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Sorrentino G, Bayen E, Câmara-Costa H, Francillette L, Toure H, Laurent-Vannier A, Meyer P, Dellatolas G, Chevignard M. Long-term burden of informal caregiver 7-years after severe childhood traumatic brain injury in the traumatisme grave de l'Enfant (TGE) study. Brain Inj 2024; 38:467-478. [PMID: 38379310 DOI: 10.1080/02699052.2024.2318588] [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: 03/20/2023] [Accepted: 02/09/2024] [Indexed: 02/22/2024]
Abstract
OBJECTIVE To investigate reported burden by the Primary Family Caregiver (PFC) 7-years after severe pediatric traumatic brain injury in the TGE (Traumatisme Grave de l'Enfant) longitudinal study. METHODS Subjective burden was estimated with the Zarit Burden Inventory (ZBI) in 36 PFC (parents), who rated their own health status (Medical Outcome Study Short Form-12), family functioning and their child's level of care and needs (Pediatric/Adult Care And Needs Scale [PCANS/CANS]). Data collection included: child and PFC sociodemographic characteristics, injury-related factors, 'objective' (e.g. overall level of disability: Glasgow Outcome Scale - Extended, GOS-E/GOS-E-Peds) and 'subjective' outcomes (e.g. participation, behavior, executive functions, quality of life and fatigue). RESULTS 25% of PFC reported mild-moderate burden, and 19% moderate-severe burden. Higher burden correlated with worse outcomes in all 'subjective' PFC-rated outcomes, and with self-reported participation. The ZBI correlated strongly with CANS/PCANS and GOS-E/GOS-E-Peds. Overall level of disability and PFC-reported executive functioning explained 62% of the ZBI variance. For equal levels of disability, burden was higher when PFC reported a 'negative' picture of their child. CONCLUSION Significant PFC-reported burden 7-years post-injury was associated with overall disability and 'subjective' PFC-rated outcomes. Factors influencing parental burden in the long term should be identified and psychological support implemented over time.
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Affiliation(s)
- Gregorio Sorrentino
- Sorbonne Université, GRC 24 Handicap Moteur et Cognitif et Réadaptation (HaMCRe), Paris, France
| | - Eléonore Bayen
- Sorbonne Université, GRC 24 Handicap Moteur et Cognitif et Réadaptation (HaMCRe), Paris, France
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, LIB, Paris, France
| | - Hugo Câmara-Costa
- Sorbonne Université, GRC 24 Handicap Moteur et Cognitif et Réadaptation (HaMCRe), Paris, France
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, LIB, Paris, France
- Rehabilitation Department for Children with Acquired Neurological Injury, Saint Maurice Hospitals, Saint Maurice, France
| | - Leila Francillette
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, LIB, Paris, France
- Rehabilitation Department for Children with Acquired Neurological Injury, Saint Maurice Hospitals, Saint Maurice, France
| | - Hanna Toure
- Rehabilitation Department for Children with Acquired Neurological Injury, Saint Maurice Hospitals, Saint Maurice, France
| | - Anne Laurent-Vannier
- Rehabilitation Department for Children with Acquired Neurological Injury, Saint Maurice Hospitals, Saint Maurice, France
| | - Philippe Meyer
- Pediatric Anesthesiology Department, Hôpital Necker Enfants Malades, Paris, France
- Faculty of Medicine, Paris Descartes University, Paris, France
| | - Georges Dellatolas
- Sorbonne Université, GRC 24 Handicap Moteur et Cognitif et Réadaptation (HaMCRe), Paris, France
| | - Mathilde Chevignard
- Sorbonne Université, GRC 24 Handicap Moteur et Cognitif et Réadaptation (HaMCRe), Paris, France
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, LIB, Paris, France
- Rehabilitation Department for Children with Acquired Neurological Injury, Saint Maurice Hospitals, Saint Maurice, France
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Cheng WY, Klonoff PS, Perumparaichallai RK. Components of self-awareness affecting caregiver burden: a long-term follow-up study. Brain Inj 2024; 38:26-31. [PMID: 38258808 DOI: 10.1080/02699052.2024.2304883] [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: 07/30/2022] [Accepted: 01/09/2024] [Indexed: 01/24/2024]
Abstract
OBJECTIVE Studies utilizing the discrepancy model of the Mayo-Portland Adaptability Inventory-4 (MPAI-4) have commonly used the cognitive and physical domains to estimate self-awareness. This study included other aspects of self-awareness such as awareness of one's social and emotional status and daily functioning to explore their effects on caregiver burden for ABI survivors. METHODS We studied 64 patient-caregiver pairs up to 29 years post-discharge from a holistic, milieu-oriented outpatient neurorehabilitation program. Discrepancy scores between ABI survivors' and caregivers' reports on the MPAI-4 subscales (i.e. Abilities, Adjustment, and Participation) and Total Score were used to determine self-awareness. Caregiver burden was measured using the Zarit Burden Interview (ZBI). RESULTS Exploratory linear regression analyses revealed that caregiver burden derived from the ZBI was predicted by the discrepancy scores generated from the Abilities (p < 0.0001), Adjustment (p < 0.01), Participation subscales (p = 0.01), and Total Score (p < 0.001), respectively. Among the exploratory models generated, the Total Score model had the highest predictive value (R2 = .33) for caregiver burden. CONCLUSIONS Measures of self-awareness should be comprehensive by considering diverse components of self-awareness. Increasing ABI survivors' self-awareness in different domains has the potential to effectively alleviate caregiver burden.
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Affiliation(s)
- Wen-Yu Cheng
- The Center for Transitional Neuro-Rehabilitation, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Pamela S Klonoff
- The Center for Transitional Neuro-Rehabilitation, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Filipčíková M, Balleine B, Kumfor F, McDonald S. Action control and selection in social disinhibition following severe TBI: a pavlovian-to-instrumental transfer and outcome devaluation study. J Clin Exp Neuropsychol 2023; 45:825-839. [PMID: 38319159 DOI: 10.1080/13803395.2024.2313257] [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: 06/27/2023] [Accepted: 11/25/2023] [Indexed: 02/07/2024]
Abstract
INTRODUCTION Social disinhibition is a significant sequela of severe traumatic brain injury (TBI). Some research suggests that it could reflect a deficiency in goal-directed behavior. The current study aimed to test whether these inappropriate behaviors tend to be deficient in goal-directed control, that is, triggered more by environmental stimuli than by the known consequences of their actions. METHOD We used a between-group design with 25 adult participants with severe TBI, and 27 control participants. Social disinhibition was measured using Frontal Systems Behavior Scale and Social Disinhibition Interview. Changes in reward-related goal-directed behavior were evaluated using a computer-based task in which we assessed the influence of cues predicting reward and of reward devaluation on choice performance. RESULTS We found no difference in the levels of social disinhibition between the TBI and control groups and, using mixed two-way ANCOVAs, no overall effect of the stimuli or outcome devaluation. However, after combing these groups and splitting them based on their disinhibition levels, a significant interaction between group (High vs Low disinhibition) and reward type (Valued vs Devalued) in sensitivity to outcome devaluation test (F = 5.99, p = .01, ηp2 = .13) appeared. Comparing with the baseline rate of responding, the Low disinhibition group decreased their responding to devalued and increased their responding to still-valued outcomes. In contrast, the High disinhibition group showed the opposite pattern of choice performance. CONCLUSIONS It appears that people with clinical levels of social disinhibition are both prone to outcome-response priming effects and insensitive to changes in the value of the consequences of their actions, that is, despite evidence they were aware of the reduction in the value of their actions's outcomes, people with high-level disinhibition kept performing those actions. This pattern has the hallmarks of a habit suggesting their disinhibition reflects a loss of executive control.
