Influence of self-efficacy and coping on quality of life and social participation after acquired brain injury: a 1-year follow-up study

"I moved from simply being to actively living." A qualitative study on peer mentorship camps for adults with acquired brain injury

PURPOSE

This study explored the experiences of an Active Rehabilitation peer mentorship camp on individuals with acquired brain injury (mentees) and its impact on their daily lives.

METHODS

The research involved field observations and longitudinal interviews with 18 mentees attending an Active Rehabilitation camp in Norway. Data were narratively analyzed using the Self-determination theory for insight and discussion.

RESULTS

Three themes were constructed from the analysis. The first theme, "Striking a balance between rest and activity," reflects how mentees managed post-injury fatigue and how camp experiences enhanced their understanding and coping strategies. The second theme, "Rebuilding who I am," addresses stigma, reduced self-esteem, and acceptance challenges faced by mentees, revealing positive effects from camp participation. The third theme, "Finding a new flock," describes the reduction in social circles after injury and how interactions at the camp expanded their peer networks during and after the camp.

CONCLUSIONS

Active Rehabilitation camps enhance community-based rehabilitation for individuals with acquired brain injury by improving knowledge, boosting self-esteem, and broadening social networks. It is recommended that camp providers assess the impact of room-sharing and devise strategies for personalizing camp activities and effectively matching mentees and peer mentors.

Rebuilding the self through valued action and group connections after acquired brain injury: Participant perspectives of the VaLiANT group intervention

Effective interventions that facilitate adjustment following acquired brain injury (ABI) are needed to improve long-term outcomes and meaningful reengagement in life. VaLiANT is an 8-week group intervention that combines cognitive rehabilitation with Acceptance and Commitment therapy to improve valued living, wellbeing, and adjustment. This study explored participant experiences of VaLiANT to optimize its ongoing development. This included characterization of individually meaningful treatment outcomes, mechanisms of action, and intervention acceptability. Qualitative interviews and quantitative ratings were collected from 39 ABI survivors (Mage = 52, SD = 15; 54% stroke) following their participation in VaLiANT. Participants reported diverse outcomes which resulted in three themes being generated following reflexive thematic analysis. "A fuller toolkit for life with brain injury" indicated increased strategy usage and better daily functioning; "The value of connection and belonging" captured the importance of social experiences in shaping recovery; and "Finding the me I can be" represented cognitive, behavioural, and emotional aspects of identity reconstruction post-ABI. The content and delivery of the intervention were rated highly but participants desired greater follow-up and tailoring of the intervention. Overall, VaLiANT appears to facilitate adjustment through several mechanisms, but greater intervention individualization and dosage may be required to enhance the treatment impact.

Feasibility of BrainSTORM, a Traumatic Brain Injury Transitional Care Intervention

OBJECTIVE

To investigate the feasibility, acceptability, and clinical outcome measures of a transitional care intervention for patients with traumatic brain injury (TBI) and their family caregivers.

SETTING

Inpatient and outpatient rehabilitation at a level I trauma center in the Southeastern United States.

PARTICIPANTS

Patients (ages 18-75) diagnosed with moderate to severe TBI, receiving rehabilitation, and their family caregivers.

DESIGN

Quasi-experimental, single-arm, single-center feasibility study with pre- and post-test design. Participants completed a 4-month transitional care program involving monthly education and social support.

MAIN MEASURES

Feasibility of enrollment, data collection, intervention completion rates, and intervention acceptability. Clinical outcome measures included patient quality of life (QOL) (12-Item Short Form Health Survey (SF-12), primary outcome) and patient and caregiver self-efficacy (Self-Efficacy for Management of Chronic Conditions Scale).

RESULTS

Eleven dyads and 1 monad enrolled (N = 23, 12 patients, 11 caregivers). All completed baseline data; 91.3% (n = 21, 11 patients, 10 caregivers) completed 2-month (intervention midpoint) data; and 86% (n = 20, 11 patients, 9 caregivers) completed 4-month (intervention endpoint) data. The intervention completion rate was 91.67%. Participants engaged in a mean of 2.17 (SD = 1.34) monthly educational webinars and 2.42 (SD = 1.51) social support groups during the intervention period. Approximately 70% of participants (n = 16, 9 patients, 7 caregivers) completed acceptability data, indicating positive intervention experiences (patients: mean 9.44/10 [SD = 1.01]; caregivers: mean 9.57/10 [SD = 0.79]). Patient QOL scores did not statistically improve over time; however, patient self-efficacy scores did statistically significantly improve from baseline (mean = 7.03, SD = 1.53; P = .0197) to intervention end point (4 months) (mean = 8.35, SD = 1.71).

CONCLUSION

Brain Injury Support To Optimize Recovering Minds (BrainSTORM) is a promising new TBI transitional care intervention that has potential to enhance care standards for patients with TBI and their family caregivers. Further research is needed to determine its efficacy.

Analysis of the correlation and influencing factors between delirium, sleep, self-efficacy, anxiety, and depression in patients with traumatic brain injury: a cohort study

Background

Patients with traumatic brain injury (TBI) often experience post-injury anxiety and depression, which can persist over time. However, the relationships between anxiety and depression in TBI patients and delirium, sleep quality, self-efficacy, and serum inflammatory markers require further investigation.

