A prospective study to evaluate a new residential community reintegration programme for severe chronic brain injury: The Brain Integration Programme

Implementation of a leisure reintegration programme for people with acquired brain injury in a community rehabilitation programme: a feasibility study

BACKGROUND

Participation in leisure activities is significantly impacted following acquired brain injury (ABI). Despite this being a common community rehabilitation goal, re-engagement with leisure activities following ABI is poorly addressed within Australian community rehabilitation services, which often cater to a mixed-diagnostic group of both ABI and non-ABI clients.

OBJECTIVES

To evaluate the feasibility and effect of a leisure reintegration group programme within a community rehabilitation service.

METHOD

A single-site, pre- and post-test feasibility study was conducted. Three cohorts of a semi-structured leisure group programme were offered, each conducted over eight sessions within 4 weeks. The Nottingham Leisure Questionnaire (NLQ) and Leisure Satisfaction Measure (LSM) were used as primary outcome measures. Measures of acceptability, including adherence, and a post-intervention participant survey were also completed.

RESULTS

Of the 14 consenting participants, 9 completed all outcome measures. Mean change score for the NLQ was -3.63 (p = 0.11) and the LSM 4.25 (p = 0.46). The programme was well attended (79%), acceptable for ABI and non-ABI participants and able to be implemented within an existing community rehabilitation service.

CONCLUSION

Providing a leisure reintegration group programme met an identified need, developed client and carer capacity and could be delivered within a community rehabilitation service for clients with mixed diagnoses including ABI. A larger trial is warranted to examine the effectiveness and cost-effectiveness of this intervention for people with ABI.

Employer and Co-worker Perspectives on Hiring and Working with People with Mental Health Conditions

The purpose of this study was to understand perspectives towards hiring and working with people with mental health conditions (PMHC). Semi-structured interviews with 25 employers and 20 co-workers were carried out. Thematic analysis was used to analyse the data. The barriers to hiring and working with PMHC identified through the interviews were concerns about safety, incompetence, PMHC not being able to get along with others, requiring more training and supervision as well as medical costs and reputational risks to the hiring organisation. Employers and co-workers suggested that improving mental health literacy of staff, pairing the PMHC with trained work buddies, having access to mental professionals when needed, and providing incentives for hiring PMHC such as tax rebates are likely to improve attitudes towards hiring and working with PMHC. Their suggestions for the additional supports required should be considered when developing initiatives to promote inclusivity of PMHC in workplaces.

Community reintegration following holistic milieu-oriented neurorehabilitation up to 30 years post-discharge

BACKGROUND

The primary goal of neurorehabilitation for individuals with acquired brain injury (ABI) is successful community reintegration, which commonly focuses on home independence, productivity, and social engagement. Previous research has demonstrated that holistic treatment approaches have better long-term outcomes than other treatment approaches. Holistic approaches go beyond the fundamental components of neurorehabilitation and address metacognition and self-awareness, as well as interpersonal and functional skills.

OBJECTIVES

The present study aimed to examine community reintegration of individuals with ABI who completed holistic milieu-oriented neurorehabilitation at the Center for Transitional Neuro-Rehabilitation (CTN), Barrow Neurological Institute (BNI) at up to 30-years post-discharge. We evaluated (a) functional independence, (b) productivity and driving status, and (c) psychosocial profiles of the brain injury survivors.

METHOD

Participants included 107 individuals with ABI with heterogeneous etiologies who attended holistic milieu-oriented neurorehabilitation between 1986 and 2016. These participants completed the Mayo-Portland Adaptability Inventory-4 (MPAI-4) and a long-term outcome questionnaire (LOQ) specifically developed for this study.