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Affiliation(s)
| | - Bernard Balleine
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Fiona Kumfor
- School of Psychology, Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Skye McDonald
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
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Kreitzer N, Adeoye O, Wade SL, Kurowki BG, Thomas S, Gillespie L, Bakas T. Iterative Development of the Caregiver Wellness After Traumatic Brain Injury Program (CG-Well). J Head Trauma Rehabil 2023; 38:E424-E436. [PMID: 36951450 PMCID: PMC10517076 DOI: 10.1097/htr.0000000000000869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
OBJECTIVES (1) To iteratively design a web/phone-based intervention to support caregivers of adults acutely following traumatic brain injury (TBI), Caregiver Wellness (CG-Well), and (2) to obtain qualitative and quantitative feedback on CG-Well from experts and caregivers to refine the intervention. SETTING A level I trauma and tertiary medical center. PARTICIPANTS Convenience sample of a total of 19 caregivers and 25 experts. DESIGN Multistep prospective study with iterative changes to CG-Well: (1) developed intervention content based on qualitative feedback from a prior study and literature review; (2) obtained qualitative feedback from 10 experts; (3) refined content using a modified Delphi approach involving 4 caregivers and 6 experts followed by qualitative interviews with 9 caregivers; (4) designed CG-Well website and videos; and (5) obtained feedback on program acceptability, appropriateness, and feasibility from 6 caregivers and 9 experts. INTERVENTIONS CG-Well included content on TBI, self-care and support, and skill-building strategies delivered through a website and telephone calls. MAIN OUTCOME MEASURES Qualitative data were analyzed using content analysis. Caregivers and experts completed Likert-type scales to rate module relevance, clarity, accuracy, utility and website acceptability, appropriateness, and feasibility (1 = strongly disagree to 5 = strongly agree). Means and standard deviations (SD) characterized ratings. RESULTS Qualitative findings were instrumental in designing and refining CG-Well. Ratings were positive for modules (means and SD for relevant [4.9, 0.33], clear [4.6, 0.53], accurate [4.9, 0.33], and useful [5, 0]) and the website (means and SD for acceptable [4.8, 0.36], appropriate [4.8, 0.35], and feasible [4.8, 0.36]). CONCLUSIONS The iterative design process for CG-Well resulted in a highly acceptable program. An early-stage randomized controlled trial is underway to estimate treatment effects for a future well-powered clinical trial.
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Affiliation(s)
- Natalie Kreitzer
- Department of Emergency Medicine (Drs Kreitzer and Gillespie and Ms Thomas) and College of Nursing (Dr Bakas), University of Cincinnati, Cincinnati, Ohio; Department of Emergency Medicine, Washington University, St Louis, Missouri (Dr Adeoye); Departments of Pediatrics (Dr Wade) and Pediatrics and Neurology and Rehabilitation Medicine (Dr Kurowki), Division of Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and University of Cincinnati College of Medicine, Cincinnati, Ohio (Dr Kurowki)
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Sun C, Meng D. Factors associated with perceived caregivers' willingness to provide care among older adults with disabilities in China. Front Public Health 2023; 11:1170594. [PMID: 37342270 PMCID: PMC10277793 DOI: 10.3389/fpubh.2023.1170594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/17/2023] [Indexed: 06/22/2023] Open
Abstract
Objective The aim of this study was to analyze the status quo and associated factors of care recipients' perceptions of caregivers' willingness to provide care among disabled older adults in China. Thus, this study contributes to our understanding of vulnerable older populations who are at a high risk of receiving support from informal caregivers who are unable or unwilling to take the caregiver role. Methods We analyzed the cross-sectional data of 3,539 disabled older adults who received informal care at home from the seventh wave of the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). Multiple logistic regression models were used to examine the variables associated with the respondents' perceived caregivers' willingness to care from five aspects: respondents' sociodemographic attributes, health-related data, family endowment, access to health care services and community-based long-term care services (CBLTCS). Results This study found that the majority of disabled older adults (90.9%) had a positive attitude toward their caregivers' willingness to care and the care they received; however, 7.0% of the adults were concerned about their caregivers' ability to handle the care. Moreover, there was a small number of disabled older people (2.1%) who felt that their caregivers were reluctant to care or lacked patience. The results from the multiple logistic regression showed that disabled older adults with socioeconomic disadvantages (living in rural areas, being poor and with no children who frequently visited) or high demand (with severe disabilities or cognitive impairment) were more likely to consider that their caregivers needed respite care. Those adults with anxiety symptoms, a lower amount of care time, poor self-rated financial status and poor accessibility to health care services were more likely to report that their caregivers were reluctant to administer care. Conclusion This study found that living in rural areas, being poor, with no children who frequently visited, severe disabilities or CI were positively associated the care recipients' perception that caregivers needed respite care. While anxiety symptoms, a lower amount of care time, poor self-rated financial status and poor accessibility to health care services were significantly associated with care recipients' perception of caregivers' reluctance to care. Our findings highlight the awareness of monitoring informal carers' willingness to care or capability to enact caring tasks.
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Kjeldgaard A, Soendergaard PL, Wolffbrandt MM, Norup A. Predictors of caregiver burden in caregivers of individuals with traumatic or non-traumatic brain injury: A scoping review. NeuroRehabilitation 2023; 52:9-28. [PMID: 36617762 DOI: 10.3233/nre-220134] [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: 01/07/2023]
Abstract
BACKGROUND Caregivers of individuals with traumatic (TBI) or non-traumatic (nTBI) brain injuries are at risk of significant caregiver burden. Consequently, it is crucial to examine predictors of caregiver burden to enable early identification and intervention. OBJECTIVE To examine predictors of caregiver burden in caregivers of individuals with TBI/nTBI. METHODS A scoping review was conducted in the bibliographic databases PubMed, EMBASE (Ovid) and APA PsycInfo (EBSCO). Search terms included: 'acquired brain injur*', 'traumatic brain injur*', 'brain injur*', 'non-traumatic brain injur*', or 'stroke*' combined with 'burden', 'caregiver burden', 'perceived burden', or 'caregiver strain'. The search was limited to articles written in English and published in academic journals between 2000 and March 2022. EndNote was used to manage the references and identify duplicates. RESULTS Twenty-four studies were included. Care recipient-related predictors of caregiver burden included more severe injuries, functional disabilities (including decreased physical and neuropsychological functioning), and worse mental health. Caregiver-related predictors included more time spent caregiving, worse mental health, and unmet needs. For several predictor variables, evidence was mixed or vague. CONCLUSION The results highlight which caregivers are at risk of caregiver burden and point to several areas of potential intervention to prevent caregiver burden. Future research should explore the relationship between characteristics of the caregiver and caregiver burden, including coping style, problem-solving techniques, and personality, as these have been sparsely investigated and are potentially modifiable through intervention. Further research is needed to elucidate if burden can be prevented by interventions targeting caregivers at risk. Addressing these gaps may clarify the link between caregiver burden and predictor variables and assist in development of interventions that may prevent burden.
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Affiliation(s)
- Amanda Kjeldgaard
- Neurorehabilitation Research and Knowledge Centre, Rigshospitalet, Copenhagen, Denmark.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Pernille Langer Soendergaard
- Neurorehabilitation Research and Knowledge Centre, Rigshospitalet, Copenhagen, Denmark.,Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Mia Moth Wolffbrandt
- Neurorehabilitation Research and Knowledge Centre, Rigshospitalet, Copenhagen, Denmark
| | - Anne Norup
- Neurorehabilitation Research and Knowledge Centre, Rigshospitalet, Copenhagen, Denmark.,Department of Psychology, University of Southern Denmark, Odense, Denmark
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Negative and positive experiences of caregiving among family caregivers of older blunt trauma patients. PLoS One 2022; 17:e0275169. [PMID: 36215237 PMCID: PMC9550085 DOI: 10.1371/journal.pone.0275169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/11/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Family caregivers play a fundamental role in the care of the older blunt trauma patient. We aim to identify risk factors for negative and positive experiences of caregiving among family caregivers. DESIGN Prospective, nationwide, multi-center cohort study. SETTING AND PARTICIPANTS 110 family caregivers of Singaporeans aged≥55 admitted for unintentional blunt trauma with an Injury Severity Score (ISS) or New Injury Severity Score (NISS)≥10 were assessed for caregiving-related negative (disturbed schedule and poor health, lack of family support, lack of finances) and positive (esteem) experiences using the modified-Caregiver Reaction Assessment (m-CRA) three months post-injury. METHODS The association between caregiver and patient factors, and the four m-CRA domains were evaluated via linear regression. RESULTS Caregivers of retired patients and caregivers of functionally dependent patients (post-injury Barthel score <80) reported a worse experience in terms of disturbed schedule and poor health (β-coefficient 0.42 [95% Confidence Interval 0.10, 0.75], p = .01; 0.77 [0.33, 1.21], p = .001), while male caregivers and caregivers who had more people in the household reported a better experience (-0.39 [-0.73, -0.06], p = .02; -0.16 [-0.25, -0.07], p = .001). Caregivers of male patients, retired patients, and patients living in lower socioeconomic housing were more likely to experience lack of family support (0.28, [0.03, -0.53], p = .03; 0.26, [0.01, 0.52], p = .05; 0.34, [0.05, -0.66], p = .02). In the context of lack of finances, caregivers of male patients and caregivers of functionally dependent patients reported higher financial strain (0.74 [0.31, 1.17], p = .001; 0.84 [0.26, 1.43], p = .01). Finally, caregivers of male patients reported higher caregiver esteem (0.36 [0.15, 0.57], p = .001). CONCLUSIONS AND IMPLICATIONS Negative and positive experiences of caregiving among caregivers of older blunt trauma patients are associated with pre-injury disability and certain patient and caregiver demographics. These factors should be considered when planning the post-discharge support of older blunt trauma patients.
