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Chan V, Estrella MJ, Syed S, Lopez A, Shah R, Colclough Z, Babineau J, Beaulieu-Dearman Z, Colantonio A. Rehabilitation among individuals with traumatic brain injury who intersect with the criminal justice system: A scoping review. Front Neurol 2023; 13:1052294. [PMID: 36733443 PMCID: PMC9886883 DOI: 10.3389/fneur.2022.1052294] [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: 09/23/2022] [Accepted: 12/02/2022] [Indexed: 01/18/2023] Open
Abstract
Traumatic brain injury (TBI), a leading cause of morbidity and mortality globally, is highly prevalent among individuals who intersect with the criminal justice system (CJS). It is well-established that TBI negatively impacts individuals' interactions both within the CJS and upon release and is associated with serious disciplinary charges and higher recidivism rates. Although rehabilitation is fundamental to TBI recovery, it is not known to what extent rehabilitation is available to, or used by, individuals who intersect with the CJS. This scoping review explores the availability and extent of rehabilitation for individuals with TBI who intersect with the CJS, based on available literature. A systematic search of electronic databases (MEDLINE, Embase, Cochrane CENTRAL Register of Clinical Trials, CINAHL, APA PsycINFO, Applied Social Sciences Index and Abstracts, and Proquest Nursing and Allied Health), relevant organizations' websites, and reference lists of eligible articles identified 22 peer-reviewed articles and 2 gray literature reports that met predetermined eligibility criteria. Extracted data were synthesized through a descriptive numerical summary and qualitative content analysis. This review provides evidence that existing rehabilitation interventions are already serving individuals with TBI with a history of CJS involvement; however, they rarely consider or acknowledge TBI or CJS in their interventions. Findings also suggest opportunities to integrate rehabilitation for individuals with TBI who intersect with the CJS through TBI screening, education on TBI within CJS settings, and linkages to the community to facilitate continuity of care. This review also highlights significant gaps in knowledge regarding sex, gender, and other intersecting factors. Research to understand how these experiences impact the rehabilitation process throughout the CJS is urgently needed to enable timely and appropriate rehabilitation and continuity of care for diverse individuals with TBI who intersect with the CJS.
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Affiliation(s)
- Vincy Chan
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada,*Correspondence: Vincy Chan ✉
| | - Maria Jennifer Estrella
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Shazray Syed
- Department of Biology, University of Toronto, Mississauga, ON, Canada
| | - Allison Lopez
- Department of Biology, University of Toronto, Mississauga, ON, Canada
| | - Riya Shah
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Zoe Colclough
- Department of Forensic Science, University of Toronto, Mississauga, ON, Canada
| | - Jessica Babineau
- Library and Information Services, University Health Network, Toronto, ON, Canada,The Institute for Education Research, University Health Network, Toronto, ON, Canada
| | | | - Angela Colantonio
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Chan V, Estrella MJ, Beaulieu-Dearman Z, Babineau J, Colantonio A. Protocol for a scoping review on rehabilitation among individuals with traumatic brain injury who intersect with the criminal justice system. PLoS One 2022; 17:e0269696. [PMID: 35771837 PMCID: PMC9246198 DOI: 10.1371/journal.pone.0269696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 05/25/2022] [Indexed: 11/20/2022] Open
Abstract
Traumatic brain injury (TBI), a leading cause of both death and disability worldwide, is highly prevalent among individuals who intersect with the criminal justice system. TBI is associated with increased behavioural, psychological, or negative outcomes, such as higher rates of mental health problems, aggression, and violent offending that may lead to negative interactions with the criminal justice system, reincarceration, and recidivism. Although rehabilitation is often recommended and holds promise in addressing TBI-related impairments, there is currently a paucity of reviews on rehabilitation for individuals with TBI who intersect with the criminal justice system (CJS). Concurrently, to the best of our knowledge, there is currently no review that considers rehabilitation among individuals with TBI who intersect with all parts of the CJS (i.e., policing, courts, corrections, and parole). This protocol is for a scoping review to address the above gaps, specifically, to identify the types of rehabilitation interventions and/or programs available to, or used by, individuals with TBI who intersect with all parts of the CJS. Primary research articles that meet pre-defined inclusion criteria will be identified from electronic databases (MEDLINE® ALL, Embase and Embase Classic, Cochrane CENTRAL Register of Clinical Trials, CINAHL, APA PsycINFO, Applied Social Sciences Index and Abstracts, Criminal Justice Abstracts, Nursing and Allied Health, and Dissertation and These Global), reference lists of included articles, and scoping or systematic reviews. Grey literature will also be searched to identify non-peer-reviewed reports. Retrieved articles will be screened by two reviewers and any disagreements will be resolved by a third reviewer. Data will be summarized quantitatively and analyzed using content analytic techniques. Intersecting identities will be charted and considered in the analysis. Stakeholders will be engaged to obtain feedback on preliminary results and the implications of findings. The scoping review will summarize the current state of rehabilitation available to, or used by, individuals with TBI who intersect with all parts of the CJS to (a) inform opportunities to integrate rehabilitation in the criminal justice system for diverse individuals and (b) identify opportunities for future research.
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Affiliation(s)
- Vincy Chan
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
| | - Maria Jennifer Estrella
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | | | - Jessica Babineau
- Library & Information Services, University Health Network, Toronto, Ontario, Canada
- The Institute for Education Research, University Health Network, Toronto, Ontario, Canada
| | - Angela Colantonio
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
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Measuring Community Integration: Development and Psychometrics of the Community Connections and Engagement Scale. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 48:619-632. [PMID: 33128094 DOI: 10.1007/s10488-020-01095-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2020] [Indexed: 10/23/2022]
Abstract
The objective of this community-based participatory research project was to develop a clinically useful, psychometrically-sound scale to measure community integration for adults with severe mental illness. Two researchers and an administrator of a behavioral health agency (BHA) recruited a group of providers, half with lived-experience of severe mental illness. Through a series of five focus groups, provider participants guided identification of four major domains of community integration and the development of 95 scale items; items and domains were reviewed by three external researchers with subject matter expertise. Initial pilot: BHA providers administered the scale to clients (n = 51) with 19 completing it twice to investigate internal consistency, test-retest reliability, and restricted variance and collinearity of items. Further piloting: providers at two BHAs administered the scale to clients (n = 178) to conduct exploratory factor analysis and analyze internal consistency. After initial pilot, 50 items remained post item reduction for restricted variance and collinearity, with Cronbach's alpha of .95 and test-retest reliability of .90. After a larger pilot, a four-factor solution emerged, aligning conceptually with the four domains as anticipated; 33 items loaded (factor loadings ≥ .4), with RMSEA of .069 and overall Cronbach's alpha of .89 (subdomains ranging .78-.86). The scale has good preliminary psychometric properties and appears to be feasible for use in BHAs for the purposes of research and evaluation, with clinical utility for assessment and treatment planning.