RESULTS

The results demonstrate that 89% of participants were productive at up to 30 years post-discharge (73% engaged in competitive work and/or school) after excluding the retired participants. Almost all of the participants who were engaged in work and/or school reported using compensatory strategies on a long-term basis. Furthermore, only 14% out of 102 study participants were driving at the time of program admission; whereas 58% out of 96 were driving at the time of discharge; and impressively, 70% out of 107 participants were driving at the time of follow-up. Regression analyses revealed that older age at the time of injury, shorter duration between injury and treatment, and better functionality indicated by lower MPAI-4 Ability Index scores significantly predicted a return to driving status at the time of study participation. Psychosocial data from the LOQ revealed positive findings with respect to patients' marital status, living situation, income, and quality of social life.

CONCLUSION

The findings from this study suggest that functional gains made during holistic neurorehabilitation have enduring effects and that patients can benefit highly from holistic milieu therapy beyond the early post-acute phases of their recovery. Additionally, they provide evidence that there is potential to return to driving, years after treatment completion.Our holistic milieu treatment approach addressing metacognition, self-awareness, social and coping skills training, and actively transitioning to community settings, is thought to have contributed to the exceptional and long-lasting outcomes in this study.

Caregivers' effects of augmented cognitive-behavioural therapy for post-stroke depressive symptoms in patients: secondary analyses to a randomized controlled trial

OBJECTIVE

To investigate the concomitant effects of two patient-directed interventions for post-stroke depressive symptoms on caregivers' well-being.

DESIGN

Secondary analyses of the results of a randomized controlled trial.

SUBJECTS

Fifty caregivers of stroke patients receiving outpatient rehabilitation.

INTERVENTIONS

Stroke patients and their caregivers were randomly allocated to either cognitive-behavioural therapy augmented with movement or occupational therapy ( n = 23) or computerized cognitive training ( n = 27) to alleviate depressive symptoms in patients.

MAIN MEASURES

Emotional burden (Involvement Evaluation Questionnaire), practical burden (Caregiver Strain Index), mental health (General Health Questionnaire) and emotional complaints (Hospital Anxiety and Depression Scale).

RESULTS

Caregivers of patients who received cognitive-behavioural therapy reported significantly higher mental health levels (mean difference (MD) = 1.78, 95% confidence interval (CI) = 0.43-3.13, P = 0.01) and less worrying about patients' well-being (MD = 1.9, 95% CI = 0.56-3.24, P < 0.01). In addition, there were positive time effects on the Involvement Evaluation Questionnaire for Brain Injury, particularly the subscales Worrying, Supervision and Tension.

CONCLUSION

The results suggest that augmented cognitive-behavioural therapy aimed at improving patients' emotional, behavioural and social functioning positively affects some aspects of caregivers' well-being.

What is Known About Transitional Living Services for Adults With an Acquired Brain Injury? A Scoping Review

Transitional living service (TLS) programmes for adults with an acquired brain injury are considered an important part of rehabilitation. However, considerable variability exists in the design and structure of these services, with limited research to guide the development of a programme based on best evidence. A scoping literature review was completed to answer the question ‘What is known about TLS programmes for adults with an acquired brain injury?’ Four electronic databases were systematically searched, followed by a grey literature search (from 1996 to 2015). 3183 articles were screened and 13 articles were included in the final review. Themes that emerged from the literature include the types of residents using TLS programmes, the subjective experience of residents and staff, intervention approaches, programme staffing, and programme outcomes. The research reviewed supports the use of TLS programmes to maximise functional independence and community integration of individuals with an acquired brain injury. Clinical practise recommendations were developed to help support implementation of TLS programmes based on best evidence, these included: to use multiple outcome measures, implement collaborative goal setting, support generalisation of skills learnt in the TLS to the home environment and for eligibility criteria for these programmes to include individuals across all phases of recovery.

A review of social participation interventions for people with mental health problems

PURPOSE

The association between social networks and improved mental and physical health is well documented in the literature, but mental health services rarely routinely intervene to improve an individual's social network. This review summarises social participation intervention models to illustrate different approaches which practitioners use, highlight gaps in the evidence base and suggest future directions for research.

METHODS

A systematic search of electronic databases was conducted, and social participation interventions were grouped into six categories using a modified narrative synthesis approach.