Objective

This study aims to explore the associations of delirium, sleep quality, self-efficacy, and serum inflammatory markers with anxiety and depression in TBI patients, and to examine potential influencing factors.

Methods

We conducted a cohort study involving 127 patients with TBI. Delirium was assessed using the Confusion Assessment Method (CAM) and CAM-ICU, while anxiety, depression, sleep quality, self-efficacy, and pain were evaluated using the appropriate tools, respectively. Serum inflammatory markers (CRP, TNF-α, IL-6) were collected within 1 day post-injury. Generalized estimating equations (GEE) were used to analyze the relationships between delirium, sleep, self-efficacy, and anxiety/depression.

Results

The study identified 56 patients with delirium. Patients with delirium differed significantly from those without delirium in age, TBI classification, sleep duration, CRP levels, TNF-α levels, pain, self-efficacy, and insomnia (P < 0.05). The GEE analysis revealed that delirium, CRP levels, self-efficacy, underlying diseases, insomnia, TBI classification, age, and sleep duration were associated with anxiety symptoms in TBI patients at 6 months post-discharge (P < 0.05). Depression in TBI patients at 6 months post-discharge was not associated with delirium or insomnia but correlated with CRP levels, TBI classification, and self-efficacy (P < 0.05).

Conclusion

TBI patients who experience delirium, insomnia, and low self-efficacy during the acute phase are likely to exhibit more anxiety at the 6-month follow-up. Depression in TBI patients is not associated with delirium or insomnia but is negatively correlated with self-efficacy. CRP levels post-TBI may serve as a biomarker to identify patients at risk of emotional symptoms and potentially accelerate patient recovery.

Cognitive Self-Efficacy in Parkinson's Disease

Cognitive self-efficacy (CSE), one's belief in their ability to control their cognitive performance, is important for participation in daily activities and rehabilitation. This study aims to understand how Parkinson's disease (PD) affects CSE. The Cognitive Self-Efficacy Questionnaire (CSEQ) was administered to 47 non-demented PD and 52 healthy comparison (HC) participants. Groups were compared on their self-reported ability to recognize (Part 1) and manage (Part 2) cognitive symptoms and to perform cognitively complex functional activities (Part 4). Relationships between CSEQ scores and individual characteristics were assessed within PD. The PD group had lower CSEQ scores than the HC group for all Parts. Within PD, Part 2 scores were lower than Parts 1 and 4, and worse depressive symptoms and higher medication dosage correlated with lower CSE. People with PD may have low CSE, which can contribute to participation restrictions and reduced engagement in treatment. Occupational therapists should consider CSE with clients with PD.

Coping Strategies in Patients with Acquired Brain Injury: A Scoping Review

In recent years, there has been marked interest in looking at the psychological consequences of medical conditions, such as traumatic or acquired brain injuries. Coping strategies are essential for clinical recovery and for dealing with the stressful events that a clinical condition brings with it. The purpose of this review is to analyze studies that explore how coping strategies influence psychological changes in patients with acquired brain injury. Studies were identified from research in the PubMed, Scopus, and Embase databases. According to our findings, patients with ABI utilize different coping strategies based on the circumstances and factors such as the diagnosis severity, their age, time lived with the pathology, and personal characteristics, which have an influence on quality of life and rehabilitation. This review demonstrated that coping strategies have an impact on different aspects of the clinical and personal lives of patients with ABI. The rehabilitation process must consider the influence of these mechanisms on dealing with situations, as they can change cognitive and emotional perceptions of patients' experience with the disease, as well as laying the foundations for functional or dysfunction in terms of the propensity of a person for the path of psychological and physical recovery.

A Look at Traumatic Brain Injury Community Programs in British Columbia: Barriers and facilitators of implementation

RESEARCH OBJECTIVES

1) Characterize the delivery of programs that support acceptance and resiliency for people with brain injury in the healthcare sector; 2) Understand the barriers and facilitators in implementation of programs to support self-acceptance and resiliency for people with brain injury.

DESIGN

Participatory focus groups were used to explore experiences of conducting brain injury programs and knowledge of the barriers and facilitators to their implementation. Focus group data were analyzed with manifest content analysis to minimally deviate from broad and structural information provided by participants.

SETTING

Four focus group sessions were conducted online through a video calling platform.

PARTICIPANTS

22 individuals from community associations conducting programs for people with brain injury. Participants were recruited from a public brain injury organization database.

RESULTS

Systemic challenges such as access to and allocation of funding require navigation support. Resource consistency and availability, including stable program leaders and a welcoming atmosphere, are important for program implementation and sustainability. Shared experiences promote connection with the community and personal development.

CONCLUSIONS

This study informs individual- and community-level approaches to promote meaningful life after brain injury. Findings highlight existing resources and support future programming for people with brain injury.