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Filipčíková M, Wearne T, Li R, McDonald S. The prevalence, predictors, associated symptoms, and outcomes of social disinhibition following moderate-to-severe TBI: A scoping review of quantitative evidence. J Clin Exp Neuropsychol 2021; 43:716-736. [PMID: 34930093 DOI: 10.1080/13803395.2021.2000589] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The present study aimed to map existing quantitative evidence of research related to the nature of social disinhibition following moderate-to-severe traumatic brain injury (TBI), with a specific focus on its prevalence, predictors, associated symptoms and outcomes in studies that met minimal methodological criteria. We conducted a scoping review of the literature following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for Scoping Reviews (PRISMA-ScR). Seventeen peer-reviewed articles including 1440 participants met the inclusion criteria and were included in the qualitative synthesis. Results of the study indicate that social disinhibition is a common and significant consequence of moderate-to-severe TBI with its prevalence estimates ranging from 21% to 32%. Inappropriate sexual behavior appears to be more prevalent in men and younger survivors. Rule-breaking/perseverative errors in fluency tests are significantly associated with social disinhibition. The perceived burden of caregivers of people with TBI is a very common outcome. An interesting finding was an association between higher social disinhibition and higher emotional empathy levels. However, similarly to many potential predictors, this was only found in a single study and therefore requires further investigation. Some common methodological flaws are discussed, such as the use of non-probability sampling, lack of sample size justification or not including a control group. Due to the heterogeneity of measures used to assess social disinhibition in the reviewed articles, conducting a meta-analysis was not possible. In conclusion, social disinhibition is a significant consequence of moderate-to-severe TBI, as it impacts both the TBI survivor and their family/caregivers. The present study extends the scope of the prior overview by offering a clearer picture of social disinhibition after surviving moderate-to-severe TBI, as it focuses on studies with strong methodology and validated measures. It also assesses potential predictors other than executive dysfunction, such as demographics and injury characteristics.
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Affiliation(s)
| | - Travis Wearne
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Ranran Li
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Skye McDonald
- School of Psychology, University of New South Wales, Sydney, Australia
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The Experience of Caregivers Following a Moderate to Severe Traumatic Brain Injury Requiring ICU Admission. J Head Trauma Rehabil 2021; 35:E299-E309. [PMID: 31479080 DOI: 10.1097/htr.0000000000000525] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Survivors of moderate and severe traumatic brain injury (TBI) require substantial care, much of which is ultimately provided by friends and family. We sought to describe the unmet needs of informal caregivers. DESIGN Qualitative, semistructured interviews with informal caregivers of moderate and severe TBI survivors were conducted 72 hours, 1 month, 3 months, and 6 months after injury. SETTING Intensive care unit of a level 1 trauma center. PARTICIPANTS Informal caregivers were friends or family who planned to provide care for the patient. Patients were 18 years or older with a moderate to severe TBI, and not expected to imminently die of their injuries. MEASUREMENTS AND MAIN RESULTS Eighteen patient-caregiver dyads were enrolled. Fifty-three interviews with caregivers were completed and analyzed over the course of 6 months. Three themes were identified in the qualitative analysis: caregiver burden, caregiver health-related quality of life, and caregiver needs for information and support. CONCLUSIONS This study provides new information about the experience of informal caregivers during the 6 months after their friend or family member survived a moderate to severe TBI. Interventions to promote caregiving may be a substantial opportunity to improve patient-centered outcomes following TBI.
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Corallo F, Pria D, Di Blasi A, Bonanno L, De Cola MC, Di Cara M, Rifici C, De Salvo S, Bramanti P, Marino S, Buono VL. The effects of caregiver's burden on dynamic structure in disorder of consciousness families: An observational study. Brain Behav 2021; 11:e2305. [PMID: 34350729 PMCID: PMC8413804 DOI: 10.1002/brb3.2305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/22/2021] [Accepted: 07/12/2021] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Disorder of consciousness is a clinical condition due to severe brain damage. The impact of consciousness disorder on the family is characterized by a combination of biopsychosocial factors. The burden and suffering perceived by caregivers can cause psychological distress characterized by anxiety, depression, and physical illness. The aim of the study was to investigate the interaction between family dynamics and caregiver burden. METHODS We enlisted 35 caregivers of subjects in a minimally conscious state. Two skilled psychologists administered the Olson's Adaptability and Family Cohesion Assessment Scale and the Novak's Burden Inventory Caregiver Scale to assess family function and family burden, respectively. RESULTS We found that the caregiver burden correlates with the family adaptability and cohesion, as well as with enmeshment, rigidity, and disengagement. CONCLUSION Findings suggest that the traumatic event does not affect the family structure. Families are able to maintain a balanced functioning and control distress.
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Affiliation(s)
| | - Deborah Pria
- IRCCS Centro Neurolesi “Bonino‐Pulejo”MessinaItaly
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Pugh M, Perrin PB, Arango-Lasprilla JC. Predicting caregiver burden over the first 4 months after acute traumatic brain injury in Latin America: a multi-country study. Brain Inj 2021; 35:769-777. [PMID: 33822684 PMCID: PMC8217148 DOI: 10.1080/02699052.2021.1907861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 03/05/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Abstract
Background: Traumatic brain injury (TBI) rates and outcomes are worse in Latin American countries relative to high-income countries. This study examined whether cognitive dysfunction, depressive mood, and poor social and emotional self-regulation in individuals with an acute TBI in Latin America predict longitudinal trajectories of caregiver burden during the first 4 months post-discharge.Method: A sample of 109 caregivers of individuals with a new TBI from Colombia and Mexico completed the observer European Brain Injury Questionnaire before hospital discharge and the Zarit Burden Inventory at the same time and again at 2 and 4 months after discharge. A hierarchical linear model (HLM) was used to assess whether cognitive dysfunction, depressive mood, and poor social and emotional self-regulation at hospital discharge predicted longitudinal trajectories of caregiver burden.Results: Results suggested that burden trajectories decreased over time and men reported higher burden than women. Additionally, results showed that poor patient social and emotional self-regulation predicted higher burden trajectories.Conclusions: Men and caregivers providing care for those experiencing poor social and emotional self-regulation may be at risk for burden. Culturally sensitive interventions focusing on social functioning of individuals with TBI and gender-informed caregiver interventions aimed at burden should be implemented in Latin America.
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Affiliation(s)
- Mickeal Pugh
- Department of Psychology, Virginia Commonwealth University, Richmond, USA
| | - Paul B. Perrin
- Department of Psychology, Virginia Commonwealth University, Richmond, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonweath University, Richmond, USA
| | - Juan Carlos Arango-Lasprilla
- BioCruces Bizkaia Health Research Institute, Cruces University Hospital Barakaldo, Barakaldo, Spain
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
- Department of Cell Biology and Histology, University of the Basque Country (UPV/EHU), Bilbao, Spain
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Othman H, Ludin SM, Saidi S, Awang MS. The needs of traumatic brain injury survivors' caregivers and the implication required during the COVID-19 pandemic: Public health issues. J Public Health Res 2021; 10. [PMID: 33855403 PMCID: PMC8129743 DOI: 10.4081/jphr.2021.2205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/19/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Traumatic brain injury (TBI) survivors require attention and dependence from their primary caregiver. This is because TBI is a defect that affects both the psychological and physical functions of the victim. Caregivers play an essential role in providing the adequate care victims need to adjust to the new problems they may experience due to their condition, as family members alone may not be able to provide for their needs. In particular, TBI caregivers may face specific challenges when assisting their patients in handling unexpected changes to their daily routines. Therefore, this quantitative study aims to explore the needs of caregivers, their coping mechanisms towards stressful and traumatic circumstances, and how they provide care to their loved ones during the COVID-19 pandemic. Design and Methods: It was conducted with ten caregivers of individuals suffering from traumatic brain injury, that were selected using a theoretical sampling method. Data were obtained using a semi-structured interview guide, which helped the caregivers provide their responses. Meanwhile, data analysis was performed using the NVIVO analysis software. Results: The results showed that there were, three significant themes namely, (a) Support needed, (b) the information need for care, and (c) developing self-resilience. The results also showed that caregivers really need support from the various parties, and the participants lack information on specific care techniques for the severe traumatic brain injury (TBI) survivors. Conclusions: In conclusion, caregivers require approval and seek more useful information to provide excellent care to their loved ones. Being aware of the caregiver’s needs would enable them to offer improved customized care. Significance for public health Caregiving is an issue affecting the quality of life for millions of individuals and demands attention from all communities. Though the funding and jurisdiction for public health initiatives comes from the federal and state government, local communities still deal with most of the burdens and practicalities of public health issues. Meanwhile, historically, scientists and practitioners alike rarely considered caregiving to be a public health issue.