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Hawley L, Hammond FM, Cogan AM, Juengst S, Mumbower R, Pappadis MR, Waldman W, Dams-OʼConnor K. Ethical Considerations in Chronic Brain Injury. J Head Trauma Rehabil 2020; 34:433-436. [PMID: 31688380 PMCID: PMC6986275 DOI: 10.1097/htr.0000000000000538] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A growing number of individuals are living with chronic traumatic brain injury. As these individuals and their families attempt to reintegrate into their communities, several ethical questions arise for clinicians and researchers. These include issues around alignment of perspectives and priorities, as well as responsibilities for ongoing treatment, education, community outreach, and research. An action plan for addressing these questions is outlined.
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Affiliation(s)
- Lenore Hawley
- Craig Hospital, Englewood, Colorado (Ms Hawley); Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine and Rehabilitation Hospital of Indiana, Indianapolis (Dr Hammond); Washington DC VA Medical Center, Washington, District of Columbia (Dr Cogan); Physical Medicine & Rehabilitation, UT Southwestern Medical Center, Dallas, Texas (Dr Juengst); Capstone College of Nursing, The University of Alabama, Tuscaloosa (Dr Mumbower); Division of Rehabilitation Sciences, School of Health Professions, The University of Texas Medical Branch, Galveston and Brain Injury Research Center, TIRR Memorial Hermann, Houston (Dr Pappadis); Resource Facilitation Program, RHI-Neuro Rehab Center, Indianapolis, Indiana (Ms Waldman); and Brain Injury Research Center, Department of Rehabilitation Medicine, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (Dr Dams-O'Connor)
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Crosscultural Validation of the Community Integration Questionnaire-Revised in an Italian Population. Occup Ther Int 2020; 2020:8916541. [PMID: 32934614 PMCID: PMC7481919 DOI: 10.1155/2020/8916541] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/10/2020] [Indexed: 12/14/2022] Open
Abstract
Objective The aims of this study are the translation, cultural adaptation, and validation of the Community Integration Questionnaire–Revised (CIQ-R) in Italian in a group of individuals with no clinical evidence of disability. Methods The test's internal consistency and validity were assessed by following international guidelines. The test's internal consistency was examined using Cronbach's alpha (α) coefficient. Pearson's correlation coefficient was calculated to assess the test's concurrent validity compared with the Short Form-12 (SF-12) health survey. Results The CIQ-R was administrated to 400 people with no clinical evidence of disease, impairment, or disability, aged between 18 and 64. Cronbach's α reported a value of 0.82 in the home integration subscale. The test also showed a good test-retest reliability, with an Intraclass Correlation Coefficient of 0.78, and a significant correlation between the total score of the CIQ-R and the Physical Component Summary (PCS) of the SF-12 (r = 0.118), between the “social integration” subscale's score and PCS12 (r = 0.121) and between the “Electronic Social Networking integration” subscale's score and PCS12 (r = 0.184), with p < 0.05. Conclusion This is the first study to report the results of the translation and validation of the CIQ-R in Italian. The CIQ-R is an important tool for Italian professionals and can be useful in both clinical practice and research for measuring the level of community integration among the healthy population.
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Razaob NA, Tham SY, Mohd Rasdi HF, Wan Yunus F, Kadar M. Translation, Validation and Reliability Testing of Community Integration Questionnaire-Revised (CIQ-R) Malay Version: A Preliminary Study. Occup Ther Health Care 2020; 34:32-47. [PMID: 31920126 DOI: 10.1080/07380577.2020.1712632] [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: 10/25/2022]
Abstract
The Community Integration Questionnaire-Revised (CIQ-R) is a self-report standardized instrument designed to assess an individual's degree of community integration. The aim of this study was to translate, validate and conduct a reliability test of the CIQ-R Malay version. The development involved the three phases of translation, content validation and cognitive interviewing, test-retest reliability and internal consistency of the CIQ-R Malay version. The Content Validity Index (CVI) showed perfect agreement between the panel experts. The Intra-class Correlation Coefficient (ICC) demonstrated a moderate to excellent level of test-retest agreement (ICC 0.72 to 0.93). The Total CIQ-R Malay version and Home Integration subscale showed good internal consistency, with values of Cronbach's alpha ranging from 0.81 to 0.90. The findings from the present study provided preliminary support for the psychometric properties of the CIQ-R Malay version as a valid and reliable instrument to be used in Malaysia.