Using hypnotic suggestion in the rehabilitation of working memory capacity after acquired brain injury: study protocol for a randomized controlled trial

OBJECTIVES

Establishment of effective evidence-based interventions in rehabilitation of working memory (WM) deficits after acquired brain injury (ABI) is sorely needed. Despite robust evidence for the efficiency of clinical hypnosis in a wide range of clinical conditions, and improved understanding of mechanisms underlying its effects, the potential of clinical hypnosis in cognitive rehabilitation is underexplored. A recent study has shown large effects of hypnotic suggestion on WM capacity following ABI. This randomized controlled trial aims to evaluate and explore the replicability of these findings and examine the generalization of treatment effects. The study will also explore possible mechanisms of change.

METHODS

Ninety patients will be recruited from the Sunnaas Rehabilitation Hospital. Inclusion criteria are nonprogressive ABI, minimum 12-month post-injury, ongoing WM deficits, and age between 18 and 67 years. Patients will be randomized to either (a) an intervention group receiving four weekly 1-h sessions with induction and hypnosis, (b) an active control group receiving four weekly 1-h sessions of induction and mindfulness, or (c) a passive control group without intervention. The targeted procedure consists of suggestions about enhancing WM functions, for example through the instantiation of preinjury WM capacity in the present using age regression or through visualizations of brain plasticity. The non-targeted suggestions contain no explicit mention of ABI- or WM-related abilities. Each participant will be assessed at baseline, immediately after intervention, and 6 months after baseline. The primary outcome is the WM index from WAIS-IV and self- and informant-reported WM subscale from BRIEF-A, a questionnaire exploring executive functioning in everyday life. Secondary outcomes include a cognitive composite score derived from tests measuring processing speed, executive functions, learning capacity and memory, and self-reported measures of emotional distress, quality of life, and community integration. Exploratory measures include self-rated ABI and WM-related self-efficacy.

DISCUSSION

Rehabilitation of impaired WM after ABI has hitherto yielded limited transfer effects beyond the training material, i.e., improvement effects on everyday WM capacity, and clinical trials of new interventions are thus warranted. Long-standing empirical evidence demonstrates that hypnosis is an effective therapeutic technique in a wide range of conditions, and recent exploratory research has suggested a high efficacy of hypnosis in improving WM capacity in patients with ABI. However, these extraordinary findings need replication in studies applying scientifically rigorous designs. If successful, our ambition is to provide recommendations and materials to implement hypnotic suggestion as an adjunct treatment following ABI. Study findings may inform future studies exploring the use of clinical hypnosis in other areas of rehabilitation, such as mild TBI, and in other neurological conditions where WM deficit is prominent.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05287542. Registered on March 2022 PROTOCOL VERSION: Protocol version 2.0, December 2023.

Long-Term Follow-Up of Critically Ill Patients With Traumatic Brain Injury: From Intensive Care Parameters to Patient and Caregiver-Reported Outcome

Abstract Traumatic brain injury (TBI) is associated with a high social and financial burden due to persisting (severe) disabilities. The consequences of TBI after intensive care unit (ICU) admission are generally measured with global disability screeners such as the Glasgow Outcome Scale-Extended (GOSE), which may lack precision. To improve outcome measurement after brain injury, a comprehensive clinical outcome assessment tool called the Minimal Dataset for Acquired Brain Injury (MDS-ABI) was recently developed. The MDS-ABI covers 12 life domains (demographics, injury characteristics, comorbidity, cognitive functioning, emotional functioning, energy, mobility, self-care, communication, participation, social support, and quality of life), as well as informal caregiver capacity and strain. In this cross-sectional study, we used the MDS-ABI among formerly ICU admitted patients with TBI to explore the relationship between dichotomized severity of TBI and long-term outcome. Our objectives were to: 1) summarize demographics, clinical characteristics, and long-term outcomes of patients and their informal caregivers, and 2) compare differences between long-term outcomes in patients with mild-moderate TBI and severe TBI based on Glasgow Coma Scale (GCS) scores at admission. Participants were former patients of a Dutch university hospital (total n = 52; mild-moderate TBI n = 23; severe TBI n = 29) and their informal caregivers (n = 45). Hospital records were evaluated, and the MDS-ABI was administered during a home visit. On average 3.2 years after their TBI, 62% of the patients were cognitively impaired, 62% reported elevated fatigue, and 69% experienced restrictions in ≥2 participation domains (most frequently work or education and going out). Informal caregivers generally felt competent to provide necessary care (81%), but 31% experienced a disproportionate caregiver burden. All but four patients lived at home independently, often together with their informal caregiver (81%). Although the mild-moderate TBI group and the severe TBI group had significantly different clinical trajectories, there were no persisting differences between the groups for patient or caregiver outcomes at follow-up. As a large proportion of the patients experienced long-lasting consequences beyond global disability or independent living, clinicians should implement a multi-domain outcome set such as the MDS-AB to follow up on their patients.

The Impact of Upper Limb Apraxia on General and Domain-Specific Self-Efficacy in Post-Stroke Patients

BACKGROUND

Upper limb apraxia (ULA) is a neurological syndrome characterized by the inability to perform purposeful movements. ULA could impact individuals' perceptions, including perceived self-efficacy. The aim of this study is to investigate whether ULA is related to general self-efficacy and self-efficacy for managing symptoms in post-stroke patients.