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Affiliation(s)
- Hamidah Othman
- Critical Care Nursing Department, Kulliyyah of Nursing, International Islamic University Malaysia (IIUM), Kuantan, Pahang.
| | - Salizar Mohamed Ludin
- Critical Care Nursing Department, Kulliyyah of Nursing, International Islamic University Malaysia (IIUM), Kuantan, Pahang.
| | - Sanisah Saidi
- Medical-Surgical Nursing Department, Kulliyyah of Nursing, International Islamic University Malaysia (IIUM), Kuantan, Pahang.
| | - Mohamed Saufi Awang
- Kulliyyah of Medicine, International Islamic University Malaysia (IIUM), Kuantan, Pahang.
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Fann JR, Hart T, Ciol MA, Moore M, Bogner J, Corrigan JD, Dams-O'Connor K, Driver S, Dubiel R, Hammond FM, Kajankova M, Watanabe TK, Hoffman JM. Improving transition from inpatient rehabilitation following traumatic brain injury: Protocol for the BRITE pragmatic comparative effectiveness trial. Contemp Clin Trials 2021; 104:106332. [PMID: 33652127 DOI: 10.1016/j.cct.2021.106332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/15/2021] [Accepted: 02/22/2021] [Indexed: 01/03/2023]
Abstract
Moderate to severe traumatic brain injury (TBI) is a common cause of long-term disability. Due to challenges that include inconsistent access to follow-up care, persons with TBI being discharged from inpatient rehabilitation facilities (IRFs) are at risk for rehospitalization, poor reintegration into the community, family stress, and other unfavorable outcomes resulting from unmet needs. In a six-center randomized pragmatic comparative effectiveness study, the BRITE trial (Brain Injury Rehabilitation: Improving the Transition Experience, ClinicalTrials.govNCT03422276), we compare the effectiveness of two existing methods for transition from IRF to community living or long-term nursing care. The Rehabilitation Discharge Plan (RDP) includes patient/family education and referrals for continued care. The Rehabilitation Transition Plan (RTP) provides RDP plus individualized, manualized care management via phone or videoconference, for 6 months. Nine hundred patients will be randomized (1:1) to RDP or RTP, with caregivers also invited to participate and contribute caregiver-reported outcomes. Extensive stakeholder input, including active participation of persons with TBI and their families, has informed all aspects of trial design and implementation planning. We hypothesize that RTP will result in better patient- and caregiver-reported outcomes (societal participation, quality of life, caregiver well-being) and more efficient use of healthcare resources at 6-months (primary outcome) and 12-months post-discharge, compared to RDP alone. Planned analyses will explore which participants benefit most from each transition model. With few exclusion criteria and other pragmatic features, the findings of this trial are expected to have a broad impact on improving transitions from inpatient TBI rehabilitation. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT03422276.
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Affiliation(s)
- Jesse R Fann
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195, United States of America.
| | - Tessa Hart
- Moss Rehabilitation Research Institute, 50 Township Line Road, Elkins Park, PA 19027, United States of America.
| | - Marcia A Ciol
- Department of Rehabilitation Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356490, Seattle, WA 98195, United States of America.
| | - Megan Moore
- School of Social Work and Harborview Injury Prevention and Research Center, University of Washington, 4101 15(th) Avenue NE, Seattle, WA 98105, United States of America.
| | - Jennifer Bogner
- Department of Physical Medicine and Rehabilitation, The Ohio State University, 480 Medical Center Drive, Columbus, OH 43210, United States of America.
| | - John D Corrigan
- Department of Physical Medicine and Rehabilitation, The Ohio State University, 480 Medical Center Drive, Columbus, OH 43210, United States of America.
| | - Kristen Dams-O'Connor
- Department of Rehabilitation Medicine, Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place Box 1163, New York, NY 10029, United States of America. Kristen.dams-o'
| | - Simon Driver
- Department of Sports Therapy and Research, Baylor Scott and White Research Institute, 3434 Live Oak, Dallas, TX 75204, United States of America.
| | - Rosemary Dubiel
- Department of Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, 909 N. Washington Avenue, Dallas, TX 75246, United States of America.
| | - Flora M Hammond
- Department of Physical Medicine and Rehabilitation, Indian University School of Medicine, 4141 Shore Drive, Indianapolis, IN 46254, United States of America.
| | - Maria Kajankova
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place Box 1163, New York, NY 10029, United States of America.
| | - Thomas K Watanabe
- Department of Physical Medicine and Rehabilitation, MossRehab at Elkins Park/Einstein Healthcare Network, 60 Township Line Road, Elkins Park, PA 19027, United States of America.
| | - Jeanne M Hoffman
- Department of Rehabilitation Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356490, Seattle, WA 98195, United States of America.
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Gonzalez-Lara LE, Munce S, Christian J, Owen AM, Weijer C, Webster F. The multiplicity of caregiving burden: a qualitative analysis of families with prolonged disorders of consciousness. Brain Inj 2021; 35:200-208. [PMID: 33385307 DOI: 10.1080/02699052.2020.1865565] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: To understand the multiple and sometimes conflicting roles substitute decision makers (SDMs) of individuals in a vegetative state (VS), minimally conscious state (MCS), or with locked-in syndrome (LIS) perform while caring for a loved one and the competing priorities derived from these roles.Methods: We conducted semi-structured qualitative interviews using a constructive-grounded theory design. Twelve SDMs, who were also family members for 11 patients, were interviewed at two time points (except one) for a total of 21 in-depth interviews.Results: Participants described that caregiving is often the central role which they identify as their top priority and around which they coordinate and to some extent subordinate their other roles. In addition to caregiving, they participated in a wide variety of roles, which were sometimes in conflict, as they became caregivers for a loved one with chronic and complex needs. SDMs described the caregiver role as complex and intense that lead to physical, emotional, social, and economic burdens.Conclusion: SDMs report high levels of burdens in caring for a person with a prolonged disorder of consciousness. Lack of health system support that recognized the broader context of SDMs lives, including their multiple competing priorities, was a major contributing factor.
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Affiliation(s)
| | - Sarah Munce
- Toronto Rehabilitation Institute - University Health Network
| | | | - Adrian M Owen
- The Brain and Mind Institute, Western University, London, Ontario, Canada
| | | | - Fiona Webster
- Labatt Family School of Nursing, Western University, London, Ontario, Canada
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Stafslien EHD, Turkstra LS. Sex-based differences in expectations for social communication after TBI. Brain Inj 2020; 34:1756-1762. [PMID: 33222531 DOI: 10.1080/02699052.2020.1849799] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Sex-based differences have been reported in several TBI outcome studies, including studies of social functioning. In some studies, social outcomes have been evaluated via perceptual judgments on questionnaires, which may be influenced by stereotypes about acceptable behaviour for men and women. To explore potential sex-based rater bias in social judgments, we asked 68 typical undergraduates (34 women) to identify problematic behaviour for men vs. women on a widely used questionnaire for TBI social outcome, the LaTrobe Communication Questionnaire. Results revealed more consensus among raters of both sexes about acceptable behaviours for men than behaviours for women, and women were more critical than men when judging persons of either sex. These findings support the importance of considering sex in TBI social outcome research, past and future, not only sex of the participant but also sex of the person judging social outcome. Sex-based differences here also have implications for social evaluations in clinic, where female clinicians are often judging male patients. Future research should consider gender (the social construct), as well as sex (the biological construct), as both may contribute to perceived social outcome after TBI.