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Affiliation(s)
- Nor Afifi Razaob
- Occupational Therapy Programme, Centre for Rehabilitation & Special Needs, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Si Yan Tham
- Occupational Therapy Programme, Centre for Rehabilitation & Special Needs, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.,Tan Tock Seng Hospital, Singapore, Singapore
| | - Hanif Farhan Mohd Rasdi
- Occupational Therapy Programme, Centre for Rehabilitation & Special Needs, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Farahiyah Wan Yunus
- Occupational Therapy Programme, Centre for Rehabilitation & Special Needs, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Masne Kadar
- Occupational Therapy Programme, Centre for Rehabilitation & Special Needs, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Chen YJ, Huang YZ, Chen CY, Chen CL, Chen HC, Wu CY, Lin KC, Chang TL. Intermittent theta burst stimulation enhances upper limb motor function in patients with chronic stroke: a pilot randomized controlled trial. BMC Neurol 2019; 19:69. [PMID: 31023258 PMCID: PMC6485156 DOI: 10.1186/s12883-019-1302-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 04/11/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Intermittent theta burst stimulation (iTBS) is a form of repetitive transcranial stimulation that has been used to enhance upper limb (UL) motor recovery. However, only limited studies have examined its efficacy in patients with chronic stroke and therefore it remains controversial. METHODS This was a randomized controlled trial that enrolled patients from a rehabilitation department. Twenty-two patients with first-ever chronic and unilateral cerebral stroke, aged 30-70 years, were randomly assigned to the iTBS or control group. All patients received 1 session per day for 10 days of either iTBS or sham stimulation over the ipsilesional primary motor cortex in addition to conventional neurorehabilitation. Outcome measures were assessed before and immediately after the intervention period: Modified Ashworth Scale (MAS), Fugl-Meyer Assessment Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), Box and Block test (BBT), and Motor Activity Log (MAL). Analysis of covariance was adopted to compare the treatment effects between groups. RESULTS The iTBS group had greater improvement in the MAS and FMA than the control group (η2 = 0.151-0.233; p < 0.05), as well as in the ARAT and BBT (η2 = 0.161-0.460; p < 0.05) with large effect size. Both groups showed an improvement in the BBT, and there were no significant between-group differences in MAL changes. CONCLUSIONS The iTBS induced greater gains in spasticity decrease and UL function improvement, especially in fine motor function, than sham TBS. This is a promising finding because patients with chronic stroke have a relatively low potential for fine motor function recovery. Overall, iTBS may be a beneficial adjunct therapy to neurorehabilitation for enhancing UL function. Further larger-scale study is warranted to confirm the findings and its long-term effect. TRIAL REGISTRATION This trial was registered under ClinicalTrials.gov ID No. NCT01947413 on September 20, 2013.
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Affiliation(s)
- Yu-Jen Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, 5, Fushing Street, Kuei-Shan District, Taoyuan City, 33305, Taiwan
| | - Ying-Zu Huang
- Neuroscience Research Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou, Taiwan.,Institute of Cognitive Neuroscience, National Central University, Taoyuan, Taiwan.,Medical School, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Yao Chen
- Medical School, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chia-Ling Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, 5, Fushing Street, Kuei-Shan District, Taoyuan City, 33305, Taiwan. .,Graduate Institute of Early Intervention, Chang Gung University, Taoyuan, Taiwan.
| | - Hsieh-Ching Chen
- Department of Industrial and Management, National Taipei University of Technology, Taipei, Taiwan
| | - Ching-Yi Wu
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, 5, Fushing Street, Kuei-Shan District, Taoyuan City, 33305, Taiwan.,Department of Occupational Therapy, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Keh-Chung Lin
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Tzu-Ling Chang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, 5, Fushing Street, Kuei-Shan District, Taoyuan City, 33305, Taiwan
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A qualitative study of LoveYourBrain Yoga: a group-based yoga with psychoeducation intervention to facilitate community integration for people with traumatic brain injury and their caregivers. Disabil Rehabil 2019; 42:2482-2491. [PMID: 30741032 DOI: 10.1080/09638288.2018.1563638] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To explore participants' experiences in a group-based yoga with psychoeducation intervention designed to facilitate community integration for people with traumatic brain injury and their caregivers.Materials and methods: We conducted semi-structured interviews with 13 people with traumatic brain injury and three caregivers who had completed LoveYourBrain Yoga, a 6-session, manualized, group-based yoga intervention that incorporates breathing exercises, yoga, meditation, and psychoeducation. Interviews were analyzed using content analysis.Results: We identified seven themes: ease of participation, belonging, sustaining community connection, physical health, self-regulation, self-efficacy, and resilience. All participants valued the community-based yoga studio environment and multifaceted structure of the program. Participants reported improvements in strength, balance, flexibility, and attention control, and a greater sense of belonging, community connection, and ability to move forward with their lives. Participants reported ongoing use of tools (e.g., breathing exercises) to cope with negative emotions and stress. About half of participants sustained relationships built during LoveYourBrain Yoga and felt more capable of accessing other activities in their community.Conclusions: LoveYourBrain Yoga successfully promoted community integration for people with traumatic brain injury. It also facilitated diverse and meaningful physical, psychological, and social health benefits, which suggest that it may be an effective mode of community-based rehabilitation.Implications for rehabilitationTraumatic brain injury survivors often struggle to participate in their community, the ultimate goal of rehabilitationYoga is a holistic therapy with many benefits, yet is not accessible to the traumatic brain injury population at the community levelParticipants in a community-based yoga with psychoeducation intervention in six states experienced diverse and meaningful physical, psychological, and social health benefitsGroup-based yoga with psychoeducation may be an effective mode of community integration and community-based rehabilitation for traumatic brain injury survivors.
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Mas MF, Mathews A, Gilbert-Baffoe E. Rehabilitation Needs of the Elder with Traumatic Brain Injury. Phys Med Rehabil Clin N Am 2018; 28:829-842. [PMID: 29031347 DOI: 10.1016/j.pmr.2017.06.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The incidence of traumatic brain injury (TBI) in older adults is increasing. As the expected life expectancy increases, there is a heightened need for comprehensive rehabilitation for this population. Elderly patients with TBI benefit from rehabilitation interventions at all stages of injury and can achieve functional gains during acute inpatient rehabilitation. Clinicians should be vigilant of unique characteristics of this population during inpatient rehabilitation, including vulnerability to polypharmacy, posttraumatic hydrocephalus, neuropsychiatric sequelae, sleep disturbances, and sensory deficits. Long-term care should include fall prevention, assessment of cognitive deficits, aerobic activity, community reintegration, and caretaker support. Life expectancy is reduced after TBI.