RESULTS

Nineteen interventions from 14 countries were identified, six of which were evaluated using a randomised controlled trial. They were grouped together as: individual social skills training; group skills training; supported community engagement; group-based community activities; employment interventions; and peer support interventions. Social network gains appear strongest for supported community engagement interventions, but overall, evidence was limited.

CONCLUSIONS

The small number of heterogeneous studies included in this review, which were not quality appraised, tentatively suggests that social participation interventions may increase individuals' social networks. Future research needs to use experimental designs with sufficient samples and follow-up periods longer than 12 months to enable us to make firm recommendations for mental health policy or practice.

Effectiveness of Interventions to Improve Occupational Performance for People With Psychosocial, Behavioral, and Emotional Impairments After Brain Injury: A Systematic Review

OBJECTIVE

This systematic review evaluates the effectiveness of interventions to improve occupational performance for people with psychosocial, behavioral, or emotional impairments after traumatic brain injury (TBI).

METHOD

Medline, PsycINFO, CINAHL, OTseeker, and the Cochrane Database of Systematic Reviews were searched. Of the 1,512 articles initially identified, 35 met the inclusion criteria.

RESULTS

Six types of interventions were identified: (1) education, (2) peer mentoring, (3) goal-directed therapy, (4) physical activity, (5) skills training, and (6) cognitive-behavioral therapy (CBT). Strong evidence from well-conducted research supports the use of CBT in individual and group settings. Moderate evidence supports goal-directed interventions, aquatic exercise, and functional skills training. Limited evidence supports peer mentoring, aerobic exercise, educational interventions, and various skills training.

CONCLUSION

An increasing body of evidence supports specific interventions to improve occupational performance and participation for people with psychosocial, behavioral, or emotional impairments after TBI.

First Consumers, Then Socially Integrated: Results of a Study on 100 Italian Drug Users Who Had Never Turned to Public or Private Addiction Services

This study, which addressed a per quota sample of 100 socially integrated drug users (SID) residing in Emilia Romagna (Italy) who have never referred to a public/private Addiction Service, has four main aims: (1) to describe the phenomenology of substance use in all its different facets; (2) to identify feared unwanted consequences due to the use of illegal substances and possible behaviors finalized to preventing them; (3) to identify possible common consumption rules; (4) to identify any differences among the SID. Two types of consumers have been compared: the "law-breakers" (i.e. those who have committed an illegal activity to procure money) and the "law-abiders" (no such action).From the interviewees some discontinuous consumption trajectories over time are reported in relation to the different levels of disposable income and the change in the relationship with the substances. Most of these consumers fear being stigmatized or labeled as drug-addicts, and cause themselves physical, psychological or economic harm; instead only a minority fear developing addiction. The most widespread protective behavior is to purchase through trusted direct channels, followed by the attempt to limit the doses and to consume only in positive emotional states. Rules of conduct implemented at a general level by all the consumers were evidenced, which the law-breakers finalize towards a greater attention to their own psycho-physical health and to better handling the effects produced by the substances, while the law-abiders seek to keep their status as consumers secret.

Non-pharmacological interventions for depression in adults and children with traumatic brain injury

BACKGROUND

Following traumatic brain injury (TBI) there is an increased prevalence of depression compared to the general population. It is unknown whether non-pharmacological interventions for depression are effective for people with TBI.

OBJECTIVES

To investigate the effectiveness of non-pharmacological interventions for depression in adults and children with TBI at reducing the diagnosis and severity of symptoms of depression.

SEARCH METHODS

We ran the most recent search on 11 February 2015. We searched the Cochrane Injuries Group Specialised Register, The Cochrane Library, MEDLINE (OvidSP), Embase (OvidSP), three other databases and clinical trials registers. Relevant conference proceedings and journals were handsearched, as were the reference lists of identified studies.

SELECTION CRITERIA

Randomised controlled trials (RCTs) of non-pharmacological interventions for depression in adults and children who had a TBI.