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Affiliation(s)
- E H Despins Stafslien
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison , Madison, Wisconsin, USA
| | - L S Turkstra
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison , Madison, Wisconsin, USA
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16
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Hanks RA, Boileau NR, Norman AL, Nakase-Richardson R, Mariouw KH, Carlozzi NE. Spirituality and outcomes in caregivers of persons with traumatic brain injury (TBI). Rehabil Psychol 2020; 65:347-359. [PMID: 31916806 PMCID: PMC7643714 DOI: 10.1037/rep0000304] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE/OBJECTIVE Spiritual well-being has been associated with better quality of life outcomes in caregivers, but the associations among the care recipient's functional status, the caregiver's spiritual well-being, and the caregiver's health-related quality of life (HRQOL) is unknown. Research Method/Design: The study examined the Spiritual Well-Being Scale in caregivers of persons with traumatic brain injury (TBI; n = 335). Participants completed measures from the Patient-Reported Outcomes Measurement Information System, the Quality of Life in Caregivers of TBI, and the Caregiver Appraisal Scale. The Mayo-Portland Adaptability Inventory-4 (MPAI-4) measured care recipient's functional status. The association between religious well-being and existential well-being and HRQOL were examined with Pearson correlation coefficients. Multiple linear regressions examined the interaction between caregiver well-being and care recipient functional status on HRQOL outcomes accounting for demographic variables. RESULTS Less favorable caregiver HRQOL was associated with military affiliation, male status, spousal caregiver relationship, and White race. MPAI-4 was moderately associated with all HRQOL subdomains. For spiritual well-being, existential well-being was moderately correlated with 9 of 16 HRQOL subdomains in comparison to religious well-being that demonstrated small correlations with 3 of 16 subdomains. MPAI-4 had negative effects on HRQOL regardless of spiritual well-being with higher existential well-being reducing the negative impact of the care recipient's functional impairment on HRQOL for significant HRQOL interactions. CONCLUSIONS/IMPLICATIONS Interventions that encourage development and maintenance of life purpose and meaning in caregivers of persons with TBI, and less so, spirituality, might have beneficial effects on HRQOL when the person with injury has more functional limitations. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Robin A Hanks
- Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine
| | - Nicholas R Boileau
- Department of Physical Medicine and Rehabilitation, University of Michigan
| | - Andria L Norman
- Department of Rehabilitation Psychology and Neuropsychology, Rehabilitation Institute of Michigan
| | - Risa Nakase-Richardson
- Mental Health and Behavioral Sciences, Polytrauma Division, Defense and Veterans Brain Injury Center, James A. Haley Veterans Hospital
| | - Kyr Hudson Mariouw
- Department of Rehabilitation Psychology and Neuropsychology, Rehabilitation Institute of Michigan
| | - Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan
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Mental Health and Family Functioning in Patients and Their Family Members after Traumatic Brain Injury: A Cross-Sectional Study. Brain Sci 2020; 10:brainsci10100670. [PMID: 32992808 PMCID: PMC7600942 DOI: 10.3390/brainsci10100670] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/23/2020] [Accepted: 09/23/2020] [Indexed: 11/17/2022] Open
Abstract
Traumatic brain injury (TBI) affects the family as a whole. This study aimed to describe and compare mental health and family functioning in TBI patients and their family members, and to identify individual and family-related factors that were associated with mental health. It was conducted at an urban, specialized, TBI outpatient clinic and included 61 patients with mild to severe TBI and 63 family members. Baseline demographics and injury-related data were collected, and the participants answered standardized, self-reported questionnaires 6-18 months post-injury that assessed mental health; general health; family functioning, communication, and satisfaction; depression and anxiety; self-efficacy; resilience; and condition-specific quality of life. The patients reported significantly worse mental health, depression, resilience, self-efficacy, and general health compared with the family members. Patients and family members had similar perceptions, showing balanced family functioning, high family communication levels, and moderate family satisfaction. Factors significantly associated with mental health in patients and family members were depression, anxiety, and resilience, explaining 56% of the variance (p < 0.001). Family-related factors were not associated with mental health. The disease burden was mainly on the patients; however, the family members also reported emotional distress. Family-targeted interventions across the TBI continuum should be considered.
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Tay M, Kong KH. Caregiver burden in familial caregivers and foreign domestic workers of patients with traumatic brain injury in a multi-ethnic Asian population. Brain Inj 2020; 34:1513-1517. [PMID: 32835512 DOI: 10.1080/02699052.2020.1809709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the prevalence and risk factors associated with caregiver burden in familial caregivers and foreign domestic workers of patients with severe traumatic brain injury. METHODS A total of 77 caregivers were consecutively recruited, who were either familial caregivers or foreign domestic workers. All caregivers were evaluated with the Zarit Burden Index (ZBI), Patient Health Questionnaire-9 (PHQ-9), and General Anxiety Disorder 7-item (GAD-7) scale. Logistic regression analysis was conducted to determine factors associated with caregiver burden. RESULTS The majority of participants were familial caregivers (N = 60), of which 70% experienced significant caregiver burden. In this group, 10.0% caregivers had clinically significant depression and 16.7% caregivers who had clinically significant anxiety. On multivariate analysis, factors found to be associated with caregiver burden were Glasgow Outcome Scale Extended (GOSE) of <7, presence of neuropsychiatric complications, and presence of anxiety. There was also a high prevalence of caregiver burden in foreign domestic workers (29.4%). CONCLUSION There is a high rate of caregiver burden in both familial caregivers and foreign domestic workers who care for patients with severe traumatic brain injury. Caregivers experiencing stress should also be monitored for the presence of anxiety or depression.
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Affiliation(s)
- Matthew Tay
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital Rehabilitation Center , Singapore
| | - Keng He Kong
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital Rehabilitation Center , Singapore
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19
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Burden and Preparedness amongst Informal Caregivers of Adults with Moderate to Severe Traumatic Brain Injury. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176386. [PMID: 32887272 PMCID: PMC7503757 DOI: 10.3390/ijerph17176386] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/21/2020] [Accepted: 08/24/2020] [Indexed: 01/23/2023]
Abstract
This study examined the patterns of informal (unpaid) caregiving provided to people after moderate to severe traumatic brain injury (TBI), explore the self-reported burden and preparedness for the caregiving role, and identify factors predictive of caregiver burden and preparedness. A cross-sectional cohort design was used. Informal caregivers completed the Demand and Difficulty subscales of the Caregiving Burden Scale; and the Mutuality, Preparedness, and Global Strain subscales of the Family Care Inventory. Chi-square tests and logistic regression were used to examine the relationships between caregiver and care recipient variables and preparedness for caregiving. Twenty-nine informal caregivers who reported data on themselves and people with a moderate to severe TBI were recruited (referred to as a dyad). Most caregivers were female (n = 21, 72%), lived with the care recipient (n = 20, 69%), and reported high levels of burden on both scales. While most caregivers (n = 21, 72%) felt “pretty well” or “very well” prepared for caregiving, they were least prepared to get help or information from the health system, and to deal with the stress of caregiving. No significant relationships or predictors for caregiver burden or preparedness were identified. While caregivers reported the provision of care as both highly difficult and demanding, further research is required to better understand the reasons for the variability in caregiver experience, and ultimately how to best prepare caregivers for this long-term role.
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20
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Ruet A, Bayen E, Jourdan C, Vallat-Azouvi C, Azerad S, Grimaldi L, Meaude L, Charanton J, Azouvi P. Potential for recovery between 4 and 8 years after a severe traumatic brain injury. Data from the PariS-TBI longitudinal study. Ann Phys Rehabil Med 2020; 64:101422. [PMID: 32763484 DOI: 10.1016/j.rehab.2020.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 06/24/2020] [Accepted: 07/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Severe traumatic brain injury (TBI) is a leading cause of complex and persistent disability. Yet, long-term change in global functioning and determinants of this change remain unclear. OBJECTIVES This study aimed to assess change in global functioning in the long-term after severe TBI and factors associated with the change. METHODS This was a prospective observational study of an inception cohort of adults with severe TBI in the Paris area (PariS-TBI). Outcome was assessed at 1, 4 and 8 years post-injury. For the included participants (n=257), change in global outcome between 4 and 8 years was evaluated with the Glasgow Outcome Scale Extended (GOSE) score, and its association with pre-injury, injury-related and post-injury variables was tested with univariate and multivariable analyses. RESULTS More than half of the 73 participants evaluated at both 4 and 8 years showed global improvement (of at least one point) in GOSE score and an improvement in mood, executive function, and subjective complaints. On univariate analysis, none of the pre-injury, injury or post-injury variables were associated with GOSE score change between 4 and 8 years, except for GOSE score at 4 years (rho=-0.24, P=0.04). On multivariable analysis, probability of increased GOSE score was associated with more years of education (odds ratio 1.18 [95% confidence interval 1.02-1.37], P=0.03). The change in GOSE score was significantly correlated with change in Hospital Anxiety Depression Scale score between 4 and 8 years (rho=-0.42, P<0.001). CONCLUSIONS Most participants with severe TBI in the present sample showed a late improvement (4 to 8 years post-injury) in global functioning. Of the socio-demographic and injury-related factors, only more years of education was associated with improvement in global functioning. Decreased anxiety and depression symptoms were associated with improved global functioning. Targeting interventions to enhance resilience may be the most effective in the long-term after severe TBI.