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Affiliation(s)
- Manuel F Mas
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, The University of Texas Health Science Center at Houston, TIRR Memorial Hermann, 1333 Moursund Street, Houston, TX 77030, USA.
| | - Amy Mathews
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, 7200 Cambridge Street, Suite 10C, Houston, TX 77030, USA
| | - Ekua Gilbert-Baffoe
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, 7200 Cambridge Street, Suite 10C, Houston, TX 77030, USA
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Rosario ER, Espinoza L, Kaplan S, Khonsari S, Thurndyke E, Bustos M, Vickers K, Navarro B, Scudder B. Patient navigation for traumatic brain injury promotes community re-integration and reduces re-hospitalizations. Brain Inj 2017. [PMID: 28650255 DOI: 10.1080/02699052.2017.1325937] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To determine the effectiveness of a Navigation programme for patients with traumatic brain injury. DESIGN Prospective programme evaluation. SETTING Inpatient rehabilitation facility and community settings. PARTICIPANTS Eighteen individuals who suffered a traumatic brain injury (TBI), were between the ages of 16-70 years, and had a Rancho Score greater than IV. INTERVENTION Patient navigation programme focused on identifying and addressing barriers to positive outcomes, including coordination of care and facilitating communication among the family and healthcare providers, psychosocial support, caregiver support, adherence to treatment, education, community resources and financial issues. MAIN OUTCOME MEASURES Functional status, re-hospitalizations, falls, neurobehavioral symptom inventory, neuroendocrine status, activities of daily living, community integration and caregiver burden. RESULTS There was a significant reduction in re-hospitalization and fall rate when comparing individuals who received navigation services and those who did not. We also observed improved adherence treatment plans and a significant increase in community integration, independence level and functional abilities. CONCLUSIONS This study begins to highlight the effectiveness of a patient navigation programme for individuals with TBI. Future research with a larger sample will continue to help us refine patient navigation for chronic disabling conditions and determine its sustainability.
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Affiliation(s)
- Emily R Rosario
- a Casa Colina Hospital and Centers for Healthcare, Research Institute , Pomona , CA , USA
| | - Laura Espinoza
- a Casa Colina Hospital and Centers for Healthcare, Research Institute , Pomona , CA , USA
| | - Stephanie Kaplan
- a Casa Colina Hospital and Centers for Healthcare, Research Institute , Pomona , CA , USA
| | - Sepehr Khonsari
- a Casa Colina Hospital and Centers for Healthcare, Research Institute , Pomona , CA , USA
| | - Earl Thurndyke
- a Casa Colina Hospital and Centers for Healthcare, Research Institute , Pomona , CA , USA
| | | | | | | | - Bonnie Scudder
- a Casa Colina Hospital and Centers for Healthcare, Research Institute , Pomona , CA , USA
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Gerber GJ, Gargaro J, McMackin S. Community integration and health-related quality-of-life following acquired brain injury for persons living at home. Brain Inj 2016; 30:1552-1560. [PMID: 27564085 DOI: 10.1080/02699052.2016.1199896] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PRIMARY OBJECTIVE To study predictors of community integration (CI) and health-related quality-of-life (HRQoL) in a sample of Canadian adult, urban, multi-ethnic persons with acquired brain injury (ABI) receiving publicly-funded community services. Hypothesis 1 examined the predictive utility of age, ratings of disability, functioning and cognition for CI and HRQoL. Hypothesis 2 examined the correlation between CI and HRQoL. RESEARCH DESIGN Cohort study. METHODS AND PROCEDURES A convenience sample of community-residing clients completed measures with their care co-ordinators: Resident Assessment Instrument-Home Care (RAI-HC), Disability Rating Scale (DRS), Community Integration Questionnaire (CIQ) and the Quality-of-Life after Brain Injury Instrument (QOLIBRI). RESULTS Regression analysis showed DRS scores explained significant variance in CIQ and QOLIBRI. Correlations also showed that cognitive skill and ADL/IADL functioning are strongly related to CI and the Daily life and autonomy QOLIBRI sub-scale. The CIQ Total was not correlated with QOLIBRI Total, although there were some significant correlations between the CIQ social sub-scale and QOLIBRI. CONCLUSIONS Lesser degree of disability is a key predictor of greater CI and QoL. The present findings suggest that rehabilitation efforts should focus on minimizing disability and promoting social integration and involvement to avoid adverse long-term effects of ABI for community-resident persons.
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Affiliation(s)
- Gary J Gerber
- a West Park Healthcare Centre , Toronto , ON , Canada
| | - Judith Gargaro
- a West Park Healthcare Centre , Toronto , ON , Canada.,b Toronto Central Community Access Centre , Toronto , ON , Canada
| | - Sally McMackin
- b Toronto Central Community Access Centre , Toronto , ON , Canada
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Curran C, Dorstyn D, Polychronis C, Denson L. Functional outcomes of community-based brain injury rehabilitation clients. Brain Inj 2016; 29:25-32. [PMID: 25180709 DOI: 10.3109/02699052.2014.948067] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Community-based rehabilitation can help to maximize function following acquired brain injury (ABI); however, data on treatment outcome is limited in quantity. OBJECTIVE To describe and evaluate client outcomes of an outpatient programme for adults with moderate-to-severe traumatic and non-traumatic ABI. METHODS Two phase design involving retrospective and longitudinal study of programme completers with ABI (n = 47). Changes in functioning were measured with the Mayo-Portland Inventory (MPAI-4), administered pre- and immediately post-rehabilitation and at 3 years follow-up. Self-ratings were supplemented with MPAI-4 data from significant others (n = 32) and staff (n = 32). RESULTS Injured individuals and informants reported improved physical and psychosocial functioning immediately following the completion of community rehabilitation, with medium-to-large and significant treatment gains noted on the MPAI-4 ability, adjustment and participation sub-scales (Cohen's d range = 0.31-1.10). A deterioration in individuals' adjustment was further reported at follow-up, although this was based on limited data. Issues with longer-term rehabilitation service provision were additionally noted. CONCLUSIONS The data support the need for continuity of care, including ongoing emotional support, to cater to the complex and dynamic needs of the ABI population. However, these results need to be considered in the context of a small sample size and quasi-experimental design.
