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LaBuzetta JN, Bongbong DN, Mlodzinski E, Sheth R, Trando A, Ibrahim N, Yip B, Malhotra A, Dinglas VD, Needham DM, Kamdar BB. Survivorship After Neurocritical Care: A Scoping Review of Outcomes Beyond Physical Status. Neurocrit Care 2024:10.1007/s12028-024-01965-9. [PMID: 38622487 DOI: 10.1007/s12028-024-01965-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/21/2024] [Indexed: 04/17/2024]
Abstract
Following intensive care unit hospitalization, survivors of acute neurological injury often experience debilitating short-term and long-term impairments. Although the physical/motor impairments experienced by survivors of acute neurological injury have been described extensively, fewer studies have examined cognitive, mental health, health-related quality of life (HRQoL), and employment outcomes. This scoping review describes the publication landscape beyond physical and/or motor sequelae in neurocritical care survivors. Databases were searched for terms related to critical illness, intensive care, and outcomes from January 1970 to March 2022. English-language studies of critically ill adults with a primary neurological diagnosis were included if they reported on at least one outcome of interest: cognition, mental health, HRQoL or employment. Data extraction was performed in duplicate for prespecified variables related to study outcomes. Of 16,036 abstracts screened, 74 citations were identified for inclusion. The studies encompassed seven worldwide regions and eight neurocritical diagnosis categories. Publications reporting outcomes of interest increased from 3 before the year 2000 to 71 after. Follow-up time points included ≤ 1 (n = 15 [20%] citations), 3 (n = 28 [38%]), 6 (n = 28 [38%]), and 12 (n = 21 [28%]) months and 1 to 5 (n = 19 [26%]) and > 5 years (n = 8 [11%]), with 28 (38%) citations evaluating outcomes at multiple time points. Sixty-six assessment tools were used to evaluate the four outcomes of interest: 22 evaluating HRQoL (56 [76%] citations), 21 evaluating cognition (20 [27%] citations), 21 evaluating mental health (18 [24%] citations), and 2 evaluating employment (9 [12%] citations). This scoping review aimed to better understand the literature landscape regarding nonphysical outcomes in survivors of neurocritical care. Although a rising number of publications highlight growing awareness, future efforts are needed to improve study consistency and comparability and characterize outcomes in a disease-specific manner, including outlining of a minimum core outcomes set and associated assessment tools.
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Affiliation(s)
- Jamie Nicole LaBuzetta
- Division of Neurocritical Care, Department of Neurosciences, University of California, San Diego Health, 9444 Medical Center Dr., East Campus Office Building 3-028, La Jolla, CA, 92037-7740, USA.
| | - Dale N Bongbong
- Division of Neurocritical Care, Department of Neurosciences, University of California, San Diego Health, 9444 Medical Center Dr., East Campus Office Building 3-028, La Jolla, CA, 92037-7740, USA
| | - Eric Mlodzinski
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California, San Diego Health, La Jolla, CA, USA
| | - Richa Sheth
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California, San Diego Health, La Jolla, CA, USA
| | - Aaron Trando
- Division of Neurocritical Care, Department of Neurosciences, University of California, San Diego Health, 9444 Medical Center Dr., East Campus Office Building 3-028, La Jolla, CA, 92037-7740, USA
| | - Nicholas Ibrahim
- Division of Neurocritical Care, Department of Neurosciences, University of California, San Diego Health, 9444 Medical Center Dr., East Campus Office Building 3-028, La Jolla, CA, 92037-7740, USA
| | - Brandon Yip
- Division of Neurocritical Care, Department of Neurosciences, University of California, San Diego Health, 9444 Medical Center Dr., East Campus Office Building 3-028, La Jolla, CA, 92037-7740, USA
| | - Atul Malhotra
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California, San Diego Health, La Jolla, CA, USA
| | - Victor D Dinglas
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA
| | - Dale M Needham
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Biren B Kamdar
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California, San Diego Health, La Jolla, CA, USA
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Hoepner JK, Dahl KA, Keegan LC, Proud DN. Healthcare perceptions of persons with traumatic brain injuries across providers: shortcomings in the chronic phase of care. Brain Inj 2024; 38:347-354. [PMID: 38354277 DOI: 10.1080/02699052.2024.2311332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 01/24/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVE This investigation sought to examine the perceptions of individuals with mild, moderate, and severe traumatic brain injury (TBIs) toward healthcare providers across rehabilitation contexts (acute, rehabilitation, and chronic). METHODS The mCARE-TBI survey was distributed via Qualtrics throughout the US and Canada. Sixty-four survey responses met criteria for analysis. Participants were ≥18 years old, one-year post onset, reported no unrelated neurological deficits prior to the single TBI, and reported no prior diagnosed psychiatric disorders. The mCARE was the primary outcome measure. Comparisons were made between provider ratings on each question. RESULTS Significant differences were found between chronic-phase care, compared to acute care and rehabilitation. Group differences were found in transitioning home after discharge and in between each therapy discipline and both nurses and doctors, as well as for really listening and pairwise differences between therapy disciplines and both nurses and doctors. Group effects were found for showing compassion and care and being positive. CONCLUSIONS All disciplines need to improve communication, and transition care/discharge planning. Dismissal of ongoing impairments continues to be an area of perceived concern with doctors in particular. Communication training is needed, particularly for nurses and doctors.
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Affiliation(s)
- Jerry K Hoepner
- Department of Communication Sciences & Disorders, University of Wisconsin, Eau Claire, Wisconsin, USA
| | - Kathleen A Dahl
- Speech-Language Pathologist, North DuPage Special Education Cooperative, Roselle, Illinois, USA
| | - Louise C Keegan
- School of Rehabilitation Sciences, Moravian University, Bethlehem, Pennsylvania, USA
| | - Daniel N Proud
- Department of Biology, Moravian University, Bethlehem, Pennsylvania, USA
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3
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Igoe A, Twomey DM, Allen N, Carton S, Brady N, O'Keeffe F. A longitudinal analysis of factors associated with post traumatic growth after acquired brain injury. Neuropsychol Rehabil 2024; 34:430-452. [PMID: 37022203 DOI: 10.1080/09602011.2023.2195190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 03/20/2023] [Indexed: 04/07/2023]
Abstract
ABSTRACTPost-Traumatic Growth (PTG) is a form of positive psychological change that occurs for some individuals following traumatic experiences. High levels of PTG have been reported among survivors of acquired brain injury (ABI). Yet it remains unclear why some survivors of ABI develop PTG and others do not. The present study investigated early and late factors that are associated with long-term PTG in people with moderate to severe ABIs. Participants (n = 32, Mage = 50.59, SD = 12.28) completed self-report outcome measures at two time-points seven years apart (one-year and eight-years post-ABI). Outcome measures assessed emotional distress, coping, quality of life and ongoing symptoms of brain injury, as well as PTG at the later timepoint. Multiple regression analyses indicated that one-year post-ABI, fewer symptoms of depression, more symptoms of anxiety, and use of adaptive coping strategies accounted for a significant amount of variance in later PTG. At eight years post-ABI, fewer symptoms of depression, fewer ongoing symptoms of brain injury, better psychological quality of life and use of adaptive coping strategies explained a substantial amount of variance in PTG. For individuals with ABIs, PTG may be promoted by implementing long-term neuropsychological support which aims to facilitate use of adaptive coping strategies, supports psychological wellbeing and allows individuals to find meaning post-ABI.
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Affiliation(s)
- Anna Igoe
- University College Dublin, Dublin, Ireland
| | | | | | - Simone Carton
- National Rehabilitation Hospital, Dun Laoghaire, Ireland
| | | | - Fiadhnait O'Keeffe
- University College Dublin, Dublin, Ireland
- Trinity College Dublin, Dublin, Ireland
- National Rehabilitation Hospital, Dun Laoghaire, Ireland
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Gabbe BJ, Keeves J, McKimmie A, Gadowski AM, Holland AJ, Semple BD, Young JT, Crowe L, Ownsworth T, Bagg MK, Antonic-Baker A, Hicks AJ, Hill R, Curtis K, Romero L, Ponsford JL, Lannin NA, O'Brien TJ, Cameron PA, Cooper DJ, Rushworth N, Fitzgerald M. The Australian Traumatic Brain Injury Initiative: Systematic Review and Consensus Process to Determine the Predictive Value of Demographic, Injury Event, and Social Characteristics on Outcomes for People With Moderate-Severe Traumatic Brain Injury. J Neurotrauma 2024. [PMID: 38115598 DOI: 10.1089/neu.2023.0461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
The objective of the Australian Traumatic Brain Injury (AUS-TBI) Initiative is to develop a data dictionary to inform data collection and facilitate prediction of outcomes of people who experience moderate-severe TBI in Australia. The aim of this systematic review was to summarize the evidence of the association between demographic, injury event, and social characteristics with outcomes, in people with moderate-severe TBI, to identify potentially predictive indicators. Standardized searches were implemented across bibliographic databases to March 31, 2022. English-language reports, excluding case series, which evaluated the association between demographic, injury event, and social characteristics, and any clinical outcome in at least 10 patients with moderate-severe TBI were included. Abstracts and full text records were independently screened by at least two reviewers in Covidence. A pre-defined algorithm was used to assign a judgement of predictive value to each observed association. The review findings were discussed with an expert panel to determine the feasibility of incorporation of routine measurement into standard care. The search strategy retrieved 16,685 records; 867 full-length records were screened, and 111 studies included. Twenty-two predictors of 32 different outcomes were identified; 7 were classified as high-level (age, sex, ethnicity, employment, insurance, education, and living situation at the time of injury). After discussion with an expert consensus group, 15 were recommended for inclusion in the data dictionary. This review identified numerous predictors capable of enabling early identification of those at risk for poor outcomes and improved personalization of care through inclusion in routine data collection.