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Affiliation(s)
| | - Eléonore Bayen
- Département de rééducation neurologique, faculté de médecine, hôpital Pitié-Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - Claire Jourdan
- Département de médecine physique et de réadaptation, CHU de Lapeyronie, Montpellier, France
| | - Claire Vallat-Azouvi
- Antenne UEROS-SAMSAH92-UGECAM IDF, hôpital Raymond-Poincaré, Garches, France; HANDIReSP, EA4047, université de Versailles Saint-Quentin, Montigny-Le-Bretonneux, France; EA 2027, laboratoire de psychopathologie et neuropsychologie, Paris, France
| | - Sylvie Azerad
- Unité de recherche clinique, hôpital Ambroise-Paré, AP-HP, Boulogne, France
| | - Lamiae Grimaldi
- Unité de recherche clinique, hôpital Ambroise-Paré, AP-HP, Boulogne, France; LA-SER and Pasteur Institute (Pharmacoepidemiology and Infectious Diseases Unit), Paris, France
| | - Layide Meaude
- Unité de recherche clinique, hôpital Ambroise-Paré, AP-HP, Boulogne, France
| | - James Charanton
- Centre ressources francilien du traumatisme crânien (CRFTC), Paris, France
| | - Philippe Azouvi
- HANDIReSP, EA4047, université de Versailles Saint-Quentin, Montigny-Le-Bretonneux, France; Service de médecine physique et réadaptation, hôpital Raymond-Poincaré, AP-HP, Garches, France
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Factors Influencing Burden in Spouse-Caregivers of Patients with Chronic-Acquired Brain Injury. BIOMED RESEARCH INTERNATIONAL 2020; 2020:6240298. [PMID: 32685509 PMCID: PMC7350075 DOI: 10.1155/2020/6240298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/27/2020] [Accepted: 06/08/2020] [Indexed: 11/17/2022]
Abstract
In this cross-sectional study, we assess associated factors of burden in spouse-caregivers of patients with acquired brain injury (ABI) in the chronic phase. 35 spouse-caregivers (71% female, mean age ± SD: 55.7 ± 11.1y) of patients with mild/moderate ABI (29% female, mean age ± SD: 57.5 ± 10.7y), admitted to the intensive rehabilitation unit of the Institute S. Anna (Crotone, Italy) between January 2013 and December 2017, were contacted 2 years postinjury and asked to complete a series of questionnaires. The outcome measure was the Caregiver Burden Inventory (CBI) test, while several demographical and clinical data were considered as predictive factors. Two years after injury, a high level of burden was reported in 34.2% of spouse-caregivers. Stepwise multiple linear regression analyses revealed that caring for a patient with more severe disability (as measured by the Barthel Index scale) and the family life cycle (from the initial phase of engagement to marriage with adult children) explain the vast majority of variance for higher caregiver burden. The functional clinical status and the stages through which a family may pass over time were identified as areas in which the spouse-caregiver of ABI patients experienced high levels of burden in the chronic phase.
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22
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Simpson GK, Anderson MI, Jones KF, Genders M, Gopinath B. Do spirituality, resilience and hope mediate outcomes among family caregivers after traumatic brain injury or spinal cord injury? A structural equation modelling approach. NeuroRehabilitation 2020; 46:3-15. [DOI: 10.3233/nre-192945] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Grahame Kenneth Simpson
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney NSW, Australia
- John Walsh Centre of Rehabilitation Research, Kolling Institute, Sydney University, Sydney NSW, Australia
| | | | - Kate Fiona Jones
- Royal Rehab, Ryde NSW, Australia
- Menzies Health Institute, Griffith University, Gold Coast QLD, Australia
| | - Michelle Genders
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney NSW, Australia
- John Walsh Centre of Rehabilitation Research, Kolling Institute, Sydney University, Sydney NSW, Australia
| | - Bamini Gopinath
- John Walsh Centre of Rehabilitation Research, Kolling Institute, Sydney University, Sydney NSW, Australia
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Hussain SA, Ortendahl JD, Bentley TGK, Harmon AL, Gupta S, Begley CE, Khilfeh I, Knoth RL. The economic burden of caregiving in epilepsy: An estimate based on a survey of US caregivers. Epilepsia 2020; 61:319-329. [PMID: 31953846 DOI: 10.1111/epi.16429] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 12/24/2019] [Accepted: 12/24/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The burden of caregiving for persons with epilepsy (PWEs) has not been examined previously in the United States. We assessed the clinical impact and direct and indirect economic costs for caregivers of PWEs. METHODS An internet survey of 500 caregivers of PWEs was conducted from May to July 2015 using a combination of validated instruments and questions designed specifically for this survey. Caregivers were stratified by PWE age (adult/child) and disease severity (low: 0 vs high: 1 + seizures in the prior month). Annual self-reported direct and indirect costs were reported per caregiver and extrapolated to all US caregivers. The economic burden of caregiving for PWEs was defined as the difference between costs for caregivers and the general population. RESULTS Caregivers reported that PWEs averaged 11.4 seizures in the prior month. Eighty percent of respondents were female and the average age was 44.3. Since becoming a caregiver, many reported anxiety (52.8%), depression (41.0%), and insomnia (30.8%). Annual mean direct medical costs for caregivers of children with low vs high seizure frequency were $4344 and $10 162, respectively. Costs for caregivers of adult PWEs were $4936 and $8518. Mean indirect costs associated with caregiving for a child with low vs high seizure frequency were $20 529 and $40 137; those for caregivers of an adult were $13 981 and $28 410. The cost estimates are higher vs the general US population; annual per-person healthcare utilization costs were $2740 and productivity loss costs were $5015. When extrapolating to the US population of PWE caregivers, annual costs exceeded $62 billion vs $14 billion for the general population, resulting in a caregiver burden of nearly $48 billion. SIGNIFICANCE The clinical and economic burden of caregivers for PWE were substantial, and greatest for those caring for children with frequent seizures. The impact on caregivers should be considered when estimating the value of interventions that control epilepsy.
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Affiliation(s)
- Shaun A Hussain
- Division of Pediatric Neurology, UCLA Mattel Children's Hospital and David Geffen School of Medicine, Los Angeles, California
| | - Jesse D Ortendahl
- Partnership for Health Analytic Research, LLC, Beverly Hills, California
| | - Tanya G K Bentley
- Partnership for Health Analytic Research, LLC, Beverly Hills, California
| | - Amanda L Harmon
- Partnership for Health Analytic Research, LLC, Beverly Hills, California
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Yeh TC, Chien WC, Chung CH, Liang CS, Chang HA, Kao YC, Yeh HW, Yang YJ, Tzeng NS. Psychiatric Disorders After Traumatic Brain Injury: A Nationwide Population-Based Cohort Study and the Effects of Rehabilitation Therapies. Arch Phys Med Rehabil 2020; 101:822-831. [PMID: 31917196 DOI: 10.1016/j.apmr.2019.12.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/16/2019] [Accepted: 12/05/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To investigate the risk of psychiatric disorders after traumatic brain injury (TBI), and to clarify whether the post-TBI rehabilitation was associated with a lower risk of developing psychiatric disorders. DESIGN A register-based, retrospective cohort design. SETTING Using data from the National Health Insurance Research Database of Taiwan, we established an exposed cohort with TBI and a nonexposed group without TBI matched by age and year of diagnosis between 2000 and 2015. PARTICIPANTS This study included 231,894 patients with TBI and 695,682 patients without TBI (N=927,576). INTERVENTIONS Rehabilitation therapies in TBI patients. MAIN OUTCOME MEASURES A multivariable Cox proportional hazards regression model was used to compare the risk of developing psychiatric disorders. RESULTS The incidence rate of psychiatric disorders was higher in the TBI group than the control group. Compared with the control group, the risk of psychiatric disorders in the TBI group was twofold (hazard ratio [HR]=2.072; 95% confidence interval [95% CI], 1.955-2.189; P<.001). Among the participants with TBI, 49,270 (21.25%) had received rehabilitation therapy and had a lower risk of psychiatric disorders (HR=0.691; 95% CI, 0.679-0.703; P<.001). In the subgroup analysis, the medium- to high-level intensity rehabilitation therapy was associated with lower risks of psychiatric disorder (HR=0.712 and 0.568, respectively), but there was no significant finding in the low-intensity group. CONCLUSIONS We found that TBI was associated with a high risk for developing psychiatric disorders, and that the post-TBI rehabilitation significantly reduced the risk of psychiatric disorders in a dose-dependent manner.