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Affiliation(s)
- Christine Curran
- a School of Psychology, Faculty of Health Sciences, University of Adelaide , Adelaide , South Australia , Australia and
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Expérience de fréquentation des lieux publics par des personnes âgées ayant subi un TCC en présence d'un accompagnateur-citoyen: projet pilote. Can J Aging 2016; 35:229-41. [PMID: 27223579 DOI: 10.1017/s0714980816000180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This pilot project aims to test and see the relevance of the direct observation method to collect data on the barriers and facilitators to attending public places by seniors with TBI. The study is based on the conceptual framework VADA WHO which focuses on the development of friendly built and technological environments for seniors. Three elderly people participated in the study, recruited from an ongoing project, The Citizen Intervention in Community Living (APIC), in the presence of their personalized attendant. The study shows the feasibility of the method in terms of its acceptability and resources mobilized. It shows its relevance to access additional data that would have been difficult to obtain using others methods (e.g., semi-structured interview), such as the identification of the strategies used by the participants to address the obstacles encountered (avoidance, travel planning, use of physical and preventative support of the personalized attendant).
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Callaway L, Winkler D, Tippett A, Herd N, Migliorini C, Willer B. The Community Integration Questionnaire - Revised: Australian normative data and measurement of electronic social networking. Aust Occup Ther J 2016; 63:143-53. [PMID: 27072343 DOI: 10.1111/1440-1630.12284] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND/AIM Consideration of the relationship between meaningful participation, health and wellbeing underpins occupational therapy intervention, and drives measurement of community integration following acquired brain injury (ABI). However, utility of community integration measures has been limited to date by lack of normative data against which to compare outcomes, and none examine the growing use of electronic social networking (ESN) for social participation. This research had four aims: (i) develop and pilot items assessing ESN to add to the Community Integration Questionnaire, producing the Community Integration Questionnaire-Revised (CIQ-R); (ii) examine factor structure of the CIQ-R; (iii) collect Australian CIQ-R normative data; and (iv) assess test-retest reliability of the revised measure. METHODS SETTING Australia. PARTICIPANTS A convenience sample of adults without ABI (N = 124) was used to develop and pilot ESN items. A representative general population sample of adults without ABI aged 18-64 years (N = 1973) was recruited to gather normative CIQ-R data. DESIGN Cross-sectional survey. MAIN MEASURES Demographic items and the CIQ-R. RESULTS The CIQ-R demonstrated acceptable psychometric properties, with minor modification to the original scoring based on the factor analyses provided. Large representative general population CIQ-R normative data have been established, detailing contribution of a range of independent demographic variables to community integration. CONCLUSION The addition of electronic social networking items to the CIQ-R offers a contemporary method of assessing community integration following ABI. Normative CIQ-R data enhance the understanding of community integration in the general population, allowing occupational therapists and other clinicians to make more meaningful comparisons between groups.
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Affiliation(s)
- Libby Callaway
- Department of Occupational Therapy, Monash University, Frankston, Victoria, Australia
| | | | - Alice Tippett
- Summer Foundation Ltd, Blackburn, Victoria, Australia
| | - Natalie Herd
- Empirica Research, Melbourne, Victoria, Australia
| | - Christine Migliorini
- Department of Occupational Therapy, Monash University, Frankston, Victoria, Australia
| | - Barry Willer
- Department of Psychiatry Medicine, University at Buffalo, Buffalo, New York, USA
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Powell JM, Rich TJ, Wise EK. Effectiveness of Occupation- and Activity-Based Interventions to Improve Everyday Activities and Social Participation for People With Traumatic Brain Injury: A Systematic Review. Am J Occup Ther 2016; 70:7003180040p1-9. [DOI: 10.5014/ajot.2016.020909] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
This systematic review presents research on the effectiveness of occupation- and activity-based interventions to improve everyday activities and areas of occupation and social participation for people with traumatic brain injury (TBI). Nineteen studies identified through a comprehensive database search were reviewed and synthesized into five themes: (1) multidisciplinary and interdisciplinary treatment approaches, (2) community-based rehabilitation programs, (3) treatment approaches using client-centered goals and relevant contexts, (4) social skills training and peer mentoring interventions, and (5) community mobility interventions. Evidence supports the use of multidisciplinary and interdisciplinary approaches across a variety of settings, with no single treatment approach or setting clearly superior to another. The specific contributions of occupational therapy practitioners and the nature of occupational therapy interventions have not been well studied, making it difficult to determine the extent to which occupation- and activity-based interventions provided by occupational therapy practitioners improve occupational performance and social participation after TBI.
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Affiliation(s)
- Janet M. Powell
- Janet M. Powell, PhD, OTR/L, FAOTA, is Associate Professor and Head, Division of Occupational Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle;
| | - Timothy J. Rich
- Timothy J. Rich, MOT, OTR/L, is Doctoral Student, PhD in Rehabilitation Science Program, University of Washington, and Occupational Therapist, Harborview Medical Center, Seattle, WA
| | - Elizabeth K. Wise
- Elizabeth K. Wise, MOT, OTR/L, is Occupational Therapist, Bonner General Health, Sandpoint, ID
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Stephens JA, Williamson KNC, Berryhill ME. Cognitive Rehabilitation After Traumatic Brain Injury: A Reference for Occupational Therapists. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2015; 35:5-22. [PMID: 26623474 DOI: 10.1177/1539449214561765] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Nearly 1.7 million Americans sustain a traumatic brain injury (TBI) each year. These injuries can result in physical, emotional, and cognitive consequences. While many individuals receive cognitive rehabilitation from occupational therapists (OTs), the interdisciplinary nature of TBI research makes it difficult to remain up-to-date on relevant findings. We conducted a literature review to identify and summarize interdisciplinary evidence-based practice targeting cognitive rehabilitation for civilian adults with TBI. Our review summarizes TBI background, and our cognitive remediation section focuses on the findings from 37 recent (since 2006) empirical articles directly related to cognitive rehabilitation for individuals (i.e., excluding special populations such as veterans or athletes). This manuscript is offered as a tool for OTs engaged in cognitive rehabilitation and as a means to highlight arenas where more empirical, interdisciplinary research is needed.
