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Svendsen EJ, Killi EM, Rohrer-Baumgartner N, Holthe IL, Sandhaug M, Borgen IMH, Wade SL, Hauger SL, Løvstad M, Bragstad LK. Children's, parents', and teachers' experiences of the feasibility of a telerehabilitation intervention for children with acquired brain injury in the chronic phase - a qualitative study of acceptability and participation in the Child In Context Intervention (CICI). BMC Health Serv Res 2023; 23:603. [PMID: 37291543 DOI: 10.1186/s12913-023-09589-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 05/16/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND This is a qualitative feasibility study of the Child in Context Intervention (CICI). The CICI is an individualized, goal-oriented and home-based tele-rehabilitation intervention which targets everyday functioning of children (6-16 years) with acquired brain injury in the chronic stage, and their families, one year or more after insult, who have ongoing challenges (physical, cognitive, behavioral, social and/or psychological). The aim of this study is to better understand how children, parents and teachers experienced participation and acceptability; to develop knowledge about the mechanisms of change, and to explore how the CICI was tailored to the context. METHODS Six families and schools participated in the intervention, which comprised seven tele-rehabilitation sessions in which the child and parent participated, one in-person parent seminar and four digital school meetings. A multidisciplinary team delivered the intervention to 23 participants over a 4- to 5-month period. The intervention involved psychoeducation about targeted acquired brain injury-related problems, such as fatigue, pain, or social challenges. All but one consented to participate in the current digital interview study. The data were analyzed using content analysis. RESULTS The experience of participation and acceptability varied among the children. Attendance was consistently high; the child participants felt mostly listened to and could influence goal setting and strategies. However, engaging and motivating the child participants proved somewhat challenging. The parents found the CICI rewarding, useful and relevant. However, they had different experiences regarding which intervention component they perceived as most helpful. Some argued in favor of the 'whole intervention', while others highlighted new knowledge, SMART goals or the school collaboration. The teachers found the intervention acceptable and useful but wanted a better meeting plan. They had difficulties in finding time for meetings, emphasized the involvement of school leaders, and appreciated the digital format. CONCLUSIONS Overall, the intervention was perceived as acceptable, and the participants felt that the various intervention components contributed to improvements. The CICI's flexibility facilitated tailoring to different contexts based on the children's functional level. The digital format saved time and provided flexibility regarding the amount of attendance but limited full participation from children with more severe cognitive impairments. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04186182.
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Affiliation(s)
- Edel Jannecke Svendsen
- Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway.
- Oslo Metropolitan University, Oslo, Norway.
- CHARM - Research Centre for Habilitation and Rehabilitation Models & Services, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Eli Marie Killi
- Department of Profession Strategy and Knowledge Brokering, Norwegian Service for Special Needs Education, Oslo, Norway
| | | | - Ingvil Laberg Holthe
- Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Maria Sandhaug
- Department of Profession Strategy and Knowledge Brokering, Norwegian Service for Special Needs Education, Oslo, Norway
| | - Ida M H Borgen
- Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Shari L Wade
- Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, OH, 45229, Cincinnati, USA
- University of Cincinnati College of Medicine, OH, Cincinnati, USA
| | - Solveig Laegreid Hauger
- Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Marianne Løvstad
- Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Line Kildal Bragstad
- Oslo Metropolitan University, Oslo, Norway
- CHARM - Research Centre for Habilitation and Rehabilitation Models & Services, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Rohrer-Baumgartner N, Holthe IL, Svendsen EJ, Røe C, Egeland J, Borgen IMH, Hauger SL, Forslund MV, Brunborg C, Øra HP, Dahl HM, Bragstad LK, Killi EM, Sandhaug M, Kleffelgård I, Strand-Saugnes AP, Dahl-Hilstad I, Ponsford J, Winter L, Wade S, Løvstad M. Rehabilitation for children with chronic acquired brain injury in the Child in Context Intervention (CICI) study: study protocol for a randomized controlled trial. Trials 2022; 23:169. [PMID: 35193666 PMCID: PMC8861614 DOI: 10.1186/s13063-022-06048-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/21/2022] [Indexed: 01/10/2023] Open