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Affiliation(s)
- Ta-Chuan Yeh
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China; Department of Psychiatry, Tri-Service General Hospital, Penghu Branch, Penghu, Taiwan, Republic of China
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China; School of Public Health, National Defense Medical Center, Taipei, Taiwan, Republic of China; Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China; School of Public Health, National Defense Medical Center, Taipei, Taiwan, Republic of China; Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan, Republic of China
| | - Chih-Sung Liang
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China; Student Counseling Center, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Yu-Chen Kao
- Department of Psychiatry, Tri-Service General Hospital, Song-Shan Branch, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Hui-Wen Yeh
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China; Institute of Bioinformatics and System Biology, National Chiao Tung University, Hsin-Chu, Taiwan, Republic of China; Department of Nursing, Tri-Service General Hospital, School of Nursing, National Defense Medical Center, Taipei, Taiwan, Republic of China; Department of Nursing, Kang Ning University (Taipei Campus), Taipei, Taiwan, Republic of China
| | - Yun-Ju Yang
- Department of Surgery, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China; Student Counseling Center, National Defense Medical Center, Taipei, Taiwan, Republic of China.
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Caregiver Issues and Concerns Following TBI: A Review of the Literature and Future Directions. PSYCHOLOGICAL INJURY & LAW 2020. [DOI: 10.1007/s12207-019-09369-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Hicks AJ, Clay FJ, Hopwood M, James AC, Jayaram M, Perry LA, Batty R, Ponsford JL. The Efficacy and Harms of Pharmacological Interventions for Aggression After Traumatic Brain Injury-Systematic Review. Front Neurol 2019; 10:1169. [PMID: 31849802 PMCID: PMC6895752 DOI: 10.3389/fneur.2019.01169] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 10/18/2019] [Indexed: 11/25/2022] Open
Abstract
Background: Aggression is a commonly reported problem following traumatic brain injury (TBI). It may present as verbal insults or outbursts, physical assaults, and/or property destruction. Aggressive behavior can fracture relationships and impede participation in treatment as well as a broad range of vocational and social activities, thereby reducing the individual's quality of life. Pharmacological intervention is frequently used to control aggression following TBI. The aim of this systematic review was to critically evaluate the evidence regarding efficacy of pharmacological interventions for aggression following TBI in adults. Methods: We reviewed studies in English, available before December 2018. MEDLINE, PubMed, CINAHL, EMBASE, PsycINFO, and CENTRAL databases were searched, with additional searching of key journals, clinical trials registries, and international drug regulators. The primary outcomes of interest were reduction in the severity of aggression and occurrence of harms. The secondary outcomes of interest were changes in quality of life, participation, psychological health (e.g., depression, anxiety), and cognitive function. Evidence quality was assessed using the Cochrane Risk of Bias tool and the Joanna Briggs Institute Critical Appraisal Instruments. Results: Ten studies were identified, including five randomized controlled trials (RCTs) and five case series. There were positive, albeit mixed, findings for the RCTs examining the use of amantadine in reducing irritability (n = 2) and aggression (n = 2). There were some positive findings favoring methylphenidate in reducing anger (n = 1). The evidence for propranolol was weak (n = 1). Individual analysis revealed differential drug response across individuals for both methylphenidate and propranolol. The less rigorous studies administered carbamazepine (n = 2), valproic acid (n = 1), quetiapine (n = 1), and sertraline (n = 1), and all reported reductions in aggression. However, given the lack of a control group, it is difficult to discern treatment effects from natural change over time. Conclusions: This review concludes that a recommendation for use of amantadine to treat aggression and irritability in adults following TBI is appropriate. However, there is a need for further well-designed, adequately powered and controlled studies of pharmacological interventions for aggression following TBI.
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Affiliation(s)
- Amelia J Hicks
- Monash-Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Fiona J Clay
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia.,Department of Forensic Medicine, Monash University, Southbank, VIC, Australia.,Professorial Psychiatry Unit Albert Road Clinic, Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia.,Professorial Psychiatry Unit Albert Road Clinic, Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Amelia C James
- Monash-Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Mahesh Jayaram
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Luke A Perry
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Rachel Batty
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Jennie L Ponsford
- Monash-Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
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Maillard J, De Pretto M, Delhumeau C, Walder B. Prediction of long-term quality of life after severe traumatic brain injury based on variables at hospital admission. Brain Inj 2019; 34:203-212. [PMID: 31648571 DOI: 10.1080/02699052.2019.1683227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: Variables collected early after severe traumatic brain injury (sTBI) could predict health-related quality of life (HRQoL). Our aim was to determine the prevalence of patients with a low HRQoL 4 years after sTBI and to develop a prediction model including early variables.Methods: Adult patients with both sTBI [abbreviated injury score of the head region (HAIS) >3] and disease-specific HRQoL assessments using the 'Quality of Life after Brain Injury' (QOLIBRI) were included. The outcome was the total score (TS) of QOLIBRI; cutoff for low HRQoL: <60 points. A multivariate logistic regression model and prediction model were performed.Results: One hundred-sixteen patients [median age 50.8 years (IQR 25.9-62.8; 21.6% >65 years)] were included; 68 (58.6%) with HAIS = 4, 48 (41.4%) with HAIS = 5. Median Glasgow Coma Scale (GCS) was 13 (IQR 3-15). Median TS was 77 (IQR 60-88). Low HRQoL was observed in 28 patients (24.1%). Two variables were associated with low HRQoL: GCS <13, working situation other than employed or retired. The prediction model had an AUROC of 0.765; calibration was moderate (Hosmer Lemeshow Chi2 6.82, p = .556).Conclusion: One in four patients had a low HRQoL after 4 years. A lower GCS and working situations were associated with low HRQoL.
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Affiliation(s)
- Julien Maillard
- Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland.,Geneva Perioperative Basic, Translational and Clinical Research Group, Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland
| | - Michael De Pretto
- Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Science and Medicine, University of Fribourg, Switzerland
| | - Cecile Delhumeau
- Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland
| | - Bernhard Walder
- Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland.,Geneva Perioperative Basic, Translational and Clinical Research Group, Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland
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Anke A, Røe C, Sigurdardottir S, Norup A, Soberg HL, Arango-Lasprilla JC, Manskow US. Family needs at one and two years after severe traumatic brain injury: a prospective study of changes and predictors. Brain Inj 2019; 34:89-97. [DOI: 10.1080/02699052.2019.1682191] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Audny Anke
- Department of Rehabilitation, University Hospital of North Norway, Tromso, Norway
- Faculty of Health Sciences, Department of Clinical Medicine, The Arctic University of Norway, Tromsø, 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
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | | | - Anne Norup
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Helene L. Soberg
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Juan Carlos Arango-Lasprilla
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- IKERBASQUE, Basque Foundation For Science, Bilbao, Spain
- Department of Cell Biology and Histology, University of the Basque Country UPV/EHU, Leioa, Spain
| | - Unn Sollid Manskow
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
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Abstract
AbstractObjective:The impact of traumatic brain injury (TBI) extends beyond the person who was injured. Family caregivers of adults with moderate to severe TBI frequently report increased burden, stress and depression. Few studies have examined the well-being of family members in the mild TBI population despite the latter representing up to 95% of all TBIs.Methods:Five areas of well-being were examined in 99 family members (including parents, partners, siblings, other relatives, adult children, friends or neighbours) of adults (aged ≥16 years) with mild TBI. At 6- and 12-month post-injury, family members completed the Bakas Caregiver Outcomes Scale, Short Form-36 Health Survey, EQ-5D-3L, Hospital Anxiety and Depression Scale and the Pittsburgh Sleep Quality Index. Outcomes and change over time and associated factors were examined.Results:At 6 months, group mean scores for health-related quality of life for mental and physical components and overall health status were similar to the New Zealand (NZ) population. Mean scores for sleep, anxiety and depression were below clinically significant thresholds. From 6 to 12 months, there were significant improvements in Bakas Caregiver Outcomes Scale scores by 2.61 (95% confidence interval: 0.72–4.49), health-related quality of life (mental component) and EQ-5D-3L overall health (P= 0.01). Minimally clinically important differences were observed in overall health, anxiety, health-related quality of life and depression at 12 months. Female family members reported significant improvements in physical health over time, and more positive life changes were reported by those caring for males with TBI.Conclusions:The findings suggest diminished burden over time for family members of adults with mild TBI.
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Evaluation of a Brief, Skill-Building, Supportive, and Educational Intervention for Couples After Brain Injury. J Head Trauma Rehabil 2019; 35:175-186. [PMID: 31479075 DOI: 10.1097/htr.0000000000000519] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the effectiveness of an intervention (Therapeutic Couples Intervention, TCI) designed to improve relationship quality for couples after acquired brain injury. SETTING Outpatient brain injury rehabilitation center. PARTICIPANTS Persons with brain injury (n = 75) and their intimate partners (n = 75). DESIGN Two-arm parallel, randomized, controlled trial with wait-listed control. METHODS Composed of 5 to 6 2-hour sessions, the TCI is a manualized, treatment program designed to enhance relationship quality by addressing issues and concerns most often identified by persons with brain injury and their partners. MAIN MEASURE Revised Dyadic Adjustment Scale completed by the persons with brain injury and their partners. RESULTS Persons with brain injury and their partners in the treatment group showed an improvement in relationship quality, both compared with their own baseline values and the control group. CONCLUSIONS Investigation provided evidence that a curriculum-based education, skill-building, and supportive intervention can benefit couples for up to 3 months after treatment. Additional research is needed to ascertain the long-term benefits of intervention and the efficacy of alternative delivery methods (eg, Internet, telephone, and group).