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Jackson D, McCrone P, Mosweu I, Siegert R, Turner-Stokes L. Service use and costs for people with long-term neurological conditions in the first year following discharge from in-patient neuro-rehabilitation: a longitudinal cohort study. PLoS One 2014; 9:e113056. [PMID: 25401992 PMCID: PMC4234538 DOI: 10.1371/journal.pone.0113056] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 10/18/2014] [Indexed: 11/18/2022] Open
Abstract
Background Knowledge of the configuration and costs of community rehabilitation and support for people with long-term neurological conditions (LTNCs) is needed to inform future service development and resource allocation. In a multicentre prospective cohort study evaluating community service delivery during the year post-discharge from in-patient neuro-rehabilitation, a key objective was to determine service use, costs, and predictors of these costs. Methods Patients consecutively admitted over one year to all nine London specialised (Level 1) in-patient neuro-rehabilitation units were recruited on discharge. They or their carers completed postal/web-based questionnaires at discharge and six and twelve months later, providing demographic data and measures of impairment, disability, service needs and provision. This paper describes health and social care service use, informal care and associated costs. Regression models using non-parametric boot-strapping identified predictors of costs over time. Results Overall, 152 patients provided consistent data. Mean formal service costs fell significantly from £13,290 (sd £19,369) during the first six months to £9,335 (sd £19,036) from six-twelve months, (t = 2.35, P<0.05), mainly due to declining health service use. At six months, informal care was received on average for 8.2 hours/day, mean cost £14,615 (sd 23,305), comprising 52% of overall care costs. By twelve months, it had increased to 8.8 hours per day, mean cost £15,468 (sd £25,534), accounting for 62% of overall care costs. Being younger and more disabled predicted higher formal care costs, explaining 32% and 30% of the variation in costs respectively at six and twelve months. Conclusion Community services for people with LTNCs carry substantial costs that shift from health to social care over time, increasing the burden on families. Prioritising rehabilitation services towards those in greatest need could limit access to others needing on-going support to promote their independence and reduce their reliance on families. This argues for greater investment in future rehabilitation services.
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Affiliation(s)
- Diana Jackson
- King's College London, Faculty of Life Sciences & Medicine, Department of Palliative Care, Policy and Rehabilitation, London, United Kingdom
| | - Paul McCrone
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Health Services and Population Research Department, London, United Kingdom
| | - Iris Mosweu
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Health Services and Population Research Department, London, United Kingdom
| | - Richard Siegert
- AUT University, School of Public Health and Psychosocial Studies and School of Rehabilitation and Occupational Studies, Centre for Person Centred Research, Auckland, New Zealand
| | - Lynne Turner-Stokes
- King's College London, Faculty of Life Sciences & Medicine, Department of Palliative Care, Policy and Rehabilitation, London, United Kingdom; Regional Rehabilitation Unit, Northwick Park Hospital, London, United Kingdom
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Rogers S, Richards KC, Davidson M, Weinstein AA, Trickey AW. Description of the moderate brain injured patient and predictors of discharge to rehabilitation. Arch Phys Med Rehabil 2014; 96:276-82. [PMID: 25305630 DOI: 10.1016/j.apmr.2014.09.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 08/26/2014] [Accepted: 09/12/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To describe patients with moderate traumatic brain injury (TBI) treated and discharged at levels I and II trauma centers in the United States; and to describe the predictors of discharge to rehabilitation after acute care. DESIGN Retrospective, cross-sectional, descriptive study. SETTING Trauma centers. PARTICIPANTS Patients with moderate TBI (N=2087; age range, 18-64 y) as reported in the 2010 National Sample Project. INTERVENTIONS None. MAIN OUTCOME MEASURE Discharge destination (rehabilitation vs home with no services). RESULTS Multivariate logistic regression models revealed that demographic, clinical, and financial characteristics influenced the likelihood of being discharged to rehabilitation. Increased age, increased severity, Medicare use, longer length of stay, and trauma center locations in the Midwest and Northeast all increased the likelihood of discharge to rehabilitation. CONCLUSIONS The decision to discharge a person with moderate TBI from acute care to rehabilitation appears to be based on factors other than just clinical need. These findings should be considered in creating more equitable access to postacute rehabilitation services for patients with moderate TBI because they risk long-term physical and cognitive problems and have the potential for productive lives with treatment.
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Affiliation(s)
- Sandra Rogers
- School of Nursing, George Mason University, Fairfax, VA.
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Supporting people with traumatic brain injury in their use of public spaces: Identifying facilitating factors and obstacles. ALTER 2014. [DOI: 10.1016/j.alter.2014.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Doucet BM, Woodson A, Watford M. Moving Toward 2017: Progress in Rehabilitation Intervention Effectiveness Research. Am J Occup Ther 2014; 68:e124-48. [DOI: 10.5014/ajot.2014.011874] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Halfway into the 10-yr American Occupational Therapy Association Centennial Vision initiative, occupational therapy has made notable progress in establishing itself as a science-driven profession. Through the diligent work of many talented occupational therapy scholars, 42 research studies exploring interventions used in rehabilitation research were published in the past 5 years. A variety of both novel and established intervention strategies were investigated using diverse research designs and measurement tools. A predominant number of studies were conducted with the poststroke population. Moving forward to 2017 and building on our success, we can recognize our full potential by fostering knowledge translation, expanding participant numbers, exploring less-studied populations, increasing the volume of systematic reviews published, and reporting occupation-centered outcomes, the unique and defining component of our profession.