DATA COLLECTION AND ANALYSIS

Two authors independently selected trials from the search results, then assessed risk of bias and extracted data from the included trials. The authors contacted trial investigators to obtain missing information. We rated the overall quality of the evidence of the primary outcomes using the GRADE approach.

MAIN RESULTS

Six studies met the inclusion criteria, with a total of 334 adult participants. We identified no studies that included children as participants. All studies were affected by high risk of bias due to a lack of blinding of participants and personnel; five studies were affected by high risk of bias for lack of blinding of outcome assessors. There was high or unclear risk of biases affecting some studies across all the Cochrane risk of bias measures.Three studies compared a psychological intervention (either cognitive behaviour therapy or mindfulness-based cognitive therapy) with a control intervention. Data regarding depression symptom outcome measures were combined in a meta-analysis, but did not find an effect in favour of treatment (SMD -0.14; 95% CI -0.47 to 0.19; Z = 0.83; P = 0.41). The other comparisons comprised of single studies of depression symptoms and compared; cognitive behaviour therapy versus supportive psychotherapy (SMD -0.09; 95% CI -0.65 to 0.48; Z = 0.30; P = 0.77); repetitive transcranial magnetic stimulation plus tricyclic antidepressant (rTMS + TCA) versus tricyclic antidepressant alone (SMD -0.84; 95% CI -1.36 to -0.32; Z = 3;19, P = 0.001); and a supervised exercise program versus exercise as usual (SMD -0.43; 95% CI -0.88 to 0.03; Z = 1.84; P = 0.07). There was very-low quality evidence, small effect sizes and wide variability of results, suggesting that no comparisons showed a reliable effect for any intervention.Only one study mentioned minor, transient adverse events from repetitive transcranial magnetic stimulation.

AUTHORS' CONCLUSIONS

The review did not find compelling evidence in favour of any intervention. Future studies should focus on participants with a diagnosed TBI and include only participants who have a diagnosis of depression, or who record scores above a clinical cutoff on a depression measure. There is a need for additional RCTs that include a comparison between an intervention and a control that replicates the effect of the attention given to participants during an active treatment.

Effective return-to-work interventions after acquired brain injury: A systematic review

OBJECTIVE

To gather knowledge about effective return-to-work (RTW) interventions for patients with acquired brain injury (ABI).

METHODS

A database search was performed in PubMed, EMBASE, PsycINFO, CINAHL and the Cochrane Library using keywords and Medical Subject Headings. Studies were included if they met inclusion criteria: adult patients with non-progressive ABI, working pre-injury and an intervention principally designed to improve RTW as an outcome. The methodological quality of included studies was determined and evidence was assessed qualitatively.

RESULTS

Twelve studies were included, of which five were randomized controlled trials and seven were cohort studies. Nine studies had sufficient methodological quality. There is strong evidence that work-directed interventions in combination with education/coaching are effective regarding RTW and there are indicative findings for the effectiveness of work-directed interventions in combination with skills training and education/coaching. Reported components of the most effective interventions were tailored approach, early intervention, involvement of patient and employer, work or workplace accommodations, work practice and training of social and work-related skills, including coping and emotional support.

CONCLUSION AND IMPLICATIONS

Effective RTW interventions for patients with ABI are a combination of work-directed interventions, coaching/education and/or skills training. These interventions have the potential to facilitate sustained RTW for patients with ABI.

Did the educational campaign to support persons with cognitive dysfunction encourage them to participate in society in Northern Kyushu, Japan?

PRIMARY OBJECTIVE

To investigate social participation and the administration of the official certificate for cognitive dysfunction in Northern Kyushu, Japan following a government-conducted educational campaign to support persons with cognitive dysfunction.

METHODS AND PROCEDURES

A questionnaire was mailed to members of the Brain Injury Association of Northern Kyushu living with traumatic brain injury; the results were compared with those of the first survey conducted in 2002.