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Affiliation(s)
- Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Health Data Research UK, Swansea University Medical School, Swansea University, Singleton Park, United Kingdom
| | - Jemma Keeves
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin School of Population Health, Curtin University, Bentley, WA, Australia
| | - Ancelin McKimmie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Adelle M Gadowski
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Andrew J Holland
- The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney School of Medicine, Westmead, Australia
| | - Bridgette D Semple
- Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, VIC, Australia
| | - Jesse T Young
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
- Clinical Sciences Murdoch Children's Research Institute, Parkville, VIC, Australia
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
- Justice Health Group, Curtin School of Population Health, Curtin University, Bentley, WA, Australia
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Louise Crowe
- Clinical Sciences Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Tamara Ownsworth
- School of Applied Psychology and the Hopkins Centre, Griffith University, Brisbane, Australia
| | - Matthew K Bagg
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin School of Population Health, Curtin University, Bentley, WA, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
- School of Health Sciences, University of Notre Dame Australia, Fremantle, WA, Australia
| | - Ana Antonic-Baker
- Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, VIC, Australia
| | - Amelia J Hicks
- Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, VIC, Australia
- School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Regina Hill
- Regina Hill Effective Consulting Pty. Ltd., Melbourne, VIC, Australia
| | - Kate Curtis
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Illawarra Shoalhaven LHD, Wollongong, NSW, Australia
- George Institute for Global Health, Newtown, NSW, Australia
| | | | - Jennie L Ponsford
- Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, VIC, Australia
- School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Natasha A Lannin
- Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, VIC, Australia
- Alfred Health, Melbourne, VIC, Australia
| | - Terence J O'Brien
- Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, VIC, Australia
| | - Peter A Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- National Trauma Research Institute, Melbourne, VIC, Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
| | - D Jamie Cooper
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia
| | | | - Melinda Fitzgerald
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin School of Population Health, Curtin University, Bentley, WA, Australia
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O'Loghlen J, Geraghty T, Kendall M, Nielsen M, Jones R, McLennan V, Watter K, Ownsworth T. Perceived vocational support needs and return-to-work outcomes in the first 12-months post-discharge in individuals with acquired brain injury and spinal cord injury: A retrospective cohort study. Work 2024; 77:275-293. [PMID: 37638466 DOI: 10.3233/wor-230090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Return-to-work (RTW) is often viewed as an important outcome following acquired brain injury (ABI) and spinal cord injury (SCI), although not all individuals have vocational goals and many experience barriers to RTW. OBJECTIVE This study investigated the relationship between RTW and psychosocial functioning at 12-months post-discharge after ABI and SCI and examined patterns of RTW according to perceived need for and receipt of vocational support. METHODS A file audit was conducted for 69 participants with ABI (n = 44) and SCI (n = 25). Data on employment status and perceived vocational support at 3- and 12-months post-discharge, home and community participation, psychological distress, and health-related quality of life were extracted. RESULTS Individuals in paid employment at 12-months post-discharge (22%, n = 15) reported significantly better psychosocial functioning at this timepoint compared to those not employed (78%; n = 54). For those not employed, three subgroups were identified: 1) Did not perceive the need for or receive vocational support (50%; n = 27); 2) Perceived vocational support needs were unmet (19%; n = 10); and 3) Perceived and received vocational support (31%; n = 17). Psychological distress was highest for those who perceived and received vocational support but were not employed. CONCLUSION RTW was associated with better psychosocial functioning after acquired neurological injury. The findings highlight the need for clinicians to explore and revisit individuals' perceived need for and preferences for vocational support and monitor the psychological well-being of those with RTW goals that are not yet successful.
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Affiliation(s)
- Jessica O'Loghlen
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Timothy Geraghty
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Division of Rehabilitation, Metro South Health Hospital and Health Service, Brisbane, Australia
| | - Melissa Kendall
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Division of Rehabilitation, Metro South Health Hospital and Health Service, Brisbane, Australia
| | - Mandy Nielsen
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Division of Rehabilitation, Metro South Health Hospital and Health Service, Brisbane, Australia
| | - Rachel Jones
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Division of Rehabilitation, Metro South Health Hospital and Health Service, Brisbane, Australia
| | - Vanette McLennan
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Kerrin Watter
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Division of Rehabilitation, Metro South Health Hospital and Health Service, Brisbane, Australia
| | - Tamara Ownsworth
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
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Hoepner JK, Keegan LC. "I Avoid Interactions With Medical Professionals as Much as Possible Now": Health Care Experiences of Individuals With Traumatic Brain Injuries. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:848-866. [PMID: 36346972 DOI: 10.1044/2022_ajslp-22-00103] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE This study examined the perceptions of health care experiences by individuals with traumatic brain injuries (TBIs) across the recovery continuum, regarding care received by a variety of health care providers following their TBI. It sought to identify whether perceptions differed across mild, moderate, and severe participants, as well as acute, subacute, and chronic recovery. METHOD Eighteen individuals with TBI were interviewed, using the Sydney Psychosocial Reintegration Scale-Second Edition (SPRS-2) and a semistructured interview about health care perceptions. A qualitative investigation employing two methods, interpretive phenomenological analysis (IPA) and Systemic Functional Linguistics (SFL; modality and appraisal analysis), provided a micro and macrolevel discourse analysis. RESULTS IPA analyses of SPRS-2 interviews differed across severity levels but included changes to relationships, identity, and changes to social engagement and activity. IPA results revealed three core themes related to the health care experiences across severity that encompassed (a) frustrations with providers and (b) lack of support in the chronic phase, and (c) that finding support is crucial. SFL results provided insight into how individuals appraised such experiences in light of their identity and personal perspectives. Key differences between individuals with mild, moderate, and severe TBI diagnoses were found, with those who experienced a mild TBI expressing the most discontent with services received. Participants were most satisfied with acute care and least satisfied with chronic phase support. CONCLUSIONS The results of this study have significant implications for health care professionals interacting with individuals who have experienced a TBI. Facilitating improved communication, referrals, increased access to mental health counseling, and resources such as groups to support identity expression could improve the health care experience.
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Guerrette MC, McKerral M. Predictors of Social Participation Outcome after Traumatic Brain Injury Differ According to Rehabilitation Pathways. J Neurotrauma 2023; 40:523-535. [PMID: 35974662 DOI: 10.1089/neu.2022.0232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Social participation (SP) is one of many objectives in the rehabilitation of patients with traumatic brain injury (TBI). Studies on predictors of SP specific to post-acute universally accessible specialized rehabilitation pathways following TBI are scarce. Our objectives were to: 1) characterize SP, as well as a set of pre-injury, injury-related, and post-injury variables in individuals participating in inpatient-outpatient or outpatient rehabilitation pathways within a universally accessible and organized trauma continuum of care; and 2) examine the ability of pre-injury, injury-related, and post-injury variables in predicting SP outcome after TBI according to rehabilitation path. Participants (N = 372) were adults admitted to an inpatient-outpatient rehabilitation pathway or an outpatient rehabilitation pathway after sustaining a TBI between 2016 and 2020, and for whom Mayo-Portland Adaptability Intentory-4 (MPAI-4) outcomes were prospectively obtained at the start and end of rehabilitation. Additional data was collected from medical files. For both rehabilitation pathways, predicted SP outcome was MPAI-4 Participation score at discharge from outpatient rehabilitation. Multiple regression models investigated the predictive value of each variable for SP outcome, separately for each care pathway. Main findings show that for the inpatient-outpatient sample, three variables (education years, MPAI-4 Ability and Adjustment scores at rehabilitation intake) significantly predicted SP outcome, with the regression model accounting for 49% of the variance. For the outpatient sample, five variables (pre-morbid hypertension and mental health diagnosis, total indirect rehabilitation hours received, MPAI-4 Abilities and Adjustment scores at rehabilitation intake) significantly predicted SP outcome, with the regression model accounting for 47% of the variance. In conclusion, different pre-morbid and post-injury variables are involved in predicting SP, depending on the rehabilitation path followed. The predictive value of those variables could help clinicians identify patients more likely of showing poorer SP at discharge and who may require additional or different interventions.