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Affiliation(s)
- Barbara M. Doucet
- Barbara M. Doucet, OTR, PhD, is Assistant Professor, Louisiana State University Health Science Center, School of Allied Health Professions, Department of Occupational Therapy, 1900 Gravier Street, New Orleans, LA 70112;
| | - Anne Woodson
- Anne Woodson, OTR, is Adjunct Faculty, University of Texas Medical Branch, Galveston
| | - Monica Watford
- Monica Watford, MA, OTR, is Doctoral Candidate, University of Texas Medical Branch, Galveston
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Ikiugu MN. The validity of occupational performance assessments: a validity generalization meta-analysis. Occup Ther Health Care 2013; 27:372-91. [PMID: 24102592 DOI: 10.3109/07380577.2013.847298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The purpose of this meta-analysis was to determine sample weighted mean validity effect sizes for occupational performance assessments, and their generalizability from research to clinical settings. The bare-bones Validity Generalization (VG) guidelines developed by Hunter and Schmidt ( 2004 ) augmented by Maximum Likelihood (ML) procedures were used to complete the meta-analysis. The sample consisted of 27 studies in which convergent, divergent, and predictive validity estimates of occupational performance assessments were investigated. The mean coefficients of assessments validated in the studies constituting the sample for this meta-analysis ranged from medium to large. Further meta-analysis with complete dis-attenuation of observed mean validity coefficients is indicated.
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Affiliation(s)
- Moses N Ikiugu
- Professor and Director of Research, Occupational Therapy Department, School of Health Sciences, University of South Dakota, Vermillion, SD, USA
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22
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Ritchie L, Wright-St Clair VA, Keogh J, Gray M. Community integration after traumatic brain injury: a systematic review of the clinical implications of measurement and service provision for older adults. Arch Phys Med Rehabil 2013; 95:163-74. [PMID: 24016401 DOI: 10.1016/j.apmr.2013.08.237] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 07/05/2013] [Accepted: 08/19/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To explore the scope, reliability, and validity of community integration measures for older adults after traumatic brain injury (TBI). DATA SOURCES A search of peer-reviewed articles in English from 1990 to April 2011 was conducted using the EBSCO Health and Scopus databases. Search terms included were community integration, traumatic brain injury or TBI, 65 plus or older adults, and assessment. STUDY SELECTION Forty-three eligible articles were identified, with 11 selected for full review using a standardized critical review method. DATA EXTRACTION Common community integration measures were identified and ranked for relevance and psychometric properties. Of the 43 eligible articles, studies reporting community integration outcomes post-TBI were identified and critically reviewed. Older adults' community integration needs post-TBI from high quality studies were summarized. DATA SYNTHESIS There is a relative lack of evidence pertaining to older adults post-TBI, but indicators are that older adults have poorer outcomes than their younger counterparts. The Community Integration Questionnaire (CIQ) is the most widely used community integration measurement tool used in research for people with TBI. Because of some limitations, many studies have used the CIQ in conjunction with other measures to better quantify and/or monitor changes in community integration. CONCLUSIONS Enhancing integration of older adults after TBI into their community of choice, with particular emphasis on social integration and quality of life, should be a primary rehabilitation goal. However, more research is needed to inform best practice guidelines to meet the needs of this growing TBI population. It is recommended that subjective tools, such as quality of life measures, are used in conjunction with well-established community integration measures, such as the CIQ, during the assessment process.
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Affiliation(s)
- Linda Ritchie
- Department of Occupational Science and Therapy, School of Rehabilitation and Occupation Studies, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Valerie A Wright-St Clair
- Department of Occupational Science and Therapy, School of Rehabilitation and Occupation Studies, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.
| | - Justin Keogh
- Research Centre for Health, Exercise and Sports Sciences, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia; Human Potential Centre, Auckland University of Technology, Auckland, New Zealand
| | - Marion Gray
- Cluster for Health Improvement, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sippy Downs, QLD, Australia
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Kim H, Colantonio A, Dawson DR, Bayley MT. Community integration outcomes after traumatic brain injury due to physical assault. Can J Occup Ther 2013; 80:49-58. [PMID: 23550497 DOI: 10.1177/0008417412473262] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Community integration is considered an ultimate goal for rehabilitation after traumatic brain injury (TBI). PURPOSE To determine (a) whether differences exist in rehabilitation outcomes between intentional and unintentional TBI populations and (b) whether TBI from assault is a predictor of community integration following inpatient rehabilitation. METHOD Retrospective cohort study using population-based data from Canadian hospital administration records, 2001 to 2006. Outcome measure was the Reintegration to Normal Living Index (RNLI). FINDINGS From a sample of 243 persons, 24 (9.9%) had sustained TBI from physical assault. Persons with TBI from physical assault reported significantly lower scores on two items on the RNLI's Daily Functioning subscale: "recreation" and "family role." IMPLICATIONS These findings suggest that targeted intervention in these specific areas could be beneficial, which are often primarily addressed by occupational therapists in both inpatient rehabilitation and community settings.
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Affiliation(s)
- Hwan Kim
- Department of Occupational Therapy, College of Rehabilitation Sciences, Daegu University, Jullyang, Gyeongsan, Gyeongbuk, Republic of Korea
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Man DWK, Poon WS, Lam C. The effectiveness of artificial intelligent 3-D virtual reality vocational problem-solving training in enhancing employment opportunities for people with traumatic brain injury. Brain Inj 2013; 27:1016-25. [PMID: 23662639 DOI: 10.3109/02699052.2013.794969] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND People with traumatic brain injury (TBI) often experience cognitive deficits in attention, memory, executive functioning and problem-solving. The purpose of the present research study was to examine the effectiveness of an artificial intelligent virtual reality (VR)-based vocational problem-solving skill training programme designed to enhance employment opportunities for people with TBI. METHOD This was a prospective randomized controlled trial (RCT) comparing the effectiveness of the above programme with that of the conventional psycho-educational approach. Forty participants with mild (n = 20) or moderate (n = 20) brain injury were randomly assigned to each training programme. Comparisons of problem-solving skills were performed with the Wisconsin Card Sorting Test, the Tower of London Test and the Vocational Cognitive Rating Scale. RESULTS Improvement in selective memory processes and perception of memory function were found. Across-group comparison showed that the VR group performed more favourably than the therapist-led one in terms of objective and subjective outcome measures and better vocational outcomes. CONCLUSIONS These results support the potential use of a VR-based approach in memory training in people with MCI. Further VR applications, limitations and future research are described.