METHODS

A cross-sectional study was conducted involving 82 post-stroke patients. Regression analyses were implemented using a stepwise model including seven dimensions of ULA: imitation (non-symbolic, intransitive, and transitive), pantomime (non-symbolic, intransitive, and transitive), and dimension of apraxic performance in activities of daily living. These dimensions were independent variables, while general self-efficacy and symptom management self-efficacy dimensions were dependent variables.

RESULTS

The findings revealed that intransitive imitation accounted for 14% of the variance in general self-efficacy and 10% of self-efficacy for managing emotional symptoms. Transitive imitation explained 10% of the variance in self-efficacy for managing global symptoms and 5% for social-home integration symptoms. The combination of intransitive imitation, non-symbolic pantomime, and alterations in activities of daily living performance associated with ULA explained 24% of the variance in cognitive self-efficacy.

CONCLUSIONS

Hence, ULA dimensions seem to be related to the levels of general perceived self-efficacy and self-efficacy for managing symptoms among post-stroke patients.

Using Self-Regulation Assessment to Explore Associations between Self-Regulation, Participation and Health-Related Quality of Life in a Rehabilitation Population

OBJECTIVE

Self-regulation, participation and health-related quality of life are important rehabilitation outcomes. The aim of this study was to explore associations between these outcomes in a multi-diagnostic and heterogenic group of former rehabilitation patients.

METHODS

This cross-sectional survey used the Self-Regulation Assessment (SeRA), Utrecht Scale for Evaluation of Rehabilitation-participation (USERParticipation) and the Patient-Reported-Outcome-Measurement-System (PROMIS) ability and PROMIS satisfaction with participation in social roles, and the EuroQol-5L-5D and PROMIS-10 Global Health. Regression analyses, controlling for demographic and condition-related factors, were performed.

RESULTS

Respondents (n = 563) had a mean age of 56.5 (standard deviation (SD) 12.7) years. The largest diagnostic groups were chronic pain disorder and brain injury. In addition to demographic and condition-related factors, self-regulation subscales explained 0-15% of the variance in participation outcome scores, and 0-22% of the variance in HRQoL outcome scores. Self-regulation subscales explained up to 22% of the variance in satisfaction subscales of participation (USER-Participation and PROMIS) and the mental health subscale of the PROMIS-10. Self-regulation subscales explained up to 11% of the restriction and frequency subscales of participation (USER-Participation) and the physical health subscale of the PROMIS-10.

CONCLUSION

Self-regulation is more strongly associated with outcomes such as satisfaction with participation and mental health compared with outcomes such as restrictions in participation and physical health.

Letting go or giving up? The influence of self-transcendence meaning of life on goal adjustment in high action crisis

When individuals pursuing personal goals encounter setbacks and failures, they often fall into a conflict between disengaging from and striving toward the goal, defined as an action crisis. The present study investigated the influence and mechanism of self-transcendence meaning of life (STML) on goal disengagement and reengagement during a high versus a low action crisis. Study 1 included situations with different action crises. In Study 1, participants with high STML exhibited significantly higher goal disengagement and reengagement during high action crisis compared with low action crisis. Study 2 replicated the findings in Study 1 using participants' personal goals by questionnaires, and further exhibited that action crisis had negative effect on self-efficacy for participants with low STML, and this process subsequently reduced goal adjustment. Interestingly, no mediation effect of self-efficacy was found between action crisis and goal adjustment among participants with high STML. Findings from the present study suggest that releasing obsessions and adopting a dialectical relationship between success and failure may help individuals in high action-crisis situations, and self-efficacy may provide flexibility and autonomy.

Effectiveness of internet-based behavioral activation on quality of life among young adult survivors of childhood brain tumor: a randomized controlled trial

PURPOSE

Diagnosis and treatment of childhood brain tumor have detrimental effects on physical, neurocognitive, psychological, and social functioning that lasts into adulthood and effects quality of life (QOL). To address diminished QOL, an Internet-based behavioral activation (BA) intervention was developed. Behavioral activation aims to increase activities and behaviors likely to improve thoughts, mood, and QOL.

METHODS

Participants included 127 young adult survivors of childhood brain tumor (SCBT) randomized into the experimental group (n= 64) or the waitlist control group (n= 63). The dependent variables included: life satisfaction, stress, and activation and were assessed with a two-way mixed analysis of variance (ANOVA).

RESULTS

Results revealed a significant interaction between the intervention and time on life satisfaction, F(1, 125)=4.793, p = 0.03. There were no significant main effects over time for perceived stress and activation.

CONCLUSIONS

Findings offer initial evidence that BA can be delivered over the internet and that Internet-delivered BA can have a positive effect on the QOL of young adult SCBT. Internet-based BA interventions can serve as a resource for young adult SCBT who desire to boost their mood and QOL.Implications for rehabilitationBehavioral activation (BA) is aimed at increasing positively reinforcing overt behaviors that are likely to promote improved thoughts, mood, and quality of life (QOL).Results indicated study participants in the experimental group demonstrated a significant gain in life satisfaction compared to the control group after receiving the Internet-based BA intervention; and provides support that the intervention was associated with positive changes across time.Findings offer initial evidence that BA can be delivered over the internet and that Internet-delivered BA can have a positive effect on the QOL of young adult survivors of childhood brain tumor (SCBT).Internet-based BA interventions can serve as a resource for young adult SCBT who desire to boost their mood and QOL.