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Affiliation(s)
- Marie-Claude Guerrette
- Department of Psychology, Université de Montréal, Center for Interdisciplinary Research in Rehabilitation of Greater Montreal-IURDPM, Montreal, Quebec, Canada
| | - Michelle McKerral
- Department of Psychology, Université de Montréal, Center for Interdisciplinary Research in Rehabilitation of Greater Montreal-IURDPM, Montreal, Quebec, Canada
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8
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Libeson L, Ross P, Downing M, Ponsford J. Exploring employment following traumatic brain injury in persons who completed an insurer funded vocational rehabilitation program in Australia. Disabil Rehabil 2022; 44:7428-7438. [PMID: 34689670 DOI: 10.1080/09638288.2021.1992516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE To extend the authors' previous research by investigating the maintenance of work performance over time and the long-term experience of employment following traumatic brain injury (TBI). MATERIALS AND METHODS Semi-structured interviews were conducted with a sample of 72 individuals with predominantly severe TBI, up to 10-years post-injury. Thematic analysis of transcribed interviews was conducted. RESULTS Four key themes were identified: brain injury influences on work performance and long-term employment; factors optimising long-term employment; and need for compromise and acceptance, which all impacted the final theme, quality of life outcome. While TBI-related difficulties such as fatigue, cognitive, and emotional difficulties still impacted work many years post-injury, work modifications and employer and vocational rehabilitation (VR) support were important factors optimising long-term employment. The timing of return to work (RTW) was also an important and potentially modifiable factor influencing work performance, which appeared to have long-term effects on the maintenance of employment. Support for acceptance of altered career goals is needed. CONCLUSION Findings support the need for early VR to facilitate employer contact, to maximise adjustment and preparation time before RTW, to educate both employees and employers and to implement work modifications to support continuing employment after TBI.Implications for rehabilitationThe maintenance of employment following TBI is of critical importance for financial independence, psychological and social well-being, and improved quality of life.Injury-related difficulties still impact work performance many years after injury requiring individuals with TBI to continue working in modified roles and for reduced hours over the long-term.Ongoing VR and employer support is needed to facilitate long-term work modifications and compensatory strategies to support work performance.Early VR involvement to facilitate employer contact and maximise adjustment and preparation time before returning to work is necessary to avoid the negative and potentially dire consequences of returning too early.Psychological support to facilitate acceptance of role changes and career compromises is also important.
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Affiliation(s)
- Lauren Libeson
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia.,Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
| | - Pamela Ross
- Monash-Epworth Rehabilitation Research Centre, Richmond, Australia.,Epworth HealthCare, Richmond, Australia
| | - Marina Downing
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia.,Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
| | - Jennie Ponsford
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia.,Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
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Arango-Lasprilla JC, Watson JD, Rodriguez M, Ramos-Usuga D, Mascialino G, Perrin PB. Employment probability trajectories in hispanics over the 10 years after traumatic brain injury: A model systems study. NeuroRehabilitation 2022; 51:397-405. [DOI: 10.3233/nre-220066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Research has found that Hispanics with traumatic brain injury (TBI) have reduced functional outcomes compared to non-Hispanic Whites, including lower probabilities of post-injury employment. However, previous studies were cross-sectional, combined racial/ethnic minority groups, and did not examine the factors that predict return to work of Hispanics longitudinally. OBJECTIVE: To determine the demographic and injury-related predictors of employment probability trajectories during the first 10 years after TBI. METHODS: 1,346 Hispanics in the TBI Model Systems Database was included. Hierarchical linear modeling was used to examine baseline predictors of employment probability trajectories across this time period. RESULTS: Employment probability demonstrated a quadratic movement over time, with an initial increase followed by a plateau or slight decrease. Hispanics with TBI had higher employment probability trajectories if they had been younger at the time of injury, spent less time in posttraumatic amnesia, had greater years of education, had been employed at the time of injury, had higher annual earnings at the time of injury, and had experienced a non-violent mechanism of injury. CONCLUSION: Culturally adapted treatment programs with a focus on early intervention incorporating vocational rehabilitation and employment programs for Hispanics with TBI who present with these risk factors are needed.
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Affiliation(s)
| | - Jack D. Watson
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Miriam Rodriguez
- Department of Health and Wellness Design, School of Public Health, Indiana University - Bloomington, Bloomington, IN, USA
| | - Daniela Ramos-Usuga
- Biomedical Research Doctorate Program, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Guido Mascialino
- Escuela de Psicología, Universidad de Las Américas, Quito, Ecuador
| | - Paul B. Perrin
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
- Central Virginia Veterans Affairs Health Care System, Richmond, VA, USA
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Yabuno S, Yasuhara T, Murai S, Yumoto T, Naito H, Nakao A, Date I. Predictive Factors of Return Home and Return to Work for Intensive Care Unit Survivors after Traumatic Brain Injury with a Follow-up Period of 2 Years. Neurol Med Chir (Tokyo) 2022; 62:465-474. [PMID: 36130904 PMCID: PMC9637400 DOI: 10.2176/jns-nmc.2022-0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Intensive care unit (ICU) survivors after traumatic brain injury (TBI) frequently have serious disabilities with subsequent difficulty in reintegration into society. We aimed to investigate outcomes for ICU survivors after moderate to severe TBI (msTBI) and to identify predictive factors of return home (RH) and return to work (RTW). This single-center retrospective cohort study was conducted on all trauma patients admitted to the emergency ICU of our hospital between 2013 and 2017. Of these patients, adult (age ≥ 18 years) msTBI patients with head Abbreviated Injury Scale ≥ 3 were extracted. We performed univariate/multivariate logistic regression analyses to explore the predictive factors of RH and RTW. Among a total of 146 ICU survivors after msTBI, 107 were included (median follow-up period: 26 months). The RH and RTW rates were 78% and 35%, respectively. Multivariate analyses revealed that the predictive factors of RH were age < 65 years (P < 0.001), HR < 76 bpm (P = 0.015), platelet count ≥ 19 × 104/μL (P = 0.0037), D-dimer < 26 μg/mL (P = 0.034), and Glasgow Coma Scale (GCS) score > 8 (P = 0.0015). Similarly, the predictive factors of RTW were age < 65 years (P < 0.001) and GCS score > 8 (P = 0.0039). This study revealed that “age” and “GCS score on admission” affected RH and RTW for ICU survivors after msTBI.
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Affiliation(s)
- Satoru Yabuno
- Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
| | - Takao Yasuhara
- Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
| | - Satoshi Murai
- Department of Neurosurgery, National Hospital Organization Iwakuni Clinical Center
| | - Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
| | - Isao Date
- Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
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11
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Potential Progression Mechanism and Key Genes in Early Stage of mTBI. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:3151090. [PMID: 35966737 PMCID: PMC9365541 DOI: 10.1155/2022/3151090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 04/30/2022] [Accepted: 05/04/2022] [Indexed: 11/30/2022]
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease caused by repetitive mild traumatic brain injury (rmTBI), and the lack of sensitive diagnostic and prognostic biomarkers for rmTBI leads to long-term sequelae after injury. The purpose of this study is to identify key genes of rmTBI and find the potential progression mechanism in early stage of mTBI. We downloaded the gene expression profiles of GSE2871 from Gene Expression Omnibus (GEO) datasets. Differentially expressed genes (DEGs) were screened from the cerebral cortex of rats 24 hours after smTBI, and these DEGs were then subjected to GO enrichment analysis, KEGG pathway analysis, PPI analysis, and hub analysis. Key genes were identified as the most significantly expressed genes and had a higher degree of connectivity from hub genes. By using homemade metal pendulum impact equipment and a multiple regression discriminant equation to assess the severity of rats after injury, smTBI and rmTBI rat models were established in batches, and q-PCR analyses were performed to verify the key genes. The main KEGG pathways were cytokine-cytokine receptor interaction and neuroactive ligand-receptor interaction. SPP1 and C3 were the most significant DEGs, and their connectivity degree was the highest 24 hours after smTBI (logFC > 4; connectivity degree >15). The q-PCR analyses were performed 24 hours and 14 days after mTBI. The results showed that SPP1 and C3 were significantly upregulated in smTBI and in rmTBI at 24 hours after injury compared with their levels in sham-injured rats, and the phenomenon persisted 14 days after injury. Notably, 14 days after injury, both of these genes were significantly upregulated in the rmTBI group compared with the smTBI. These pathways and genes identified could help understanding the development in mTBI.
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12
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Borg DN, Fleming J, Bon JJ, Foster MM, Kendall E, Geraghty T. The influence of personal factors, unmet need and service obstacles on the relationship between health service use and outcome after brain injury. BMC Health Serv Res 2022; 22:445. [PMID: 35382821 PMCID: PMC8980503 DOI: 10.1186/s12913-022-07811-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 03/15/2022] [Indexed: 12/05/2022] Open
Abstract
Background This exploratory study aimed to: (i) examine the relationship between health service use and quality of life, psychological wellbeing, global function and participation after discharge from brain injury inpatient rehabilitation, and (ii) determine the influence of personal factors, unmet need for services and service obstacles on the relationship between service use and these outcomes. Methods Using a prospective cohort design, 41 adults with acquired brain injury (median age = 46 years; 71% male; 61% severe traumatic injury) were followed for 6-months after discharge from specialist brain injury inpatient rehabilitation. Service use was continuously recorded and obtained through data linkage methods, focusing on the use of: outpatient medical services, outpatient nursing, outpatient allied health; medical acute services; incidents of re-hospitalization; and transitional rehabilitation service use. Outcome questionnaire measures were completed via telephone, at 6-months after discharge, and included: the EuroQol-5D; Depression Anxiety and Stress Scale, Mayo-Portland Adaptability Inventory and Sydney Psychosocial Reintegration Scale. Data were analyzed in a heterogeneous treatment effects framework, using Bayesian Additive Regression Trees. Results There was weak evidence that transitional rehabilitation service use was associated with better psychological wellbeing scores. The posterior probability of lower depression, anxiety and stress scores was .87, .81 and .86, respectively (average treatment effect). There was also weak evidence that re-hospitalization was associated with worse independent living skills scores. The posterior probability of worse scores was .87. However, most re-hospitalizations were due to unavoidable medical complications. We did not find that place of residence at discharge, marital status, unmet need, or service obstacles affected the relationship between service use and the studied outcomes. Conclusions This study may highlight the importance of participation in transitional rehabilitation, in the 6-months after discharge from brain injury rehabilitation. Replication in a larger sample size is required to confirm these findings. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07811-y.