Abstract
Background Pediatric acquired brain injury (pABI) is associated with long-term cognitive, behavioral, social, and emotional problems, which may affect the quality of life, school, and family functioning. Yet, there is a lack of evidence-based community-centered rehabilitation programs for chronic pABI and these children do not systematically receive comprehensive rehabilitation. The Child In Context Intervention (CICI) study is a pragmatic randomized controlled trial (RCT) for children with chronic pABI, which aims to evaluate the effectiveness of an individualized and goal-oriented intervention targeting everyday functioning of the child and family. Methods Children aged 6–16 years with MRI/CT-verified intracranial abnormalities will be included in the CICI study if they have persistent self- or parent-reported cognitive, emotional, and/or behavioral challenges 1 year or more after insult and attend school regularly. A total of 70 families will be randomized 1:1 to an intervention or a control group. The intervention consists of seven family sessions, one parent seminar, and four school sessions delivered over approximately 6 months. The parent seminar will be held in person, and the other sessions will mainly be video based. The children’s and families’ self-reported major challenges in everyday life will be targeted using SMART goals. Evidence-based strategies, when available, will be applied to achieve the goals, combined with psychoeducation. Goal attainment scaling (GAS) will be used to evaluate goal attainment. Data is collected at baseline and after approximately 6 and 9 months. External assessors are blinded to group allocation. Primary outcomes are parent-reported brain injury symptoms in children and parenting self-efficacy at 9 months of follow-up. Secondary outcomes include child-reported brain injury symptoms, quality of life, executive functioning in daily life, parent emotional symptoms, family functioning, and unmet family health care needs. A process evaluation will be conducted. Discussion The current study provides an innovative approach to rehabilitation for children in the chronic phase of ABI and their families. This complex intervention may contribute to the development of evidence-based, high-quality rehabilitation for a large patient group, which is underrepresented in clinical research. It may also improve collaboration between specialized rehabilitation facilities, schools, and local health care services. Inclusion for the trial started in April 2021. Trial registration ClinicalTrials.govNCT04798859. Registered on March 15, 2021 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06048-8.
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Affiliation(s)
| | - Ingvil Laberg Holthe
- Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway.,Institute of Psychology, University of Oslo, Oslo, Norway
| | - Edel Jannecke Svendsen
- Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway.,Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway.,Research Center for Habilitation and Rehabilitation Services and Models (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Cecilie Røe
- Research Center for Habilitation and Rehabilitation Services and Models (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway.,Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jens Egeland
- Institute of Psychology, University of Oslo, Oslo, Norway.,Vestfold Hospital Trust, Tønsberg, Norway
| | - Ida M H Borgen
- Institute of Psychology, University of Oslo, Oslo, Norway.,Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Solveig L Hauger
- Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway.,Institute of Psychology, University of Oslo, Oslo, Norway
| | - Marit V Forslund
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Hege Prag Øra
- Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway
| | - Hilde Margrete Dahl
- Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
| | - Line Kildal Bragstad
- Research Center for Habilitation and Rehabilitation Services and Models (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Occupational Therapy, Prosthetics and Orthotics Oslo Metropolitan University, Oslo, Norway
| | - Eli Marie Killi
- Statped: Norwegian Service for Special Needs Education, Oslo, Norway
| | - Maria Sandhaug
- Statped: Norwegian Service for Special Needs Education, Oslo, Norway
| | - Ingerid Kleffelgård
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | | | | | - Jennie Ponsford
- School of Psychological Sciences, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
| | - Laraine Winter
- Philadelphia Research and Education Foundation, Philadelphia, PA, USA.,Nursing Service, Department of Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Shari Wade
- Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Marianne Løvstad
- Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway.,Institute of Psychology, University of Oslo, Oslo, Norway
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