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Faulkner JW, Callagher E, Snell D, Nielsen K, Cairncross M, Theadom A. Evaluation of a biopsychosocial education resource for mild traumatic brain injury: a mixed method exploratory study. Front Neurol 2024; 15:1429928. [PMID: 39268065 PMCID: PMC11390456 DOI: 10.3389/fneur.2024.1429928] [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: 05/13/2024] [Accepted: 08/15/2024] [Indexed: 09/15/2024] Open
Abstract
Introduction Education is strongly advocated as a key component of treatment for mild traumatic brain injury (mTBI) in clinical guidelines. However, there is mixed evidence on the benefit of education. This study aimed to evaluate a new education resource for mTBI. CLARITY is a freely available animated video based on a biopsychosocial conceptualization of mTBI, explaining the complex psychological, environmental and biological mechanisms behind symptoms and recovery. Methods 24 adults with a history of mTBI participated in this mixed method study to examine prior experience of mTBI education and to evaluate CLARITY. Following viewing of the education video participants' were invited to engage in a semi-structured interview and to share their perceptions of it via an online anonymous questionnaire. Results Thematic analysis of semi-structured interviews revealed one overarching theme: education is the foundation of recovery. Participants emphasised the critical role of coherent education in facilitating understanding, engagement in rehabilitation, and positive expectations during recovery. However, the first subtheme was that existing foundations are weak. Participants' previous education was often limited in scope, inconsistent, and delivered in inaccessible ways. The second subtheme was that new foundations are stronger. Participants responded positively to CLARITY, highlighting its explanatory biopsychosocial approach, focus on mental health factors and accessible delivery methods as key strengths. Questionnaire responses revealed favourable endorsement of CLARITY's utility, comprehensibility and accessibility. Discussion Recommendations for minor refinements to CLARITY were provided and made, as well as for its use in health care services.
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Affiliation(s)
- Josh W Faulkner
- Te Herenga Waka-Victoria University of Wellington, Wellington, New Zealand
| | - Elise Callagher
- Te Herenga Waka-Victoria University of Wellington, Wellington, New Zealand
| | - Deborah Snell
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Kristopher Nielsen
- Te Herenga Waka-Victoria University of Wellington, Wellington, New Zealand
| | - Molly Cairncross
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - Alice Theadom
- TBI Network, Auckland University of Technology, Auckland, New Zealand
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Ray S, Luke J, Kreitzer N. Patient-centered mild traumatic brain injury interventions in the emergency department. Am J Emerg Med 2024; 79:183-191. [PMID: 38460465 DOI: 10.1016/j.ajem.2024.02.038] [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: 12/12/2023] [Revised: 02/21/2024] [Accepted: 02/25/2024] [Indexed: 03/11/2024] Open
Abstract
INTRODUCTION Traumatic brain injury (TBI) results in 2.5 million emergency department (ED) visits per year in the US, with mild traumatic brain injury (mTBI) accounting for 90% of cases. There is considerable evidence that many experience chronic symptoms months to years later. This population is rarely represented in interventional studies. Management of adult mTBI in the ED has remained unchanged, without consensus of therapeutic options. The aim of this review was to synthesize existing literature of patient-centered ED treatments for adults who sustain an mTBI, and to identify practices that may offer promise. METHODS A systematic review was conducted using the PubMed and Cochrane databases, while following PRISMA guidelines. Studies describing pediatric patients, moderate to severe TBI, or interventions outside the ED were excluded. Two reviewers independently performed title and abstract screening. A third blinded reviewer resolved discrepancies. The Mixed Methods Appraisal Tool (MMAT) was employed to assess the methodological quality of the studies. RESULTS Our search strategy generated 1002 unique titles. 95 articles were selected for full-text screening. The 26 articles chosen for full analysis were grouped into one of the following intervention categories: (1) predictive models for Post-Concussion Syndrome (PCS), (2) discharge instructions, (3) pharmaceutical treatment, (4) clinical protocols, and (5) functional assessment. Studies that implemented a predictive PCS model successfully identified patients at highest risk for PCS. Trials implementing discharge related interventions found the use of video discharge instructions, encouragement of daily light exercise or bed rest, and text messaging did not significantly reduce mTBI symptoms. The use of electronic clinical practice guidelines (eCPG) and longer leaves of absence from work following injury reduced symptoms. Ondansetron was shown to reduce nausea in mTBI patients. Studies implementing ED Observation Units found significant declines in inpatient admissions and length of hospital stay. The use of tablet-based tasks was found to be superior to many standard cognitive assessments. CONCLUSION Validated instruments are available to aid clinicians in identifying patients at risk for PCS or serious cognitive impairment. EDOU management and evidence-based modifications to discharge instructions may improve mTBI outcomes. Additional research is needed to establish the therapeutic value of medications and lifestyle changes for the treatment of mTBI in the ED.