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Affiliation(s)
- David N Borg
- Griffith University, Menzies Health Institute Queensland, The Hopkins Centre, Brisbane, Australia. .,Griffith University, School of Allied Health Sciences, Brisbane, Australia.
| | - Jennifer Fleming
- University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Australia
| | - Joshua J Bon
- Griffith University, Menzies Health Institute Queensland, The Hopkins Centre, Brisbane, Australia.,Australian Research Council Centre of Excellence for Mathematical and Statistical Frontiers, Brisbane, Australia.,Queensland University of Technology, School of Mathematical Sciences, Brisbane, Australia
| | - Michele M Foster
- Griffith University, Menzies Health Institute Queensland, The Hopkins Centre, Brisbane, Australia.,Griffith University, School of Allied Health Sciences, Brisbane, Australia
| | - Elizabeth Kendall
- Griffith University, Menzies Health Institute Queensland, The Hopkins Centre, Brisbane, Australia.,Griffith University, School of Allied Health Sciences, Brisbane, Australia
| | - Timothy Geraghty
- Griffith University, Menzies Health Institute Queensland, The Hopkins Centre, Brisbane, Australia.,Metro South Health Hospital and Health Service, Division of Rehabilitation, Brisbane, Australia
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13
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Tarnai K, Marcopulos B. Developing a model of return to school: A Traumatic Brain Injury Model Systems study. Brain Inj 2022; 36:544-552. [PMID: 35380490 DOI: 10.1080/02699052.2022.2051739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE A common goal for those recovering from moderate to severe brain injury is to reengage in education or employment. There is significant overlap between the skills relevant for successful job and academic performance in high school and college, and many deficits reported after brain injury are consistent across young adults and adults. This study utilized a return to work (RTW) model framework to develop a model of return to school (RTS). METHOD Days of post-traumatic amnesia (PTA), length of stay (LOS), rehabilitation discharge Disability Rating Scale (DRS) scores, presence of pre-injury learning limitation, and educational level were used to predict RTS one-year post-injury in a student sample (N = 158, 58.8% white, 69.6% male) within the Traumatic Brain Injury Model Systems National Database. RESULTS The overall RTS rate for this sample was 62%. Logistic regression indicated that lower DRS discharge scores and being in high school pre-injury resulted in the best outcome. CONCLUSION Results showed partial support for the translation of RTW factors to a student sample; however, results may also favor the conceptual distinction in RTS versus RTW, which are elaborated. More outreach for college students may improve awareness of disability services, thereby heightening the future return rate.
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Affiliation(s)
- Kathryn Tarnai
- Department of Graduate Psychology, James Madison University, Harrisonburg, Virginia, USA
| | - Bernice Marcopulos
- Department of Graduate Psychology, James Madison University, Harrisonburg, Virginia, USA.,Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, Virginia, USA
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14
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Witten JA, Coetzer R, Turnbull OH. Shades of Rage: Applying the Process Model of Emotion Regulation to Managing Anger After Brain Injury. Front Psychol 2022; 13:834314. [PMID: 35369166 PMCID: PMC8971361 DOI: 10.3389/fpsyg.2022.834314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/28/2022] [Indexed: 11/30/2022] Open
Abstract
Uncontrollable anger is common following an acquired brain injury (ABI), with impaired emotion regulation (ER) being one of the main contributors. Existing psychological interventions appear moderately effective, though studies typically include limitations such as small sample sizes, issues of long-term efficacy, and standardization of content. While ER has been a popular research field, the study of ER for anger management after ABI is less well investigated, and contains few interventions based on the widely used Process Model of ER. This review surveys the efficacy of ER strategies in individuals with ABI, and proposes a novel research design for future interventions. Recommendations are made about: strategy number and type, shared decision-making, approaches to data analysis, and mode of delivery.
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Affiliation(s)
- Jade Abigail Witten
- School of Human and Behavioral Sciences, Bangor University, Bangor, United Kingdom
| | - Rudi Coetzer
- School of Human and Behavioral Sciences, Bangor University, Bangor, United Kingdom
- The Disabilities Trust, Wakefield, United Kingdom
| | - Oliver H. Turnbull
- School of Human and Behavioral Sciences, Bangor University, Bangor, United Kingdom
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15
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Hoepner JK, Yingst H, Harder B, Zehm C. "I never thought I would be an international speaker … but I am": an interpretive qualitative analysis of experiences of a project-based advocacy intervention. Neuropsychol Rehabil 2022; 32:2077-2101. [PMID: 35297728 DOI: 10.1080/09602011.2022.2050410] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Acquired brain injuries (ABI) result in changes to physical, cognitive, psychosocial, and economic domains, which alter an individual's sense of self and identity. Interactions with healthcare providers may further contribute to conceptualization of self after ABI. Cognitive rehabilitation is intended to address cognitive-communication impairments, as well as psychological changes to the sense of self and identity that follow ABI. The present investigation examined a project-based intervention, focused on advocacy. Participants developed a presentation for healthcare providers regarding consequences of ABI, strategies and supports necessary to successfully overcome daily challenges, and insights into the lived experience. Ten individuals with chronic ABI participated in one of three roles (presenter, video contributor, or content developer). Written interviews allowed participants to generate and refine their responses. Interpretive Description qualitative analyses was used to examine interviews. Iterative analysis identified five themes across all participant roles: renewed sense of self, positive impact on providers to care of future individuals with brain injuries, rewarding and humbling, being heard, and alternate personal narratives and identities. The remaining theme applied only to presenters, improved clarity and conciseness. Group, project-based interventions have the potential to positively influence sense of self in combination with narrative therapy techniques in the chronic phase of recovery.
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Affiliation(s)
- Jerry K Hoepner
- Communication Sciences & Disorders, University of Wisconsin - Eau Claire, Eau Claire, WI, USA
| | - Hannah Yingst
- Communication Sciences & Disorders, University of Wisconsin - Eau Claire, Eau Claire, WI, USA
| | - Bailey Harder
- Communication Sciences & Disorders, University of Wisconsin - Eau Claire, Eau Claire, WI, USA
| | - Crystal Zehm
- Communication Sciences & Disorders, University of Wisconsin - Eau Claire, Eau Claire, WI, USA
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16
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Samuelkamaleshkumar S, Reethajanetsureka S, Elango A, Padankatti SM, John JA, George J, Thomas R. Community reintegration of people with traumatic brain injury in south India: role of a comprehensive transdisciplinary rehabilitation programme. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2022. [DOI: 10.12968/ijtr.2020.0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/aims Successful community reintegration is the ultimate goal of traumatic brain injury rehabilitation and care. The aim of this study was to explore the community reintegration of people with a traumatic brain injury living in south India who had completed a comprehensive holistic rehabilitation programme. The level of community reintegration based on the demographic variables of the patients was also investigated. Methods A total of 104 community-dwelling people with a traumatic brain injury, and a minimum of 1 year post injury, received treatment from a rehabilitation team in a therapeutic centre for 7 hours a day, 6 days a week for a maximum of 16 weeks. A usual care, transdisciplinary service delivery model was implemented, and the Craig Handicap Assessment and Reporting Technique was used to quantify the main outcome measures. Results The mean and standard deviation scores for each Craig Handicap Assessment and Reporting Technique domain were physical independence (91 ± 23), social integration (87 ± 20), cognitive independence (70 ± 33), economic self-sufficiency (67 ± 40), occupation (66 ± 40) and mobility (63 ± 29). The participants who had gone back to work after their traumatic brain injury showed significantly higher scores in all the domains of the Craig Handicap Assessment and Reporting Technique than those who were unemployed. Only the occupation and mobility domain scores were influenced by the severity of the traumatic brain injury. The economic self-sufficiency, occupation and mobility domain scores were higher among married patients compared to those who were unmarried. Conclusions A significant proportion of the participants were able to return to work and reintegrate into community life through this service delivery model. This comprehensive, holistic approach, which targets physical, cognitive and psychosocial needs and then provides adequate vocational rehabilitation, can result in good outcomes in people with a traumatic brain injury.