Resilience and Anxiety Among Healthcare Workers During the Spread of the SARS-CoV-2 Delta Variant: A Moderated Mediation Model

INTRODUCTION

The B.1.617.2 (Delta) variant of SARS-COV-2 has caused a surge in COVID-19 cases worldwide, placing a great burden on the health care system under the zero-tolerance epidemic prevention policy in China. The present study aimed to investigate the prevalence of anxiety among health care workers during the spread of the SARS-CoV-2 Delta variant, and to discuss the mediating role of positive coping style between resilience and anxiety, and the moderating role of general self-efficacy.

METHOD

Connor-Davidson Resilience scale (CD-RISC), Generalized Anxiety Disorder Scale (GAD-7), General Self-efficacy Scale (GSES) and Simplified Coping Style Questionnaire (SCSQ) were used in this cross-sectional study among 390 healthcare workers in Jiangsu Province, China. Mackinnon's four-step procedure was applied to test the mediation effect, and Hayes PROCESS macro was conducted to examine the moderated mediation model.

RESULTS

The prevalence of anxiety among Chinese healthcare workers during the spread of the SARS-CoV-2 Delta variant was 41.8%. Male, unmarried, childless and younger subjects reported higher levels of anxiety. Positive coping partially mediated the effect of resilience on anxiety among healthcare workers and the indirect effect was stronger with the increase of general self-efficacy.

CONCLUSIONS

Anxiety was prevalent among healthcare workers during the spread of SARS-CoV-2 Delta variant. This research sheds new light on the potential mechanism underlying the association between resilience and anxiety and provides new insight into the prevention of anxiety among healthcare workers during the spread of the SARS-CoV-2 Delta variant.

The Impact of General Self-Efficacy on Psychological Resilience During the COVID-19 Pandemic: The Mediating Role of Posttraumatic Growth and the Moderating Role of Deliberate Rumination

Purpose: This study used a moderated mediation model to explore the relationship between general self-efficacy (GSE) and psychological resilience (PR) and the associated mechanisms, the mediating role of posttraumatic growth (PTG), and the moderating role of deliberate rumination (DR) during the coronavirus disease 2019 (COVID-19) pandemic. Knowledge of the relationship between these four variables examined further understanding of the PR improvement mechanism of college students and even the general public. Methods: The college students who participated in this study came from an independent college in Guangdong Province, China. A total of 918 college students completed the survey, and the final data sample size was 881. SPSS 23.0 and PROCESS (version 3.3) were used to conduct Pearson's correlation analysis and hierarchical regression linear analysis on the data. Results: (1) The correlation analysis showed that GSE and PR were positively correlated and that PTG was positively correlated with GSE and PR. DR was positively correlated with GSE, PTG, and PR. (2) The results of mediation analysis showed that GSE had a direct predictive effect on DR, and PTG partially mediated the relationship between the two. (3) The results of moderating effect analysis showed that DR hindered the effect of GSE on PTG but enhanced the positive impact of PTG on PR. Conclusions: General self-efficacy can improve PR under the mediating influence of PTG. DR played a positive moderating role in the relationship between GSE and PTG, and played a negative moderating role in the relationship between PTG and PR. These results advance the understanding of the mechanism between GSE and PR.

Predictive Factors of Self-Reported Quality of Life in Acquired Brain Injury: One-Year Follow-Up

Background: The sequelae and disabilities that follow an acquired brain injury (ABI) may negatively affect quality of life (QoL). The main objective of the study is to describe the QoL after an ABI and identify the predictors of a better QoL. Methods: Prospective cohort study with follow-up measurement after one-year. The sample comprised 203 adults with ABIs (64% male) aged 18–86 years (M = 53.01, SD = 14.44). Stroke was the main etiology of the injury (55.7%), followed by a TBI (32.8%), and the average time since injury was 8 years (M = 8.25, SD = 7.83, range = 0.5–47.5). Patients assessed their QoL through the scale Calidad de Vida en Daño Cerebral (CAVIDACE self-reported version; “quality of life in brain injury” in English), an ABI-specific tool based on the eight-domain QoL model. Other variables measured were: depression, self-awareness, community integration, resilience, and social support at baseline and one-year follow-up. Results: The studied factors showed few significant changes over time. The analyses showed statistically significant differences in QoL scores in several sociodemographic (age, civil status, education, legal capacity, and dependency), injury-related (time, location, and comorbidity), rehabilitation, and personal-social variables (self-awareness, depression, social support, resilience, and community integration). The levels of dependency, depression, and satisfaction with social support were independent predictors of the total QoL score one-year follow-up. Conclusions: QoL after ABI depends on multiple elements that must be considered. There are factors such as satisfaction with social support, depression, community integration, and resilience that must be monitored throughout the rehabilitation process.