MAIN OUTCOMES AND RESULTS

This study evaluated 159 individuals (response rate: 72.6%, 135 males and 24 females), whose mean age at time of injury was 28 years. Eighty-two per cent of the participants were living at home; 72% were independent in activities of daily living. Fifty-nine per cent and 33% had certificates of physical and mental disability, respectively, and 37% were engaged in employment or school attendance. The number of participants who had obtained certificates of physical or mental disability and the number of participants who returned to employment or school significantly increased in comparison to the first survey (χ2 test, p < 0.05).

CONCLUSIONS

The model project and educational campaign facilitated social participation and increased the acquisition of the official certificate of cognitive dysfunction.

Using wireless technology in clinical practice: does feedback of daily walking activity improve walking outcomes of individuals receiving rehabilitation post-stroke? Study protocol for a randomized controlled trial

BACKGROUND

Regaining independent ambulation is the top priority for individuals recovering from stroke. Thus, physical rehabilitation post-stroke should focus on improving walking function and endurance. However, the amount of walking completed by individuals with stroke attending rehabilitation is far below that required for independent community ambulation. There has been increased interest in accelerometer-based monitoring of walking post-stroke. Walking monitoring could be integrated within the goal-setting process for those with ambulation goals in rehabilitation. The feedback from these devices can be downloaded to a computer to produce reports. The purpose of this study is to determine the effect of accelerometer-based feedback of daily walking activity during rehabilitation on the frequency and duration of walking post-stroke.

METHODS

Participants will be randomly assigned to one of two groups: feedback or no feedback. Participants will wear accelerometers daily during in- and out-patient rehabilitation and, for participants in the feedback group, the participants' treating physiotherapist will receive regular reports of walking activity. The primary outcome measures are the amount of daily walking completed, as measured using the accelerometers, and spatio-temporal characteristics of walking (e.g. walking speed). We will also examine goal attainment, satisfaction with progress towards goals, stroke self-efficacy, and community-integration.

DISCUSSION

Increased walking activity during rehabilitation is expected to improve walking function and community re-integration following discharge. In addition, a focus on altering walking behaviour within the rehabilitation setting may lead to altered behaviour and increased activity patterns after discharge.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01521234.

Doing resilience with "half a brain:" navigating moral sensibilities 35 years after hemispherectomy

This paper investigates experiences of resilience in the context of individuals suffering from disability as a result of severe intractable seizure disorder and consequent hemispherectomy, a surgical procedure in which part or all of either the left or right cerebral hemisphere is removed. Two adults who underwent childhood hemispherectomies-one left and one right-are the focus of this study. Previous research has extensively detailed the clinical outcomes of this neurological procedure, yet the actual day-to-day experiences of individuals living post-hemispherectomy remains unexplored. Utilizing open-ended, qualitative, and narrative techniques from a phenomenology of performativity perspective, the authors question how each individual's experiences of daily living are invariably acts of resilience, involving several different strategies that are somewhat unique to each. Rather than working as an adjective or noun signifying certain environmental or individual attributes, this paper proposes that "resilience" is best conceptualized as the individualized intentional actions which disabled, distraught, or at risk individuals perform in contextually relevant and idiosyncratic ways as they navigate health and well-being within their local social and moral worlds.

Effect of psychological interventions on depressive symptoms in long-term rehabilitation after an acquired brain injury: a systematic review and meta-analysis

OBJECTIVE

To summarize empirical studies on the effectiveness of psychological interventions in long-term rehabilitation after an acquired brain injury (ABI) in reducing depressive symptoms.

DATA SOURCES

A systematic literature search was conducted on MEDLINE, PsycINFO, Embase, and CINAHL to identify articles published between January 1990 and October 2011. Search terms included the 3 concepts (1) "brain injur*" or "stroke," (2) "psychotherap*" or "therapy" or "intervention" or "rehabilitation," and (3) "depress*."

STUDY SELECTION

Studies evaluating psychological interventions in patients after ABI were included. Time since injury was on average more than 1 year. Trials reported data on validated depression questionnaires before and after the psychological intervention.