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Affiliation(s)
- Selvaraj Samuelkamaleshkumar
- Department of Physical Medicine and Rehabilitation Christian Medical College, Dr. Mary Verghese Rehabilitation Institute, Vellore, India
| | - Stephen Reethajanetsureka
- Department of Physical Medicine and Rehabilitation Christian Medical College, Dr. Mary Verghese Rehabilitation Institute, Vellore, India
| | - Arumugam Elango
- Department of Physical Medicine and Rehabilitation Christian Medical College, Dr. Mary Verghese Rehabilitation Institute, Vellore, India
| | - Sanjeev M Padankatti
- Department of Physical Medicine and Rehabilitation Christian Medical College, Dr. Mary Verghese Rehabilitation Institute, Vellore, India
| | - Judy Ann John
- Department of Physical Medicine and Rehabilitation Christian Medical College, Dr. Mary Verghese Rehabilitation Institute, Vellore, India
| | - Jacob George
- Department of Physical Medicine and Rehabilitation Christian Medical College, Dr. Mary Verghese Rehabilitation Institute, Vellore, India
| | - Raji Thomas
- Department of Physical Medicine and Rehabilitation Christian Medical College, Dr. Mary Verghese Rehabilitation Institute, Vellore, India
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17
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Van Deynse H, Ilunga Kazadi C, Kimpe E, Hubloue I, Moens M, Putman K. Predictors of return to work after moderate-to-severe traumatic brain injury: a systematic review of current literature and recommendations for future research. Disabil Rehabil 2021; 44:5750-5757. [PMID: 34494491 DOI: 10.1080/09638288.2021.1954247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To identify factors associated with employment between six months and five years after traumatic brain injury (TBI). METHODS Using a predefined search algorithm, four electronic databases were searched for literature published between 2014 and the first half of April 2021 containing predictors of employment outcome. Data were selected in accordance with the PRISMA flow and the whole process was conducted by two reviewers who had to attain a consensus. The study results were discussed with an expert panel, in order to provide guidance for future research on this topic. RESULTS This review found clear evidence for employment status at time of injury, occupation at time of injury, Glasgow Coma Scale, length of stay, disability level and primary payer to be predictors of return to work after TBI. CONCLUSIONS More literature investigating in depth the functioning and environmental factors is required for further improvement of predictions, rehabilitation and policy.Implications for rehabilitationThis study identifies predictors of return to work in TBI patients, which can be used to identify patients with high risk early in the recovery process.Current literature shows difficulties with general functioning are a barrier for return to work, but gives no indication about effective therapeutic interventions.More knowledge about modifiable factors is desirable to improve rehabilitation and, thereby, employment outcomes after TBI.
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Affiliation(s)
- Helena Van Deynse
- Interuniversity Centre for Health Economics Research, Vrije Universiteit Brussel, Brussels, Belgium
| | - Carl Ilunga Kazadi
- Interuniversity Centre for Health Economics Research, Vrije Universiteit Brussel, Brussels, Belgium
| | - Eva Kimpe
- Interuniversity Centre for Health Economics Research, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ives Hubloue
- Emergency and Disaster Medicine, Department Emergency Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Maarten Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Radiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Koen Putman
- Interuniversity Centre for Health Economics Research, Vrije Universiteit Brussel, Brussels, Belgium
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18
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Mendelsohn S, Khoja L, Alfred S, He J, Anderson M, DuBois D, Touma Z, Engel L. Cognitive impairment in systemic lupus erythematosus is negatively related to social role participation and quality of life: A systematic review. Lupus 2021; 30:1617-1630. [PMID: 34264148 PMCID: PMC8489690 DOI: 10.1177/09612033211031008] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction At least 38% of patients with Systemic Lupus Erythematosus (SLE) experience cognitive impairment (CI). Patients report CI impacts their health-related quality of life (HRQoL) and social role participation. Objectives To synthesize and critically appraise the quantitative literature on the relationship of CI to HRQoL and social role participation in individuals with SLE. Methods Six electronic databases were searched in December 2018 and June 2020 by an information specialist. Two reviewers independently completed all screening phases and data extraction; a third reviewer resolved disagreements. The Mixed Methods Appraisal Tool was used to critically appraise the quality of included studies. Data has been synthesized and analyzed descriptively to present evidence on the relationship of CI to HRQoL and social role participation. Results A total of 7182 references were identified and screened, with 14 articles included. Four of the included articles investigated the relationship between CI and HRQoL and all identified a negative relationship. Ten of the 14 studies investigated CI and social role participation, eight identified a negative relationship. There was heterogeneity of measures used between studies to examine CI, HRQoL, and social role participation. As such, results were interpreted descriptively and could not be pooled for meta-analysis. Conclusion The presence of CI is negatively related to HRQoL and social role participation in patients with SLE. Healthcare professionals should be aware of this relationship so that it can be addressed in clinical practice. Further research, using consistent methods of quantifying CI, HRQoL and social role participation, is needed to enable data pooling.
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Affiliation(s)
| | - Lina Khoja
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Sofia Alfred
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer He
- Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada
| | - Melanie Anderson
- Library and Information Services, University Health Network, Toronto, Ontario, Canada
| | - Denise DuBois
- School of Rehabilitation Therapy, Canadian Institute for Military and Veterans Health Research, Queen's University, Kingston, Ontario, Canada
| | - Zahi Touma
- Centre for Prognosis Studies in the Rheumatic Diseases, University of Toronto Lupus Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Lisa Engel
- Department of Occupational Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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19
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Pittet JF, Hu PJ, Honavar J, Brandon AP, Evans CA, Muthalaly R, Ding Q, Wagener BM. Estrogen Alleviates Sex-Dependent Differences in Lung Bacterial Clearance and Mortality Secondary to Bacterial Pneumonia after Traumatic Brain Injury. J Neurotrauma 2020; 38:989-999. [PMID: 33203297 DOI: 10.1089/neu.2020.7327] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Traumatic brain injury (TBI) is the leading cause of injury-related death and disability in patients under the age of 46 years. Survivors of the initial injury often endure systemic complications such as pulmonary infection, and Pseudomonas aeruginosa is one of the most common causes of nosocomial pneumonia in intensive care units. Female patients are less likely to develop secondary pneumonia after TBI, and pre-clinical studies have revealed a salutary role for estrogen after trauma. Therefore, we hypothesized that female mice would experience less mortality after post-TBI pneumonia with P. aeruginosa. We employed a mouse model of TBI followed by P. aeruginosa pneumonia. Male mice had greater mortality and impaired lung bacterial clearance after post-TBI pneumonia compared with female mice. This was confirmed as a difference in sex hormones, as oophorectomized wild-type mice had mortality and lung bacterial clearance similar to male mice. There were differences in tumor necrosis factor-α secretion in male and female alveolar macrophages after P. aeruginosa infection. Finally, injection of male or oophorectomized wild-type female mice with estrogen restored lung bacterial clearance and prevented mortality. Our model of TBI followed by P. aeruginosa pneumonia is among the first to reveal sex dimorphism in secondary, long-term TBI complications.
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Affiliation(s)
- Jean-Francois Pittet
- Divisions of Critical Care Medicine and University of Alabama at Birmingham, Birmingham, Alabama, USA.,Molecular and Translational Biomedicine, Department of Anesthesiology and Perioperative Medicine and University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Parker J Hu
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jaideep Honavar
- Molecular and Translational Biomedicine, Department of Anesthesiology and Perioperative Medicine and University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Angela P Brandon
- Molecular and Translational Biomedicine, Department of Anesthesiology and Perioperative Medicine and University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Cilina A Evans
- Molecular and Translational Biomedicine, Department of Anesthesiology and Perioperative Medicine and University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Rebekah Muthalaly
- Molecular and Translational Biomedicine, Department of Anesthesiology and Perioperative Medicine and University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Qiang Ding
- Molecular and Translational Biomedicine, Department of Anesthesiology and Perioperative Medicine and University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Brant M Wagener
- Divisions of Critical Care Medicine and University of Alabama at Birmingham, Birmingham, Alabama, USA.,Molecular and Translational Biomedicine, Department of Anesthesiology and Perioperative Medicine and University of Alabama at Birmingham, Birmingham, Alabama, USA
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20
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Norup A, Kruse M, Soendergaard PL, Rasmussen KW, Biering-Sørensen F. Socioeconomic Consequences of Traumatic Brain Injury: A Danish Nationwide Register-Based Study. J Neurotrauma 2020; 37:2694-2702. [PMID: 32808586 DOI: 10.1089/neu.2020.7064] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study examined if acquiring a traumatic brain injury (TBI) increases utilization of health care costs, increases risk of job loss for the patient and the closest relatives, and increases the risk of divorce 1 to 5 years following the injury. The study was conducted as a Danish national population-based register study with follow-up. Participants included a cohort of patients with TBI (n = 18,328) admitted to a hospital or treated in an emergency room (ER) and a matching control group (n = 89,155). For both the TBI group and the matching controls, relatives were identified, using national registers (TBI relatives: n = 25,708 and control relatives: n = 135,325). The outcome measures were utilization of health care costs (including hospital services, use of general practitioner and practicing specialists, and prescribed medication), risk of job loss, and risk of divorce among the TBI group and the control group and their relatives. Patients with TBI had significantly increased health care costs at baseline (i.e., the year before the injury) and during the following 4 years. Further, TBI relatives had a significantly higher utilization of health care costs the first and the third year after injury. The TBI group had a significant increased risk of job loss (odds ratio [OR] = 2.88; confidence interval [CI]: 2.70-3.07) and divorce (OR = 1.44; CI: 1.27-1.64) during the first 3 years following injury. In conclusion, the TBI group had significantly higher utilization of health care costs, both pre-morbidly and post-injury. Further, increased risk of job loss and divorce were found, emphasizing that the socioeconomic consequences of TBI last for years post-injury.