Mediators of quality of life in brain injury

PRIMARY OBJECTIVE

This study examined the mediating role of perceived social support and mastery on quality of life (QOL) among adults with brain injury.

RESEARCH DESIGN

An a priori structural model hypothesizing the relationships among symptom severity, mastery, social support, and QOL variables were tested.

METHODS AND PROCEDURES

Individuals with brain injury across the United States participated in an online survey (N = 183). Structural equation modeling (SEM) was used to examine the model fit.

MAIN OUTCOMES AND RESULTS

The model fit the data well (χ² ₍₁₅₎ = 13.68). The Normed Bentler-Bonnet Fit Index (NFI) was.97; Goodness-of-Fit Statistic (GFI) was .98; Adjusted-Goodness-of-Fit (AGFI) was.96; and the Comparative Fit Index (CFI) was 1.00. The direct effects supported all expected relationships among the study variables. Social support and mastery fully mediated the relationship between symptom severity and QOL. Mastery partially mediated the relationship between social support and QOL.

CONCLUSIONS

These findings underscore the importance of incorporating psychosocial factors into interventions, with attention on increasing levels of perceived social support and mastery skills to foster greater QOL.

The Impact of Self-Efficacy and Health Locus of Control on Performance Validity Testing

OBJECTIVE

Recent research has examined potential influences to performance validity testing beyond intentional feigning. The current study sought to examine the hypothesized relationships of two psychological constructs (self-efficacy and health locus of control) with performance validity testing (PVT).

METHOD

Retrospective review of 158 mild traumatic brain injury (mTBI) cases referred to an Army outpatient clinic for neuropsychological evaluation. The mTBI cases were classified according to passing or failing the Medical Symptom Validity Test (MSVT) or Non-Verbal Medical Symptom Validity Test (NV-MSVT). Group comparisons were performed utilizing one-way ANOVA to evaluate the differences between the PVT-Pass and PVT-Fail groups on self-efficacy (MMPI-2-RF Inefficacy scale) and locus of control (Multi-Dimensional Health Locus of Control).

RESULTS

There was no relationship between self-efficacy or health locus of control and passing/failing PVTs.

CONCLUSIONS

Further research is warranted to explore potential influences on PVT performance, which we conceptualize as analogous to experimental nuisance variables that may be amenable to intervention.

A Scoping Review of Predictors of Community Integration Following Traumatic Brain Injury: A Search for Meaningful Associations

OBJECTIVE

The purpose of this scoping review was to identify predictors of community integration for adults with traumatic brain injury.

DATA SOURCES

We searched the PubMed and PsycINFO databases and reviewed references of included studies. We selected studies exploring multiple components of community integration, including instrumental activities of daily living, leisure activities, and social activities. A total of 53 studies were included.

DATA EXTRACTION

We extracted data on sample size and sample characteristics (stage of injury and recovery, severity) and examined predictor variables, outcome measures for community integration, and significant findings, reported as correlations.

DATA SYNTHESIS

We found that the predictors of community integration fell into 4 categories: demographics, injury characteristics, disability and impairments, and environmental factors. There was large variability in reported relationships for demographics (r = 0.01-0.43), injury characteristics (r = 0.01-0.58), disability/functional impairments (r = 0.003-0.98) and environmental factors (r = 0.11-0.58). Cognition, disability, mobility/physical functioning, mood, social support, and length of posttraumatic amnesia had the strongest relationships with community integration outcomes.

CONCLUSIONS

Strategies for the management of cognitive, physical, and emotional functioning, and building and training a strong support system, may facilitate community integration outcomes. Additional work is warranted to further explore the discrepancies found among studies.

Spatial exploration strategy training for spatial neglect: A pilot study

Spatial neglect is a syndrome due to impaired neural networks critical for spatial attention and related cognitive and motor functions. Affected individuals also have impaired self-awareness of their own neglect symptoms. The present randomized controlled study was the first proof-of-concept pilot examining the multi-context treatment approach using a protocol of spatial exploration strategy training in one brief session (20-30 minutes). The therapist provided supportive feedback and semi-structured guidance to promote strategy learning and self-discovery of omission errors. 40 patients with left-sided neglect after right brain stroke were included. The results showed that the treatment reduced lateralized bias toward the ipsilesional side of space but did not improve overall detection performance. Impaired general self-awareness of daily-life spatial difficulties was found independent of treatment outcome. This implies that judgment regarding responsiveness to treatment should not be made based on an awareness interview or the severity of neglect symptoms. Lastly, the treatment showed the potential of improving online contextual self-awareness of spatial abilities. A collaborative and interactive approach that focuses on helping the patient self-discover, monitor and self-manage their errors, appears to have a potential for decreasing neglect symptoms. Future studies are required to examine additional aspects of the multi-context treatment approach.

Peer support interventions for individuals with acquired brain injury, cerebral palsy, and spina bifida: a systematic review

Background

Neurological disorders may negatively impact community integration and/or quality of life. Peer support has emerged as a potential strategy to enhance patients’ efficacy in managing their own health. This review examines the key characteristics and impact of peer support interventions for adults with acquired brain injury, cerebral palsy, and spina bifida on community integration and quality of life.

