitation: Protocol for a longitudinal evaluation of mobility outcomes (Preprint). JMIR Res Protoc 2022; 11:e12506. [PMID: 35648455 PMCID: PMC9201706 DOI: 10.2196/12506] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/02/2022] [Indexed: 01/23/2023] Open
Abstract
Background Rapid advances in technologies over the past 10 years have enabled large-scale biomedical and psychosocial rehabilitation research to improve the function and social integration of persons with physical impairments across the lifespan. The Biomedical Research and Informatics Living Laboratory for Innovative Advances of New Technologies (BRILLIANT) in community mobility rehabilitation aims to generate evidence-based research to improve rehabilitation for individuals with acquired brain injury (ABI). Objective This study aims to (1) identify the factors limiting or enhancing mobility in real-world community environments (public spaces, including the mall, home, and outdoors) and understand their complex interplay in individuals of all ages with ABI and (2) customize community environment mobility training by identifying, on a continuous basis, the specific rehabilitation strategies and interventions that patient subgroups benefit from most. Here, we present the research and technology plan for the BRILLIANT initiative. Methods A cohort of individuals, adults and children, with ABI (N=1500) will be recruited. Patients will be recruited from the acute care and rehabilitation partner centers within 4 health regions (living labs) and followed throughout the continuum of rehabilitation. Participants will also be recruited from the community. Biomedical, clinician-reported, patient-reported, and brain imaging data will be collected. Theme 1 will implement and evaluate the feasibility of collecting data across BRILLIANT living labs and conduct predictive analyses and artificial intelligence (AI) to identify mobility subgroups. Theme 2 will implement, evaluate, and identify community mobility interventions that optimize outcomes for mobility subgroups of patients with ABI. Results The biomedical infrastructure and equipment have been established across the living labs, and development of the clinician- and patient-reported outcome digital solutions is underway. Recruitment is expected to begin in May 2022. Conclusions The program will develop and deploy a comprehensive clinical and community-based mobility-monitoring system to evaluate the factors that result in poor mobility, and develop personalized mobility interventions that are optimized for specific patient subgroups. Technology solutions will be designed to support clinicians and patients to deliver cost-effective care and the right intervention to the right person at the right time to optimize long-term functional potential and meaningful participation in the community. International Registered Report Identifier (IRRID) PRR1-10.2196/12506
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Affiliation(s)
- Sara Ahmed
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Lethbridge-Layton-Mackay, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
- Center for Outcome Research and Evaluation, McGill University Health Center Research Institute, Montreal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
| | - Philippe Archambault
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
- Jewish Rehabilitation Hospital, Centre intégré de santé et de services sociaux de Laval, Laval, QC, Canada
| | - Claudine Auger
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Institut universitaire sur la réadaptation en déficience physique de Montréal, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Audrey Durand
- Computer Science and Software Engineering Department, Faculty of Science and Engineering, Université Laval, Quebec City, QC, Canada
| | - Joyce Fung
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
- Jewish Rehabilitation Hospital, Centre intégré de santé et de services sociaux de Laval, Laval, QC, Canada
| | - Eva Kehayia
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
- Jewish Rehabilitation Hospital, Centre intégré de santé et de services sociaux de Laval, Laval, QC, Canada
| | - Anouk Lamontagne
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
- Jewish Rehabilitation Hospital, Centre intégré de santé et de services sociaux de Laval, Laval, QC, Canada
| | - Annette Majnemer
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Center for Outcome Research and Evaluation, McGill University Health Center Research Institute, Montreal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
| | - Sylvie Nadeau
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Institut universitaire sur la réadaptation en déficience physique de Montréal, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Joelle Pineau
- School of Computer Science, McGill University, Montreal, QC, Canada
| | - Alain Ptito
- Department of Neurology and Neurosurgery, Faculty of Medicine, McGill University Health Centre Research Institute, Montreal, QC, Canada
| | - Bonnie Swaine
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Institut universitaire sur la réadaptation en déficience physique de Montréal, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
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Negotiating the transition from acute hospital care to home: perspectives of patients with traumatic brain injury, caregivers and healthcare providers. JOURNAL OF INTEGRATED CARE 2021. [DOI: 10.1108/jica-04-2021-0023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose is to explore experiences transitioning home from acute hospital care from perspectives of younger traumatic brain injury (TBI) patients, family caregivers and healthcare providers (HCPs).Design/methodology/approachThe authors conducted 54 qualitative interviews (N = 36: 12 patients, 8 caregivers, 16 HCPs) and analyzed data using conventional content analysis.FindingsThe transition from hospital to home was described as a negotiation, finding a way through these obstacles: (1) preparing for discharge home during acute hospital care; (2) navigating transitions in healthcare and health; (3) addressing recovery concerns, and (4) setting goals to return to normal. Factors influencing the negotiation process included social support, health-related knowledge or training, coping mechanisms, financial stability, and home environment stability.Originality/valueYounger TBI patients and caregivers have unique needs during the transition home from the hospital. Needed support from HCPs was inconsistently provided. Findings are foundational for integrated care research and practice with TBI.
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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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