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Affiliation(s)
- Anne Norup
- Department of Neurorehabilitation, TBI Unit, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Marie Kruse
- DaCHE - Danish Center for Health Economics, University of Southern Denmark, Odense, Denmark
| | - Pernille Langer Soendergaard
- Department of Neurorehabilitation, TBI Unit, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Katrine Winther Rasmussen
- Department of Neurorehabilitation, TBI Unit, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Fin Biering-Sørensen
- Clinic for Spinal Cord Injury, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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21
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Exploring Perceived Interactions Between Consequences of Traumatic Brain Injury. J Head Trauma Rehabil 2020; 36:E209-E217. [PMID: 32898026 DOI: 10.1097/htr.0000000000000601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To explore the perceived interactions between consequences of traumatic brain injury (TBI). PARTICIPANTS Fifteen clinicians experienced in working with patients with TBI. METHODS Participating clinicians completed an online questionnaire in which they estimated the degree to which consequences of TBI (taken from the Brief ICF Core Set for Traumatic Brain Injury) causally relate to each other. Based on these perceived interactions, a visual network was constructed and centrality measures for this network were computed. RESULTS The resulting network demonstrates various strong perceived causal relations between the consequences of TBI. Impairments in consciousness were perceived to most strongly cause other TBI consequences in the network. Difficulties with acquiring, keeping, and terminating a job were perceived to be most strongly caused by other TBI consequences. Difficulties in partaking in complex interpersonal interactions were also perceived to play a central role in the network. CONCLUSION In the perception of clinicians, consequences of TBI interact with each other and are thus not solely a direct result of the injury. While more research is needed to map the interactions between consequences of TBI, our results could have important implications for the way we understand and treat the problems patients are faced with after TBI.
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22
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Jacob L, Oh H, Koyanagi A, Smith L, Kostev K. Relationship between physical conditions and attempted or completed suicide in more than 9,300 individuals from the United Kingdom: a case-control study. J Affect Disord 2020; 274:457-463. [PMID: 32663976 DOI: 10.1016/j.jad.2020.05.121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/15/2020] [Accepted: 05/17/2020] [Indexed: 11/15/2022]
Abstract
AIMS The present study of 9,352 adults from the United Kingdom aimed to analyze associations between physical conditions and attempted or completed suicide. METHODS This case-control study included patients aged 16-90 years with a first attempted or completed suicide who were followed in general practices in the United Kingdom between January 2008 and December 2017 (index date). Individuals who had not attempted or completed suicide were matched (1:1) to those who had attempted or completed suicide by sex, age, index year, index month, and practice. Variables included sex, age, index year, index month, and all physical and psychiatric conditions diagnosed in more than 1% of patients who had attempted or completed suicide in the year prior to the index date. A multivariable logistic regression analysis was performed to assess possible associations. RESULTS The case-control study included 4,676 patients who had and 4,676 patients who had not attempted or completed suicide. After (1:1) matching, 52.1% of the patients were women and the mean (standard deviation) age was 33.6 (15.1) years. After adjusting for psychiatric conditions, we found that three past-year physical conditions were significantly associated with attempted or completed suicide. These conditions were unspecified injuries to the head (odds ratio [OR]=4.26, 95% confidence interval [CI]=2.27-8.00), sleep disorders (OR=1.60, 95% CI=1.09-2.32), and epilepsy (OR=1.57, 95% CI=1.04-2.39). CONCLUSIONS Head injuries, sleep disorders, and epilepsy were associated with attempted or completed suicide. Further research is needed to gain a better understanding of the mechanisms underlying these relationships.
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Affiliation(s)
- Louis Jacob
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France; Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain
| | - Hans Oh
- Suzanne Dworak Peck School of Social Work, University of Southern California, 1149 Hill Street, Suite #1422, Los Angeles, CA 90015, USA
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain; ICREA, Pg. Lluis Companys 23, Barcelona, Spain
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Science, Anglia Ruskin University, Cambridge, UK
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Fortune DG, Walsh RS, MacConaill S, Harte M, Richards HL. Facilitating a return to productive roles following acquired brain injury: The impact of pre-injury work level, current abilities, and neuropsychological performance. Neuropsychol Rehabil 2020; 31:914-934. [PMID: 32223509 DOI: 10.1080/09602011.2020.1746674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The primary aim of this study was to examine predictors of Return to Productive Roles (RTPR) in individuals with ABI following participation in a community-based RTPR intervention. One hundred and thirty participants were inducted to an ABI-specific RTPR programme. At induction, information on clinical and social demographics, previous education and employment roles were collected. Participants underwent a comprehensive neuropsychological assessment at baseline and completed assessments of disability, mental health and community integration. Participants were followed up at the end of their programme to assess RTPR. Three out of four participants who entered the RTPR programme returned to productive roles. Despite the relatively high levels of anxiety and depression in the sample, people who returned to productive roles were not significantly less anxious or depressed than those who did not. Logistic regression suggested that participants who returned to productive roles following the programme had higher levels of pre-ABI work engagement, less disability and performed better on neuropsychological assessment in terms of their language skills. Results suggest that these factors which cut across specific prior experience, cognitive performance, and social and disability areas of functioning represent barriers to an effective return to productive roles for people with ABI accessing RTPR intervention.
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Affiliation(s)
- Dónal G Fortune
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - R Stephen Walsh
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | | | | | - Helen L Richards
- Department of Clinical Psychology, Mercy University Hospital Cork, Cork, Ireland
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24
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Algethamy H. Baseline Predictors of Survival, Neurological Recovery, Cognitive Function, Neuropsychiatric Outcomes, and Return to Work in Patients after a Severe Traumatic Brain Injury: an Updated Review. Mater Sociomed 2020; 32:148-157. [PMID: 32843865 PMCID: PMC7428895 DOI: 10.5455/msm.2020.32.148-157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Introduction Severe traumatic brain injury (sTBI) is a common cause of death and disability worldwide, with long-term squeal among survivors that include cognitive deficits, psychosocial and neuropsychiatric dysfunction, failure to return to pre-injury levels of work, school and inter-personal relationships, and overall reduced quality of and satisfaction with life. Aim The aim of this work is to review the current literature on baseline predictors of outcomes in adults post sTBI. Method Most of available literature on baseline predictors of outcomes in adults post sTBI were reviewed and summarized in this work. Results Currently, a sizeable number of composite predictors of mortality and overall function exists; however, these instruments tend to over-estimate poor outcomes and fail to address issues like cognition, psychosocial/ neuropsychiatric dysfunction, and return to work or school. Conclusion This article reviews currently-identified predictors of all these outcomes.
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Affiliation(s)
- Haifa Algethamy
- Department of Anaesthesia and Critical Care, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
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25
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Manoli R, Delecroix H, Daveluy W, Moroni C. Impact of cognitive and behavioural functioning on vocational outcome following traumatic brain injury: a systematic review. Disabil Rehabil 2019; 43:2531-2540. [DOI: 10.1080/09638288.2019.1706105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Romina Manoli
- PSITEC Lab (EA 4072), Department of Psychology, University of Lille, Lille, France
| | - Helene Delecroix
- PSITEC Lab (EA 4072), Department of Psychology, University of Lille, Lille, France
- UEROS, UGECAM Hauts-de-France, Lille, France
| | - Walter Daveluy
- UEROS, UGECAM Hauts-de-France, Lille, France
- Service de Rééducation Neurologique Cérébrolésion, Hopital Swynghedauw, CHRU de Lille, Lille, France
| | - Christine Moroni
- PSITEC Lab (EA 4072), Department of Psychology, University of Lille, Lille, France
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26
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LaBuzetta JN, Rosand J, Vranceanu AM. Review: Post-Intensive Care Syndrome: Unique Challenges in the Neurointensive Care Unit. Neurocrit Care 2019; 31:534-545. [PMID: 31486026 PMCID: PMC7007600 DOI: 10.1007/s12028-019-00826-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Within the last couple of decades, advances in critical care medicine have led to increased survival of critically ill patients, as well as the discovery of notable, long-term health challenges in survivors and their loved ones. The terms post-intensive care syndrome (PICS) and PICS-family (PICS-F) have been used in non-neurocritical care populations to characterize the cognitive, psychiatric, and physical sequelae associated with critical care hospitalization in survivors and their informal caregivers (e.g., family and friends who provide unpaid care). In this review, we first summarize the literature on the cognitive, psychiatric, and physical correlates of PICS and PICS-F in non-neurocritical patient populations and draw attention to their long-term negative health consequences. Next, keeping in mind the distinction between disease-related neurocognitive changes and those that are associated directly with the experience of a critical illness, we review the neuropsychological sequelae among patients with common neurocritical illnesses. We acknowledge the clinical factors contributing to the difficulty in studying PICS in the neurocritical care patient population, provide recommendations for future lines of research, and encourage collaboration among critical care physicians in all specialties to facilitate continuity of care and to help elucidate mechanism(s) of PICS and PICS-F in all critical illness survivors. Finally, we discuss the importance of early detection of PICS and PICS-F as an opportunity for multidisciplinary interventions to prevent and treat new neuropsychological deficits in the neurocritical care population.