Methods

Eligible studies reported on peer support interventions for adults (16 years of age or older) with acquired brain injury, cerebral palsy, or spina bifida. Only randomized controlled trials published in English in the last 10 years were included. MEDLINE, EMBASE, PsycINFO, and CINAHL were used to conduct the literature search. Two reviewers independently screened studies, abstracted data, and evaluated the risk of bias (for individual study elements and overall) using the Cochrane Risk of Bias Tool.

Results

The systematic review included 6 trials reporting on acquired brain injury only. Of these studies, 4 reported on stroke and 2 reported on traumatic brain injury. Two studies found significant improvements in quality of life following peer support. No studies reported significant results on community integration. Considerable heterogeneity existed in the key characteristics of interventions.

Conclusions

There are a limited number of studies on the impact of peer support interventions for adults with acquired brain injury, cerebral palsy, or spina bifida on community integration and quality of life. Standardization of key intervention characteristics may aid the global adoption of peer support as a formalized, evidence-based practice.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-4110-5) contains supplementary material, which is available to authorized users.

Ontario Brain Injury Association Peer Support Program: a mixed methods protocol for a pilot randomised controlled trial

INTRODUCTION

The objective of this study is to conduct a pilot randomised controlled trial (RCT) of the Ontario Brain Injury Association (OBIA) Peer Support Program. The RCT is designed to evaluate the effectiveness and dose-response of the Peer Support Program in improving participation and mood for people with moderate-to-severe traumatic brain injury compared with a wait-list control group.

METHODS AND ANALYSIS

The proposed research is a three-phase, mixed methods pilot RCT. Consistent with an integrated knowledge translation approach, the study design has been informed in consultation with the knowledge user (ie, OBIA). It will include an initial qualitative examination of barriers and enablers to the trial implementation (phase 1), a pilot RCT (phase 2) and conclude with a qualitative component (phase 3). A qualitative descriptive approach will be adopted for both qualitative phases of the study (n=20-25) and thematic analysis will be used. The 6 months phase-2 trial will be conducted with 60 participants. These participants will be randomised to one of three groups: a twice a week programme (n=20), a once a week programme (n=20) or the wait-list control group (n=20). The feasibility of participant recruitment and retention, data collection, as well as participant adherence to the OBIA Peer Support Program will be evaluated. The primary outcome measure will be participation, as measured by the Participation Assessment with Recombined Tools-Objective. Other proposed outcomes of interest will include mood, health-related quality of life and self-efficacy.

ETHICS AND DISSEMINATION

Ethics approval will be obtained from the principal author's institution (University Health Network Research Ethics Board). The results of this study will inform the development of a larger scale RCT and will inform future iterations of the OBIA Peer Support Program including a revised programme curriculum.

TRIAL REGISTRATION NUMBER

NCT03450460; Pre-results.

A study of the influence of cognitive complaints, cognitive performance and symptoms of anxiety and depression on self-efficacy in patients with acquired brain injury

OBJECTIVE:

To examine the relationship between self-efficacy for managing brain injury-specific symptoms and cognitive performance, subjective cognitive complaints and anxiety and depression symptoms in patients with acquired brain injury (ABI).

DESIGN:

Clinical cohort study.

SETTING:

General hospitals, rehabilitation centres.

SUBJECTS:

A total of 122 patients with newly ABI (mean age = 54.4 years (SD, 12.2)) were assessed at discharge home from inpatient neurorehabilitation or at start of outpatient neurorehabilitation after discharge home from acute hospital. Mean time since injury was 14.1 weeks (SD, 8.6).

MAIN MEASURES:

Self-efficacy was measured using the Traumatic Brain Injury (TBI) Self-Efficacy Questionnaire (SEsx), mean score = 82.9 (SD, 21.8). Objective cognitive performance was measured with the Symbol Digit Modalities Test (SDMT), mean z-score = -1.36 (SD, 1.31). Anxiety and depression symptoms were measured with the Hospital Anxiety and Depression Scale (HADS), cognitive complaints with the self-rating form of the Dysexecutive Questionnaire (DEX-P).

RESULTS:

Higher levels of subjective cognitive complaints and higher levels of anxiety and depression symptoms were significantly associated with lower self-efficacy (β = -0.35; P = .001 and β =-0.43; P < .001, respectively). Objective cognitive performance was not significantly associated with self-efficacy (β = 0.04, P = .53). DEX-P scores accounted for 42% and HADS scores for 7% of the total 57% variance explained. Objective cognitive performance did not correlate significantly with subjective cognitive complaints (r = -.13, P = .16).

CONCLUSION:

Control over interfering emotions and mastery over brain injury-associated symptoms seems important in the development of self-efficacy for managing brain injury-specific symptoms.

Is the effect of coping styles disease specific? Relationships with emotional distress and quality of life in acquired brain injury and multiple sclerosis

OBJECTIVE

To investigate the use of coping styles and the relationships linking coping to emotional distress and quality of life in patients with acquired brain injury and multiple sclerosis.