DATA EXTRACTION

Two independent reviewers extracted information from the sample, the intervention, and the outcome of the included studies and calculated effect sizes (ESs) from depression questionnaires. Thirteen studies were included in a pre-post analysis. Seven studies were eligible for a meta-analysis of ESs in active interventions and control conditions.

DATA SYNTHESIS

Pre-post ESs were significant in 4 of 13 studies. The overall ES of .69 (95% confidence interval [CI], .29-1.09) suggests a medium effectiveness of psychological interventions on depressive symptoms compared with control conditions. Moderator analysis of the number of sessions and adequate randomization procedure did not show significant ES differences between strata. Studies with adequate randomization did not, however, suggest the effectiveness of psychological interventions on depressive symptoms after ABI.

CONCLUSIONS

Psychological interventions are a promising treatment option for depressive symptoms in long-term rehabilitation after ABI. Since only a few adequately randomized controlled trials (RCTs) exist, more RCTs are required to confirm this initial finding.

Measuring participation after stroke: a review of frequently used tools

OBJECTIVE

To identify and critique the measures currently used to assess participation in clinical stroke studies.

DATA SOURCES

Relevant articles published between January 2001 and April 2012 identified through Medline, CINAHL, and ProQuest Central databases.

STUDY SELECTION

Published articles involving poststroke assessment of participation. Case studies, cohort studies, and randomized controlled trials were included.

DATA EXTRACTION

The most frequently used measures were identified and the psychometric properties evaluated. Three raters independently evaluated each measure relative to the first and second coding levels of the International Classification of Functioning, Disability and Health (ICF) Activities and Participation domain categories.

DATA SYNTHESIS

Thirty-six measures were identified. The Stroke Impact Scale (SIS), London Handicap Scale, Assessment of Life Habits (LIFE-H), Frenchay Activities Index, and Activity Card Sort (ACS) were used most frequently. No single measure met criteria across all psychometric indices, and not one covered all 9 of the ICF Activities and Participation domains. The SIS, LIFE-H, and ACS covered the widest range. The domains covered most frequently were Community, Social and Civic Life, Domestic Life, and Mobility. Learning and Applying Knowledge, General Tasks and Demands, and Communication were the domains less frequently covered.

CONCLUSIONS

This review identified and evaluated the most frequently used participation measures in clinical stroke studies. The SIS, LIFE-H, and ACS covered the ICF Activities and Participation domain categories most comprehensively. However, none of the measures covered all the ICF Activities and Participation domain categories. The information provided in this systematic review can be used to guide the selection of participation measures to meet specific clinical and research purposes.

Accommodation Outcomes and Transitions Following Community-Based Intervention for Individuals with Acquired Brain Injury

Objectives: To explore living situation, support and participation outcomes of people with severe acquired brain injury (ABI) residing in either home-like or disability-specific accommodation settings, who were provided with 3 years of occupational therapy intervention based on the Community Approach to Participation (CAP).

To examine transitions for a subgroup whose accommodation and support model changed during this 3-year period and identify factors critical to this change.

Method: Forty-three participants who had sustained severe to extremely severe ABI, and were an average of 6.73 years post-injury, were provided with CAP intervention over a 3-year period. Living situation and support model, participation levels and accommodation transition data were collected at four time points.

Results: Participants were living in a range of home-like and disability-specific accommodation settings at baseline. The disability-specific accommodation group had mainly noncompensable injuries and required a significantly higher level of daily support at all four time points. They also received higher total hours of support, which averaged 170.83 hours per week at baseline and did not change significantly over the 3 years. In contrast, 86% of the participants residing in home-like settings had compensable injuries and received an average of 91.46 hours of support per week at baseline. This reduced to 70.97 hours per week over the 3-year intervention period, a change that was statistically significant.

Conclusion: It is possible to achieve accommodation transitions to more independent, home-like situations many years post-injury and regardless of injury severity. Home-like settings provide scope to adjust support along a continuum to reflect gains in independence, community integration and role participation that the fixed models and hours of support in disability-specific accommodation do not. Over time, these gains can flow into a significant reduction in hours of support.