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Affiliation(s)
- Jamie Nicole LaBuzetta
- Division of Neurocritical Care, Department of Neurosciences, University of California-San Diego, 9444 Medical Center Drive, ECOB 3-028, MC 7740, La Jolla, CA, 92037, USA.
| | - Jonathan Rosand
- Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, USA
| | - Ana-Maria Vranceanu
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, USA
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, USA
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27
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Gormley M, Devanaboyina M, Andelic N, Røe C, Seel RT, Lu J. Long-term employment outcomes following moderate to severe traumatic brain injury: a systematic review and meta-analysis. Brain Inj 2019; 33:1567-1580. [PMID: 31454278 DOI: 10.1080/02699052.2019.1658222] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Returning to employment following moderate to severe traumatic brain injury (msTBI) is critical for a survivor's well-being, yet currently there are no systematic reviews that comprehensively describe employment outcomes following msTBI. The objective of this study was to systematically synthesize literature on employment outcomes following msTBI.Methods: Original studies published through April 2018 on MEDLINE/PubMed, PsychINFO, and CINAHL were eligible if the objective was to investigate employment outcomes following msTBI; outcome was measured ≥1 year; participants were ≥15; and size was ≥60. Post-injury employment prevalence and return to pre-injury level of work were summarized through meta-analysis.Results: Of 38 eligible studies, post-injury employment prevalence was most often reported (n = 35), followed by job stability (n = 6), and return to pre-injury level of work (n = 4). Overall post-injury employment prevalence was 42.2%; whereas the return-to-previous-work prevalence was 33.0%. Post-injury employment prevalence appeared to increase over time, from 34.9% at 1 year to 42.1% up to 5 years and 49.9% beyond 5 years.Conclusion: Nearly half of individuals with msTBI were employed post-injury, yet only a third returned to pre-injury level of work. Future researchers are recommended to standardize employment outcome measures to enable better comparison of outcomes across studies.
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Affiliation(s)
- Mirinda Gormley
- Department of Family Medicine and Population Health, Division of Epidemiology and Community Health, Virginia Commonwealth University, Richmond, VA, USA
| | - Monika Devanaboyina
- Department of Family Medicine and Population Health, Division of Epidemiology and Community Health, Virginia Commonwealth University, Richmond, VA, USA
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ronald T Seel
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | - Juan Lu
- Department of Family Medicine and Population Health, Division of Epidemiology and Community Health, Virginia Commonwealth University, Richmond, VA, USA
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28
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Nowell C, Downing M, Bragge P, Ponsford J. Current practice of cognitive rehabilitation following traumatic brain injury: An international survey. Neuropsychol Rehabil 2019; 30:1976-1995. [PMID: 31164047 DOI: 10.1080/09602011.2019.1623823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Traumatic brain injury (TBI) is a global public health issue, frequently resulting in impairments in the cognitive domains of attention, information processing speed, memory, executive function, and communication. Despite the importance of rehabilitating cognitive difficulties, and the release of clinical practice guidelines (CPGs) for cognitive rehabilitation, little is known about current clinician practice. This study aimed to explore current international clinician practice of cognitive rehabilitation. One hundred and fifteen English-speaking allied health professionals, including neuropsychologists and occupational therapists, from 29 countries outside Australia, were surveyed online about their current practice and reflections on cognitive rehabilitation. Both cognitive retraining and functional compensation approaches to cognitive rehabilitation were commonly utilized. Clinicians mostly targeted deficits in attention and executive functioning with retraining interventions, whilst memory deficits were mostly targeted with compensatory interventions. Clinicians were aware of and utilized various resources for cognitive rehabilitation, including CPGs. Clinicians considered the client's social support network, client engagement and motivation in rehabilitation, multidisciplinary team collaboration, and goal setting and implementation as highly impactful factors on the success of cognitive rehabilitation interventions. Whilst practice is broadly consistent with current CPG recommendations, addressing facilitating factors can further optimize client outcomes and quality of life following TBI.
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Affiliation(s)
- Clare Nowell
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monsah University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia
| | - Marina Downing
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monsah University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia
| | - Peter Bragge
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Melbourne, Australia
| | - Jennie Ponsford
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monsah University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia
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29
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Bayen E, Ruet A, Jourdan C, Ghout I, Meaude L, Pradat-Diehl P, Nelson G, Vallat-Azouvi C, Charanton J, Aegerter P, Azouvi P. Lawsuit and Traumatic Brain Injury: The Relationship Between Long-Lasting Sequelae and Financial Compensation in Litigants. Results From the PariS-TBI Study. Front Neurol 2019; 10:320. [PMID: 31031685 PMCID: PMC6473085 DOI: 10.3389/fneur.2019.00320] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 03/14/2019] [Indexed: 11/26/2022] Open
Abstract
Purpose: People with traumatic brain injury are frequently involved in a litigation because another person was at fault for causing the accident. A compensation amount will often be settled to compensate the victim for the past, present, future damages and losses suffered. We report descriptive data about the full and final personal compensation amount and investigated its association with patient's outcomes. Methods: We used a longitudinal prospective study of severe TBI patients injured in 2005–2007 (PariS-TBI). Questions regarding involvement in a litigation were asked concurrently with 4 and 8-year outcomes. Results: Among 160 participants assessed 4 and/or 8 years post-injury, a total of 67 persons declared being involved in a litigation, among which 38 people reported a compensation amount of a mean €292,653 (standard deviation = 436,334; interquartile 25–50–75 = 37,000–100,000–500,000; minimum = 1,500-maximum = 2,000,000). A higher compensation amount was associated with more severe disability and cognitive impairment in patients, and with more informal care time provided by caregivers. However, no significant association related to patient's gender, age, years of education, motor/balance impairment, return to work status, mood and related to caregiver's subjective burden was found. Conclusion: Financial compensation was related to victims' long-term severity of impairment, although some extreme cases with severe disability were granted very poor compensation.
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Affiliation(s)
- Eléonore Bayen
- Physical Medicine and Rehabilitation Department, Assistance Publique des Hôpitaux de Paris, Pitie-Salpetriere Hospital, Paris, France.,Physical and Rehabilitation Department, Sorbonne Université GRC18, Paris, France.,Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States
| | - Alexis Ruet
- Physical Medicine and Rehabilitation Department, Caen Faculty Hospital, INSERM U1077, France
| | - Claire Jourdan
- Physical Medicine and Rehabilitation Department, Lapeyronie Faculty Hospital, Montpellier, France
| | - Idir Ghout
- Department of Biostatistics, Assistance Publique des Hôpitaux de Paris, Ambroise Paré Hospital, Boulogne, France
| | - Layide Meaude
- Unité de Recherche Clinique Paris Ile-de-France Ouest, Ambroise Paré Hospital (APHP), Paris, France
| | - Pascale Pradat-Diehl
- Physical Medicine and Rehabilitation Department, Assistance Publique des Hôpitaux de Paris, Pitie-Salpetriere Hospital, Paris, France.,Physical and Rehabilitation Department, Sorbonne Université GRC18, Paris, France.,Laboratoire d'Imagerie Biomedicale INSERM U1146, Paris, France
| | - Gaëlle Nelson
- Regional Reference Center for Brain Injury in the Parisian Area, Paris, France
| | - Claire Vallat-Azouvi
- Laboratoire de Recherches Cliniques et en Santé publique sur les Handicaps Psychiques, Cognitifs et Moteurs (HANDIReSP, EA4047), Université de Versailles Saint-Quentin, Montigny-Le-Bretonneux, France.,Physical Medicine and Rehabilitation Department, Assistance Publique des Hôpitaux de Paris, Raymond-Poincaré Faculty Hospital, Garches, France
| | - James Charanton
- Regional Reference Center for Brain Injury in the Parisian Area, Paris, France
| | - Philippe Aegerter
- Department of Biostatistics, Assistance Publique des Hôpitaux de Paris, Ambroise Paré Hospital, Boulogne, France
| | - Philippe Azouvi
- Laboratoire de Recherches Cliniques et en Santé publique sur les Handicaps Psychiques, Cognitifs et Moteurs (HANDIReSP, EA4047), Université de Versailles Saint-Quentin, Montigny-Le-Bretonneux, France.,Physical Medicine and Rehabilitation Department, Assistance Publique des Hôpitaux de Paris, Raymond-Poincaré Faculty Hospital, Garches, France
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30
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Ruet A, Bayen E, Jourdan C, Ghout I, Meaude L, Lalanne A, Pradat-Diehl P, Nelson G, Charanton J, Aegerter P, Vallat-Azouvi C, Azouvi P. A Detailed Overview of Long-Term Outcomes in Severe Traumatic Brain Injury Eight Years Post-injury. Front Neurol 2019; 10:120. [PMID: 30846966 PMCID: PMC6393327 DOI: 10.3389/fneur.2019.00120] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 01/29/2019] [Indexed: 11/29/2022] Open
Abstract
Background and aims: Severe traumatic brain injury is a leading cause of acquired persistent disabilities, and represents an important health and economic burden. However, the determinants of long-term outcome have rarely been systematically studied in a prospective longitudinal study of a homogeneous group of patients suffering exclusively from severe TBI Methods: Prospective observational study of an inception cohort of adult patients with severe traumatic brain injury in the Parisian area (PariS-TBI). Outcome was assessed with face-to-face interview 8 years after Traumatic Brain Injury, focusing on impairments, activity limitations, and participation restriction. Results: Five hundred and four patients were included between 2005 and 2007. At 8-year follow-up, 261 patients were deceased, 128 were lost to follow-up, 22 refused to participate, and 86 were finally evaluated. Age, gender, initial injury severity did not significantly differ between evaluated patients and lost to follow-up, but the latter were more frequently students or unemployed. Mean age was 41.9 (SD 13.6), 79% were male, median initial Glasgow Coma Scale Score was 6. The most frequent somatic complaints concerned balance (47.5%), motricity (31%), and headaches (36%), but these were less frequent than cognitive complaints (Memory 71%, Slowness 68%, Concentration 67%). According to the Hospital Anxiety and Depression Scale (HADS), 25 % had a score >8 for anxiety and 23.7% for depression. According to the Extended Glasgow Outcome Scale, 19.8% remained severely disabled, 46.5% moderately disabled, 33.7% had a good recovery. Older age, longer education duration, lower functional status upon intensive care discharge, and more severe 8-year dysexecutive problems were significantly associated with a lower Extended Glasgow Outcome Scale score in multivariable analysis. At 8 years, 48.7% of patients were employed in a productive job. Of those, 38% declared a salary loss since traumatic brain injury. Unemployment was significantly associated with lower 1-year GOSE score and more severe 8-year dysexecutive problems. Conclusions: These results from an inception cohort study highlight the fact that long-term outcome after severe TBI is determined by a complex combination of injury-related, demographic and neuropsychological factors. Long after the injury, persisting impairments still interfere with social integration, and participation.