METHOD

Cross-sectional cohort study of 143 patients with acquired brain injury and 310 patients with multiple sclerosis in the chronic stage. Quality of life was measured with the Life Satisfaction Questionnaire (LiSat-9), coping styles with the Coping Inventory for Stressful Situations (CISS-T, task-oriented; CISS-E, emotion-oriented; CISS-A, avoidance), emotional distress with the Hospital Anxiety and Depression Scale (HADS).

RESULTS

Coping styles did not differ between types of multiple sclerosis and varied only little with regard to severity of disease. In both patient groups, task-oriented coping was most used followed by avoidance and emotion-oriented coping. Patients with multiple sclerosis used all styles to a greater extent. In acquired brain injury, lower CISS-E and lower HADS scores were associated with higher LiSat-9 scores. CISS-E had a direct effect on LiSat-9 and an indirect effect via HADS. In multiple sclerosis, next to lower CISS-E and lower HADS scores, higher CISS-A scores were also associated with higher LiSat-9 scores. CISS-E had an indirect effect and CISS-A had a direct and indirect effect on LiSat-9.

CONCLUSION

In both patient groups, coping patterns are similar, and emotion-oriented coping negatively influences quality of life. Additionally, in multiple sclerosis, seeking emotional support and distraction (CISS-A) was positively associated with quality of life. Interventions to improve adaptive coping could be organized within a neurorehabilitation setting for both patient groups together.

Improving personal self-advocacy skills for individuals with brain injury: A randomized pilot feasibility study

OBJECTIVE

To investigate the feasibility of a self-advocacy intervention for individuals with acquired brain injury (ABI).

DESIGN

Two-arm, parallel-design, randomized feasibility study.

METHODS

Twelve participants, 1-year or more post-ABI (TBI and cerebral vascular accident (CVA)), were randomized into treatment/control groups. The treatment group received a group intervention and workbook; the control group received the workbook only. Outcome measures, taken at baseline, post-treatment and 6-weeks follow-up, included the General Self-Efficacy Scale (GSES), Satisfaction with Life Scale (SWLS) and Goal Attainment Scale (GAS) and two exploratory measures developed for the study: the Self Advocacy Scale (SAS) and the Personal Advocacy Activity Scale (PAAS).

RESULTS

Participants were successfully recruited and treated per protocol. The treatment group exhibited improvements from baseline to post-treatment on all measures; the control group improved on the GSES and declined on all others. Both groups exhibited improvement on all measures at follow-up, except the PAAS, which declined. There were no significant group differences on non-parametric analysis at any assessment points; however, the magnitude of change at post-treatment approached significance for the SAS and PAAS.

CONCLUSIONS

Initial feasibility for the methodology was demonstrated. Positive trends were noted. Further research could result in an evidence-based intervention to enhance self-advocacy post-ABI.

The nature of self-esteem and its relationship to anxiety and depression in adult acquired brain injury

Acquired brain injury (ABI) has a negative impact on self-esteem, which is in turn associated with mood disorders, maladaptive coping and reduced community participation. The aim of the current research was to explore self-esteem as a multi-dimensional construct and identify which factors are associated with symptoms of anxiety or depression. Eighty adults with ABI aged 17-56 years completed the Robson Self-Esteem Scale (RSES), of whom 65 also completed the Hospital Anxiety and Depression Scale; 57.5% of the sample had clinically low self-esteem. The RSES had good internal consistency (α =   .89), and factor analysis identified four factors, which differed from those found previously in other populations. Multiple regression analysis revealed anxiety was differentially predicted by "Self-Worth" and "Self-Efficacy", R² =   .44, F(4, 58) =   9, p <   .001, and depression by "Self-Regard", R² =   .38, F(4, 58) =   9, p <   .001. A fourth factor, "Confidence", did not predict depression or anxiety. In conclusion, the RSES is a reliable measure of self-esteem after ABI. Self-esteem after ABI is multidimensional and differs in structure from self-esteem in the general population. A multidimensional model of self-esteem may be helpful in development of transdiagnostic cognitive behavioural accounts of adjustment.

Toward an evidence-based patient-provider communication in rehabilitation: linking communication elements to better rehabilitation outcomes

Background:

There is a growing interest in linking aspects of patient-provider communication to rehabilitation outcomes. However, the field lacks a conceptual understanding on: (a) ‘how’ rehabilitation outcomes can be improved by communication; and (b) through ‘which’ elements in particular. This article elaborates on the conceptual developments toward informing further practice and research.

Methods:

Existing models of communication in healthcare were adapted to rehabilitation, and its outcomes through a comprehensive literature review.

Results:

After depicting mediating mechanisms and variables (e.g. therapeutic engagement, adjustment toward disability), this article presents the ‘4 Rehab Communication Elements’ deemed likely to underpin rehabilitation outcomes. The four elements are: (a) knowing the person and building a supportive relationship; (b) effective information exchange and education; (c) shared goal-setting and action planning; and (d) fostering a more positive, yet realistic, cognitive and self-reframing.

Discussion:

This article describes an unprecedented, outcomes-oriented approach toward the design of rehabilitation communication, which has resulted in the development of a new intervention model: the ‘4 Rehab Communication Elements’. Further trials are needed to evaluate the impact of this whole intervention model on rehabilitation outcomes.