Three-year follow-up results of a residential community reintegration program for patients with chronic acquired brain injury

OBJECTIVE

To evaluate outcomes of a residential community reintegration program 3 years after treatment on independent living, societal participation, emotional well-being, and quality of life in patients with chronic acquired brain injury and psychosocial problems hampering societal participation.

DESIGN

A follow-up assessment 3 years after treatment was compared with the 1-year follow-up assessment in a prospective cohort study.

SETTING

A tertiary rehabilitation center for acquired brain injury.

PARTICIPANTS

Of the 67 patients assessed at the 1-year follow-up, 63 subjects (94%; 42 men; mean age at admission to treatment 24.7y; mean time postonset 5.1y) were available at the 3-year follow-up and taken into account in the analyses.

INTERVENTION

A structured residential treatment program directed at improving independence in domestic life, work, leisure time, and social interactions.

MAIN OUTCOME MEASURES

Community Integration Questionnaire, Employability Rating Scale, living situation, school, work situation, work hours, Center for Epidemiological Studies-Depression scale, and the World Health Organization Quality of Life Scale Abbreviated (5 scales).

RESULTS

There were no significant differences for any of the outcome measures between the 1-year and 3-year follow-up assessment.

CONCLUSIONS

These results indicate that the established significant and clinically relevant improvements after a residential community reintegration program remain stable in the long term.

A prospective study to evaluate a residential community reintegration program for patients with chronic acquired brain injury

OBJECTIVE

To examine the effects of a residential community reintegration program on independent living, societal participation, emotional well-being, and quality of life in patients with chronic acquired brain injury and psychosocial problems hampering societal participation.

DESIGN

A prospective cohort study with a 3-month waiting list control period and 1-year follow up.

SETTING

A tertiary rehabilitation center for acquired brain injury.

PARTICIPANTS

Patients (N=70) with acquired brain injury (46 men; mean age, 25.1y; mean time post-onset, 5.2y; at follow up n=67).

INTERVENTION

A structured residential treatment program was offered directed at improving independence in domestic life, work, leisure time, and social interactions.

MAIN OUTCOME MEASURES

Community Integration Questionnaire (CIQ), Employability Rating Scale, living situation, school, work situation, work hours, Center for Epidemiological Studies Depression Scale, EuroQOL quality of life scale (2 scales), World Health Organization Quality of Life Scale Abbreviated (WHOQOL-BREF; 5 scales), and the Global Assessment of Functioning (GAF) scale.

RESULTS

There was an overall significant time effect for all outcome measures (multiple analysis of variance T(2)=26.16; F(36,557) 134.9; P=.000). There was no spontaneous recovery during the waiting-list period. The effect sizes for the CIQ, Employability Rating Scale, work hours, and GAF were large (partial η(2)=0.25, 0.35, 0.22, and 0.72, respectively). The effect sizes were moderate for 7 of the 8 emotional well-being and quality of life (sub)scales (partial η(2)=0.11-0.20). The WHOQOL-BREF environment subscale showed a small effect size (partial η(2)=0.05). Living independently rose from 25.4% before treatment to 72.4% after treatment and was still 65.7% at follow up.

CONCLUSIONS

This study shows that a residential community reintegration program leads to significant and relevant improvements of independent living, societal participation, emotional well-being, and quality of life in patients with chronic acquired brain injury and psychosocial problems hampering societal participation.

Prospective study of a community reintegration programme for patients with acquired chronic brain injury: effects on caregivers' emotional burden and family functioning

OBJECTIVE

To examine the effects of a residential community reintegration programme for patients with psychosocial problems due to acquired chronic brain injury on caregivers' emotional burden and family functioning.

DESIGN

A prospective cohort study with waiting list control and 1-year follow-up.

SUBJECTS

Forty-one caregivers of which 28 female. Mean age was 48 ± 8.3 years and 33 caregivers were parents.