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Affiliation(s)
- Alexis Ruet
- Physical Medicine and Rehabilitation Department, CHRU, Caen, France.,Laboratoire de Recherches Cliniques et en Santé publique sur les Handicaps Psychiques, Cognitifs et Moteurs (HANDIReSP, EA4047), Université de Versailles Saint-Quentin, Montigny-Le-Bretonneux, France.,EPHE, INSERM, U1077, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
| | - Eléonore Bayen
- Physical Medicine and Rehabilitation Department, Pitie-Salpetriere Hospital, APHP, Paris, France.,Sorbonne Université GRC18, Paris, France
| | - Claire Jourdan
- Physical Medicine and Rehabilitation Department, Lapeyronie Hospital, CHRU, Montpellier, France
| | - Idir Ghout
- Unité de Recherche Clinique Paris Ile-de-France Ouest, Ambroise Paré Hospital, APHP, Boulogne, France
| | - Layidé Meaude
- Unité de Recherche Clinique Paris Ile-de-France Ouest, Ambroise Paré Hospital, APHP, Boulogne, France
| | - Astrid Lalanne
- Physical Medicine and Rehabilitation Department, APHP, Raymond-Poincaré Hospital, Garches, France
| | - Pascale Pradat-Diehl
- Physical Medicine and Rehabilitation Department, Pitie-Salpetriere Hospital, APHP, Paris, France.,Laboratoire d'Imagerie Biomedicale Inserm U1146, Sorbonne Université GRC18, Paris, France
| | - Gaëlle Nelson
- Regional Reference Center for Bain Injury in the Parisan Area, CRFTC, Paris, France
| | - James Charanton
- Regional Reference Center for Bain Injury in the Parisan Area, CRFTC, Paris, France
| | - Philippe Aegerter
- Unité de Recherche Clinique Paris Ile-de-France Ouest, Ambroise Paré Hospital, APHP, Boulogne, France
| | - Claire Vallat-Azouvi
- Laboratoire de Recherches Cliniques et en Santé publique sur les Handicaps Psychiques, Cognitifs et Moteurs (HANDIReSP, EA4047), Université de Versailles Saint-Quentin, Montigny-Le-Bretonneux, France.,Antenne UEROS-SAMSAH92-UGECAM IDF, Hôpital Raymond Poincaré, Garches, France.,Laboratoire de Psychopathologie et Neuropsychologie, EA 2027, Université Paris 8, Saint-Denis, France
| | - Philippe Azouvi
- Laboratoire de Recherches Cliniques et en Santé publique sur les Handicaps Psychiques, Cognitifs et Moteurs (HANDIReSP, EA4047), Université de Versailles Saint-Quentin, Montigny-Le-Bretonneux, France.,Physical Medicine and Rehabilitation Department, APHP, Raymond-Poincaré Hospital, Garches, France
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31
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DiSanto D, Kumar RG, Juengst SB, Hart T, O'Neil-Pirozzi TM, Zasler ND, Novack TA, Dillahunt-Aspillaga C, Graham KM, Cotner BA, Rabinowitz AR, Dikmen S, Niemeier JP, Kesinger MR, Wagner AK. Employment Stability in the First 5 Years After Moderate-to-Severe Traumatic Brain Injury. Arch Phys Med Rehabil 2018; 100:412-421. [PMID: 30055162 DOI: 10.1016/j.apmr.2018.06.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 06/20/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To characterize employment stability and identify predictive factors of employment stability in working-age individuals after moderate-to-severe traumatic brain injury (TBI) that may be clinically addressed. DESIGN Longitudinal observational study of an inception cohort from the Traumatic Brain Injury Model Systems National Database (TBIMS-NDB) using data at years 1, 2, and 5 post-TBI. SETTING Inpatient rehabilitation centers with telephone follow-up. PARTICIPANTS Individuals enrolled in the TBIMS-NDB since 2001, aged 18-59, with employment data at 2 or more follow-up interviews at years 1, 2, and 5 (N=5683). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Employment stability, categorized using post-TBI employment data as no paid employment (53.25%), stably (27.20%), delayed (10.24%), or unstably (9.31%) employed. RESULTS Multinomial regression analyses identified predictive factors of employment stability, including younger age, white race, less severe injuries, preinjury employment, higher annual earnings, male sex, higher education, transportation independence postinjury, and no anxiety or depression at 1 year post-TBI. CONCLUSIONS Employment stability serves as an important measure of productivity post-TBI. Psychosocial, clinical, environmental, and demographic factors predict employment stability post-TBI. Notable predictors include transportation independence as well as the presence of anxiety and depression at year 1 post-TBI as potentially modifiable intervention targets.
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Affiliation(s)
- Dominic DiSanto
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Raj G Kumar
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Shannon B Juengst
- Department of Physical Medicine and Rehabilitation, University of Texas-Southwestern Medical Center, Dallas, Texas; Department of Rehabilitation Counseling, University of Texas-Southwestern Medical Center, Dallas, Texas
| | - Tessa Hart
- Moss Rehabilitation Research Institute, Montgomery, Alabama
| | - Therese M O'Neil-Pirozzi
- Spaulding-Harvard Traumatic Brain Injury Model System, Boston, Massachusetts; Spaulding Rehabilitation Hospital and Department of Communication Sciences and Disorders, Northeastern University, Boston, Massachusetts
| | - Nathan D Zasler
- Concussion Care Centre of Virginia, Ltd, and Tree of Life Services, Inc, Richmond, Virginia; Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia; Department of Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, Virginia; International Brain Injury Association, Alexandria, Virginia
| | - Thomas A Novack
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama
| | - Christina Dillahunt-Aspillaga
- Rehabilitation and Mental Health Counseling Program, Department of Child and Family Studies, University of South Florida, Tampa, Florida; VA HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), Tampa, Florida
| | - Kristin M Graham
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia
| | - Bridget A Cotner
- VA HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), Tampa, Florida; Department of Anthropology, University of South Florida, Tampa, Florida
| | - Amanda R Rabinowitz
- Moss Rehabilitation Research Institute, Montgomery, Alabama; Department of Rehabilitation, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sureyya Dikmen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington; Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Janet P Niemeier
- Carolinas Rehabilitation, Carolinas Medical Center, Charlotte, North Carolina
| | | | - Amy K Wagner
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania; Center for Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania; Safar Center of Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania.
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32
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Sigurdardottir S, Andelic N, Wehling E, Anke A, Skandsen T, Holthe OO, Manskow US, Roe C. Return to work after severe traumatic brain injury: a national study with a one-year follow-up of neurocognitive and behavioural outcomes. Neuropsychol Rehabil 2018; 30:281-297. [PMID: 29667477 DOI: 10.1080/09602011.2018.1462719] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The objectives were to investigate the frequency of return-to-work (RTW) one year after severe traumatic brain injury (sTBI: Glasgow Coma Scale, GCS 3-8) and to identify which demographic and injury-related characteristics and neurocognitive factors are associated with RTW. This study is part of a prospective national study on sTBI conducted in all four Norwegian Trauma Referral Centres, including patients aged >15 years over a period of three years (n = 378). For the purpose of this study, only pre-employed individuals of working age (16 to 67 years) were investigated for RTW (n = 143), and of these, 104 participants underwent neuropsychological testing. Measures of acute injury severity, neuropsychological composite scores (Memory, Processing Speed, Executive Functions) at the one-year follow-up, and the Behaviour Rating Inventory of Executive Functions (patient- and relative reports) were explored as predictors of RTW. The frequency of RTW was 54.5%. Multivariate logistic regression analyses identified younger age, shorter length of stay in intensive care, better Processing Speed scores, and lower levels of metacognitive difficulties as rated by relatives as significant predictors of RTW. Findings support the importance of neuropsychological measures in predicting long-term RTW and highlight the need to address neurocognitive and behavioural difficulties to improve RTW after sTBI.
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Affiliation(s)
- Solrun Sigurdardottir
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway.,Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nada Andelic
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Clinical Neuroscience, Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Eike Wehling
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway
| | - Audny Anke
- Department of Rehabilitation, University Hospital of North Norway, Tromso, Norway.,Department of Clinical Medicine, University of Tromso, The Arctic University of Norway, Tromso, Norway
| | - Toril Skandsen
- Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Faculty of Medicine and Heath Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Oyvor Oistensen Holthe
- Division of Clinical Neuroscience, Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Unn Sollid Manskow
- Department of Rehabilitation, University Hospital of North Norway, Tromso, Norway.,Faculty of Health Sciences, Department of Health and Care Sciences, University of Tromso, Tromso, Norway
| | - Cecilie Roe
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Clinical Neuroscience, Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
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