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Affiliation(s)
- David Wai Kwong Man
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, PR China
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Brasure M, Lamberty GJ, Sayer NA, Nelson NW, Macdonald R, Ouellette J, Wilt TJ. Participation after multidisciplinary rehabilitation for moderate to severe traumatic brain injury in adults: a systematic review. Arch Phys Med Rehabil 2013; 94:1398-420. [PMID: 23348125 DOI: 10.1016/j.apmr.2012.12.019] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 11/29/2012] [Accepted: 12/19/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the effectiveness and comparative effectiveness of multidisciplinary rehabilitation programs for moderate to severe traumatic brain injury (TBI) in improving participation-related outcomes in adults. This article presents results of select key questions from a recent Agency for Healthcare Quality and Research comparative effectiveness review. DATA SOURCES MEDLINE, Cochrane Central Register of Controlled Trials, and PsycINFO; hand searches of previous relevant reviews. STUDY SELECTION We included prospective controlled studies that evaluated the effectiveness or comparative effectiveness of multidisciplinary rehabilitation programs delivered to adults with moderate to severe TBI on their participation in life and community. DATA EXTRACTION We extracted data, assessed risk of bias, and evaluated strength of evidence. Participation was selected as our primary outcome and included measures of productivity (eg, return to employment or military service) and select scales measuring community integration. Only data from studies with a low or moderate risk of bias were synthesized. DATA SYNTHESIS Twelve studies met our inclusion criteria; of these, 8 were of low or moderate risk of bias (4 randomized controlled trials of 680 patients and 4 cohort studies of 190 patients, sample size 36-366). Heterogeneous populations, interventions, and outcomes precluded pooled analysis. Evidence was insufficient to draw conclusions about effectiveness. Evidence on comparative effectiveness often demonstrated that improvements were not different between groups; however, this evidence was low strength and may have limited generalizability. CONCLUSIONS Our review used a rigorous systematic review methodology and focused on participation after multidisciplinary rehabilitation programs for impairments from moderate to severe TBI. The available evidence did not demonstrate the superiority of one approach over another. This conclusion is consistent with previous reviews that examined other patient-centered outcomes. While these findings will have little clinical impact, they do point out the limited evidence available to assess effectiveness and comparative effectiveness while highlighting important issues to consider in future comparative effectiveness research on this topic.
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Affiliation(s)
- Michelle Brasure
- Minnesota Evidence-based Practice Center, Minneapolis, MN 55455, USA.
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Perroux M, Lefebvre H, Levert MJ, Malo D. Besoins perçus et participation sociale des personnes ayant un traumatisme crânien léger. SANTE PUBLIQUE 2013. [DOI: 10.3917/spub.136.0719] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Rao AK. Occupational therapy in neurological disorders: looking ahead to the American Occupational Therapy Association's centennial vision. Am J Occup Ther 2012; 66:e119-30. [PMID: 23106997 PMCID: PMC3665413 DOI: 10.5014/ajot.2012.005280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The Centennial Vision articulated by the American Occupational Therapy Association includes moving the profession to being science driven and evidence based. The American Journal of Occupational Therapy contributes to this vision by publishing high-quality research. I reviewed research in the practice area of neurological rehabilitation published between May 2010 and October 2011. In particular, I reviewed effectiveness and efficacy studies, instrument development and testing, and basic research studies. Concerns emerging from the review were (1) few studies in neurological rehabilitation; (2) many disorders not represented; (3) exclusive use of impairment-level outcomes in some studies; and (4) high preponderance of case series designs in effectiveness studies. To achieve the Centennial Vision, the field needs to improve the volume and diversity of research in neurological rehabilitation. It is also important to modify academic and clinical practice to enable occupational therapists to spend more time in producing high-quality evidence to support the crucial role they play in neurological rehabilitation.
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Affiliation(s)
- Ashwini K Rao
- Department of Rehabilitation and Regenerative Medicine and G. H. Sergievsky Center, Columbia University, New York, NY, USA.
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Transitions and Brain Injury: A Qualitative Study Exploring the Journey of People with Traumatic Brain Injury. BRAIN IMPAIR 2012. [DOI: 10.1017/brimp.2012.3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This qualitative study aimed to explore transitions from hospital to the home over a period of one year.Methods and procedures: A longitudinal, phenomenological approach was employed and 18 individuals with severe traumatic brain injury, their family members and rehabilitation professionals were interviewed using semistructured interviews, when the person with brain injury was discharged from the ward, after 6 months and again after one year.Results: Themes identified within the data included returning home, getting back to normal, moving forward and the role of rehabilitation in the transitional period. Further subthemes were also identified including issues of life-course disruption, self-identity, status and reconstruction.Conclusions: Data suggested that access to rehabilitation programs employing individualised, contextual interventions following discharge to the home were integral in enabling the transition through to autonomy and independence. Consideration of issues of identity and status can enable a different and potentially important perspective on the experience of transitions for those with brain injury. Reclaiming personal autonomy and control appeared to be central to the reconstruction of a coherent sense of self, enabling a meaningful life after brain injury.
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Wolf TJ. Rehabilitation, Disability, and Participation Research: Are Occupational Therapy Researchers Addressing Cognitive Rehabilitation After Stroke? Am J Occup Ther 2011. [DOI: 10.5014/ajot.2011.002089] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
I reviewed articles published in the American Journal of Occupational Therapy (AJOT) in 2009 and 2010 to assess (1) whether research was published in the practice area of rehabilitation, disability, and participation and (2) the evidence being produced in an underdeveloped subcategory of this practice area: cognitive rehabilitation after stroke. The review revealed one intervention effectiveness study that addressed cognitive rehabilitation poststroke published in the 2-year period. Further analysis of outside repositories of evidence in this area revealed that although some evidence supports rehabilitation approaches for people with cognitive dysfunction after a stroke, little research has been devoted to this practice area. The poststroke cognitive intervention approaches in use have been shown to have little or no effect on improving everyday life activity. Occupational therapy has a key research and practice role with the poststroke population, and occupational therapists should be at the forefront in developing the science to support the effectiveness of their services.
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Affiliation(s)
- Timothy J. Wolf
- Timothy J. Wolf, OTD, MSCI, OTR/L, is Assistant Professor, Program in Occupational Therapy and Department of Neurology, Washington University School of Medicine, St. Louis, MO 63108;
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