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Affiliation(s)
- Sarah Ray
- University of Cincinnati School of Medicine, USA
| | - Jude Luke
- University of Cincinnati School of Medicine, USA
| | - Natalie Kreitzer
- Department of Emergency Medicine, University of Cincinnati, USA.
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Sullivan K, Kinmond S, Singaravelu Jaganathan K. Postconcussion discharge advice does not improve concussion knowledge in a community sample. Inj Prev 2022; 28:507-512. [PMID: 35701109 DOI: 10.1136/injuryprev-2022-044593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/18/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Poor concussion knowledge in the community has been linked to reduced injury identification. This study investigated if concussion knowledge could be improved by providing standard postinjury advice (written brochure). METHODS This study was a prospective, controlled study, with random allocation of 199 Australian adults to receive either a concussion information (CI, n=101), or non-CI (n=98). All participants completed the Rosenbaum Concussion Knowledge and Attitudes Survey on three occasions: pre-education and posteducation, and 1 week later. RESULTS A 2 (condition) × 3 (occasion) mixed analysis of variance with concussion knowledge as the dependent variable did not find a statistically significant interaction (p>0.05). This result was unchanged: (1) with the covariate addition of background education and; (2) in a subgroup analysis (individuals with initially 'low' self-rated knowledge). Some key misconceptions about concussion were identified. CONCLUSION The community knowledge of concussion was not significantly improved by the concussion advice. Since injury recognition relies ton an extent on community knowledge, the identified misconceptions should be addressed. This could occur via public health messaging. In clinical settings and for future research, the next steps should also include regular updating of concussion information to keep pace with advances in the field.
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Affiliation(s)
- Karen Sullivan
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Sally Kinmond
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Kannan Singaravelu Jaganathan
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
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Abdul Rahman N'I, Nurumal MS, Awang MS, Mohd Shah ANS. Emergency department discharge instruction for mild traumatic brain injury: Evaluation on readability, understandability, actionability and content. Australas Emerg Care 2020; 23:240-246. [PMID: 32713770 DOI: 10.1016/j.auec.2020.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/31/2020] [Accepted: 06/20/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Emergency departments (EDs) routinely provide discharge instructions due to a large number of patients with mild traumatic brain injury (mTBI) being discharged home directly from ED. This study aims to evaluate the quality of available mTBI discharge instructions provided by EDs of Malaysia government hospitals. METHODS All 132 EDs were requested for a copy of written discharge instruction given to the patients. The mTBI discharge instructions were evaluated using the Patient Education Materials Assessment-Printable Tool (PEMAT-P) for understandability and actionability. Readability was measured using an online readability tool of Malay text. The content was compared against the discharge instructions recommended by established guidelines. RESULTS 49 articles were eligible for the study. 26 of the articles met the criteria of understandability, and 3 met the criteria for actionability. The average readability level met the ability of average adult. Most of the discharge instructions focused on emergency symptoms, and none contained post-concussion features. CONCLUSION Majority of the discharge instructions provided were appropriate for average people to read but difficult to understand and act upon. Important information was neglected in most discharge instructions. Thus, revision and future development of mTBI discharge instruction should consider health literacy demand and cognitive ability to process such information.