INTERVENTION

A structured residential treatment programme was offered to the patients directed at domestic life, work, leisure time and social interactions.

MEASURES

The Involvement Evaluation Questionnaire for Brain Injury (IEQ-BI) for emotional burden, the General Health Questionnaire (GHQ) for psychological health and the Family Assessment Device (FAD) for family functioning were used.

RESULTS

There was an overall significant effect of Time for all outcome measures (MANOVA T(2 )= 9.1, F(15,317) = 64.1, p = 0.000). The effect sizes were moderate for three IEQ-BI sub-scales (partial η(2 )= 0.12-0.17) and small for two sub-scales (partial η(2 )= 0.05-0.09). The effect size for GHQ was moderate (partial η(2 )= 0.11). As for FAD no significant time effects were present (partial η(2 )= 0.00-0.04).

CONCLUSIONS

Emotional burden and psychological health of the caregivers improved significantly when patients with acquired brain injury and psychosocial problems followed a residential community reintegration programme. Family dynamics remained stable.

Outcomes of post-acute rehabilitation for persons with brain injury

OBJECTIVES

To examine the impact of multifaceted rehabilitation services on functional outcomes after traumatic brain injury (TBI) for individuals with significant physical and cognitive difficulties, as well as those with added behavioural complications.

DESIGN

Cohort, non-randomized, intervention study with a pre-test-post-test, follow-up design.

SETTING

Community integrated post-acute rehabilitation centre.

PARTICIPANTS

Individuals with primarily severe TBI receiving post-acute neurorehabilitation services (NR, n = 129) as well as similarly impaired individuals with additional antagonistic/disruptive behaviours receiving neurobehavioural services (NB, n = 76).

INTERVENTIONS

Multi-faceted behavioural and cognitive therapy methods delivered individually and in groups.

MAIN OUTCOME MEASURE

The Functional Area Outcome Menu (FAOM), a behaviourally anchored 5-step scale rated by rehabilitation teams at three time periods.

CONCLUSIONS

The rehabilitation treatment model achieved significant functional gains of approximately 1.5 levels for neuropsychologically-impaired adults with and without associated behavioural and substance problems.

Experienced emotional burden in caregivers: psychometric properties of the Involvement Evaluation Questionnaire in caregivers of brain injured patients

Objective: To examine the psychometric properties (internal consistency, discriminant validity, and responsiveness) of the Involvement Evaluation Questionnaire for Brain Injury measuring emotional burden in caregivers of patients with chronic acquired brain injury.

Design: Inception cohort study.

Subjects: Caregivers of chronic acquired brain injury patients.

Main measures: Besides the Involvement Evaluation Questionnaire for Brain Injury, the Family Assessment Device and the General Health Questionnaire were used.

Methods: Ninety-eight caregivers filled out all questionnaires, of which 41 caregivers did this twice, before and after the persons they cared for had started a residential community reintegration programme. Cronbach’s alpha and Intra class Correlation Coefficient were calculated for internal consistency. Pearson correlation coefficients were used for discriminant validity and Intra class Correlation Coefficient and Cohen’s d were calculated to determine responsiveness.

Results: The internal consistency of the Involvement Evaluation Questionnaire for Brain Injury was good (α = 0.73—0.84; Intra class Correlation Coefficient = 0.69—0.76). As expected, low correlations were found between the Involvement Evaluation Questionnaire for Brain Injury and either the General Health Questionnaire (r = 0.11—0.40) or the Family Assessment Device subscales (r = —0.29—0.19). Regarding responsiveness of the Involvement Evaluation Questionnaire for Brain Injury, a moderate effect size was found (Cohen’s d = 0.36) while the Intra class Correlation Coefficient was good (0.80).

Conclusions: The Involvement Evaluation Questionnaire for Brain Injury measures the experienced emotional burden in caregivers of patients with chronic acquired brain injury and seems to be a promising new instrument with good internal consistency, discriminant validity and responsiveness.