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Affiliation(s)
- Nurul 'Inayati Abdul Rahman
- Department of Critical Care Nursing, Kulliyyah (Faculty) of Nursing, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia.
| | - Mohd Said Nurumal
- Department of Critical Care Nursing, Kulliyyah (Faculty) of Nursing, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia
| | - Mohamed Saufi Awang
- Neurosurgery Unit, Department of Surgery, Kulliyyah (Faculty) of Medicine, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia
| | - Aida Nur Sharini Mohd Shah
- Department of Internal Medicine, Kulliyyah (Faculty) of Medicine, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia
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Hart T, Driver S, Sander A, Pappadis M, Dams-O'Connor K, Bocage C, Hinkens E, Dahdah MN, Cai X. Traumatic brain injury education for adult patients and families: a scoping review. Brain Inj 2018; 32:1295-1306. [PMID: 30084694 DOI: 10.1080/02699052.2018.1493226] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Traumatic brain injury (TBI) is increasingly viewed as a chronic condition, bringing long-term needs for patient and caregiver knowledge pertaining to symptom and problem management over time. In light of these needs, we performed a scoping review of the literature on brain injury education provided to adult patients and/ or family members affected by TBI. Objectives were to describe the types of educational interventions that have been developed; to review the effects of these interventions; and to determine gaps that might be filled by future research efforts. Of 88 articles meeting search criteria and subjected to data extraction, 34 concerned education about mild TBI and 54, moderate to severe TBI. Most mild TBI articles focused on education in the Emergency Room, while most moderate/ severe TBI education was directed toward family members/ caregivers and was frequently combined with other treatment components, making the effects of education difficult to discern. Only 1 article incorporated elements of self-management training (SMT), a model proved effective in other chronic health conditions. We recommend further exploration of SMT principles in long-term TBI care, as well as more precise definition of treatment components in all patient and family interventions, so that the specific effects of education and other treatment elements may be more readily evaluated.
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Affiliation(s)
- Tessa Hart
- a Moss Rehabilitation Research Institute , Elkins Park , PA , USA
| | - Simon Driver
- b Department of Rehabilitation Research , Baylor Scott and White Institute for Rehabilitation , Dallas , TX , USA
| | - Angelle Sander
- c Department of Physical Medicine and Rehabilitation , Baylor College of Medicine , Houston , TX , USA.,d Brain Injury Research Center , TIRR Memorial Hermann , Houston , TX , USA
| | - Monique Pappadis
- d Brain Injury Research Center , TIRR Memorial Hermann , Houston , TX , USA.,e Division of Rehabilitation Sciences, School of Health Professions , University of Texas Medical Branch at Galveston , TX , USA
| | - Kristen Dams-O'Connor
- f Department of Rehabilitation Medicine, Department of Neurology Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Claire Bocage
- g American Institutes for Research , Washington , DC , USA
| | - Emma Hinkens
- g American Institutes for Research , Washington , DC , USA
| | - Marie N Dahdah
- b Department of Rehabilitation Research , Baylor Scott and White Institute for Rehabilitation , Dallas , TX , USA.,h Department of Medical Psychology , Baylor Scott and White Medical Center , Plano , TX , USA
| | - Xinsheng Cai
- g American Institutes for Research , Washington , DC , USA
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Thomas DG, Bradley L, Servi A, Reilly S, Niskala Apps J, McCrea M, Hammeke T. Parental Knowledge and Recall of Concussion Discharge Instructions. J Emerg Nurs 2017; 44:52-56. [PMID: 28527643 DOI: 10.1016/j.jen.2017.04.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 03/31/2017] [Accepted: 04/12/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Children increasingly are being seen in the emergency department for a concussion, or mild traumatic brain injury (mTBI). A key aim of the ED visit is to provide discharge advice that can help parents to identify an evolving neurosurgical crisis, facilitate recovery, and prevent reinjury. The present study examined parents' knowledge of symptoms and recall of discharge instructions after their adolescent's mTBI and the effect of supplementing written discharge instructions with verbal instruction and reinforcement. METHODS We performed a nested observational study of parents/caregivers of patients who participated in a larger mTBI study. After their adolescent's mTBI, parents were given verbal and standardized written instructions. The ED discharge process was observed using a structured checklist, and parents were surveyed 3 days after discharge on knowledge and recall of discharge instructions. RESULTS Ninety-three parents completed the postsurvey. Nearly 1 in 5 parents were confused about when to return to the emergency department after evaluation for head injury. Up to 1 in 4 parents could not recall specific discharge advice related to concussion. Parents who received verbal reinforcement of written discharge instructions were more likely to recall them. CONCLUSION Emergency nurses and clinicians should strive to utilize both verbal and written discharge instructions with families to help increase understanding.
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