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Anderson MI, Daher M, Simpson GK. A predictive model of resilience among family caregivers supporting relatives with traumatic brain injury (TBI): A structural equation modelling approach. Neuropsychol Rehabil 2019; 30:1925-1946. [PMID: 31132931 DOI: 10.1080/09602011.2019.1620787] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Constructs from positive psychology were employed to create an explicit model of caregiver resilience. Predictive and mediating relationships among resilience and related variables (personality, coping, self-efficacy, hope, social support) were then tested for their association with burden and psychological adjustment among family members caring for relatives with severe TBI. Family participants (n = 131) from six rehabilitation units from New South Wales and Queensland completed assessments which elicited explanatory (Eysenck Personality Questionnaire, Ways of Coping Questionnaire), mediating (Connor-Davidson Resilience Scale, General Self-Efficacy Scale, Herth Hope Scale, Medical Outcome Study Social Support Survey), and caregiver outcome (Caregiver Burden Scale, Mental Health sub-Scale-SF36, General Health Questionnaire, and Positive and Negative Affect Scale) variables. Structural Equation Modeling (SEM) showed that resilience had a direct effect on positive affect in caregivers. Resilience also played a protective role in relation to two variables associated with caregiver vulnerability: an indirect association with caregiver burden mediated through social support; a direct effect on hope, which, in turn, was associated with positive mental health. Positive mental health then played a buffering role in relation to psychological distress and negative affect. Resilience, in combination with other psychological attributes, was associated with reduced morbidity among family caregivers after severe TBI.
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Affiliation(s)
| | - Maysaa Daher
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Liverpool, Sydney, Australia.,Brain Injury Rehabilitation Directorate, Agency for Clinical Innovation, NSW Health, Sydney, Australia
| | - Grahame K Simpson
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Liverpool, Sydney, Australia.,John Walsh Centre for Rehabilitation Research, University of Sydney, Sydney, Australia
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Barrett JW. A retrospective review of patients with significant traumatic brain injury transported by emergency medical services within the south east of England. Br Paramed J 2019; 3:1-7. [PMID: 33328810 PMCID: PMC7706740 DOI: 10.29045/14784726.2019.03.3.4.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Traumatic brain injury (TBI) will be a leading cause of death and disability within the Western world by 2020. Currently, 80% of all TBI patients in England are transported to hospital by an ambulance service. The aim of this retrospective study is to compare TBI patients transported to a major trauma centre (MTC) against those transported to a trauma unit (TU). METHOD All patients with a primary injury of TBI who were transported to hospital by South East Coast Ambulance Service NHS Foundation Trust (SECAmb) from 1 January 2016 to 31 December 2016 and entered into the Trauma Audit & Research Network (TARN) registry were reviewed. Patients were stratified by hospital designation (MTC or TU). Severity of TBI was categorised using the patients' pre-hospital Glasgow Coma Scale (GCS) and Abbreviated Injury Score (AIS) Head. The outcomes of interest were 30-day mortality and Glasgow Outcome Score (GOS) at discharge. RESULTS Between 1 January and 31 December 2016, 549 TBI patients were identified in the TARN database as being transported by SECAmb to either an MTC or a TU. The majority of patients were transported to a TU (77.96%), and the median age of the TU cohort was older than the MTC group (TU 82.15 IQR 16.73 vs. MTC 62.1 IQR 42.6). The median Injury Severity Score (ISS) was greater in the MTC cohort (22 IQR 10 vs. 17 IQR 9), where falls from height and road traffic collisions (RTCs) contributed to 50.51% of all injuries. Within the TU cohort, falls from less than 2 metres (standing height) were the main mechanism of injury (MOI) (77.62%). The median length of hospital stay (LOS) was longer in the MTC cohort compared to the TU cohort (10 IQR 13.25 vs. 8 IQR 14). CONCLUSION The high proportion of mild TBI and absence of reliable triage guidelines make it difficult for ambulance clinicians to identify patients who will benefit from transport to an MTC. Future research should focus on how TBI triage influences outcomes and how ambulance services can better identify patients with a TBI and who would benefit from specialist care.
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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: 76] [Impact Index Per Article: 15.2] [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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Manskow US, Arntzen C, Damsgård E, Braine M, Sigurdardottir S, Andelic N, Røe C, Anke A. Family members' experience with in-hospital health care after severe traumatic brain injury: a national multicentre study. BMC Health Serv Res 2018; 18:951. [PMID: 30526574 PMCID: PMC6286568 DOI: 10.1186/s12913-018-3773-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 11/27/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Family member's experience and satisfaction of health care in the acute care and in-patient rehabilitation are important indicators of the quality of health care services provided to patients with severe traumatic brain injury (TBI). The objective was to assess family members' experience of the health care provided in-hospital to patients with severe TBI, to relate experiences to family member and patient demographics, patients' function and rehabilitation pathways. METHODS Prospective national multicentre study of 122 family members of patients with severe TBI. The family experience of care questionnaire in severe traumatic brain injury (FECQ-TBI) was applied. Independent sample t-tests or analysis of variance (ANOVA) were used to compare the means between 2 or more groups. Paired samples t-tests were used to investigate differences between experience in the acute and rehabilitation phases. RESULTS Best family members` experience were found regarding information during the acute phase, poorest scores were related to discharge. A significantly better care experience was reported in the acute phase compared with the rehabilitation phase (p < 0.05). Worst family members` experience was related to information about consequences of the injury. Patient's dependency level (p < 0.05) and transferral to non-specialized rehabilitation were related to a worse family members` experience (p < 0.01). CONCLUSIONS This study underscores the need of better information to family members of patients with severe TBI in the rehabilitation as well as the discharge phase. The results may be important to improve the services provided to family members and individuals with severe TBI.
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Affiliation(s)
- Unn Sollid Manskow
- Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway.
- Faculty of Health Sciences, Department of Health and Care Sciences, UiT, The Arctic University of Norway, Tromsø, Norway.
| | - Cathrine Arntzen
- Faculty of Health Sciences, Department of Health and Care Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Elin Damsgård
- Faculty of Health Sciences, Department of Health and Care Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Mary Braine
- School of Health and Society, University of Salford, Salford, UK
| | | | - 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
| | - Audny Anke
- Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway
- Faculty of Health Sciences, Department of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
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Bohart S, Egerod I, Bestle MH, Overgaard D, Christensen DF, Jensen JF. Reprint of Recovery programme for ICU survivors has no effect on relatives' quality of life: Secondary analysis of the RAPIT-study. Intensive Crit Care Nurs 2018; 50:111-117. [PMID: 30522822 DOI: 10.1016/j.iccn.2018.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Relatives of intensive care patients are at risk of developing symptoms of anxiety, depression and posttraumatic stress resulting in reduced health-related quality of life. Recovery programmes for patients have been implemented, but their effect on relatives is uncertain. AIM To determine whether relatives benefit from a recovery programme intended for intensive care survivors. RESEARCH DESIGN A randomised controlled trial of 181 adult relatives: intervention group (n = 87), control group (n = 94). SETTING Ten intensive care units in Denmark. MAIN OUTCOME MEASURES Primary outcome: health-related quality of life (HRQOL). SECONDARY OUTCOMES Sense of coherence (SOC), and symptoms of anxiety, depression and posttraumatic stress, compared to standard care at 12 months after intensive care discharge. RESULTS No difference in HRQOL between groups was observed at 12 months (mean difference in mental component summary score, 1.35 [CI 95%: -3.13; 5.82], p = 0.55; and physical component summery score, 1.86 [CI 95%: -1.88; 5.59], p = 0.33). No differences were found in secondary outcomes. CONCLUSION The recovery programme intended for intensive care survivors did not have an effect on the relatives. Future recovery programmes should be targeted to help both patient and family, and future research should be conducted on a larger scale to make conclusions with higher probability.
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Affiliation(s)
- Søs Bohart
- Department of Anesthesiology, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, 2730 Herlev, Denmark.
| | - Ingrid Egerod
- Health & Medical Sciences, University of Copenhagen, and Intensive Care Unit 4131, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Morten H Bestle
- Nordsjællands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark.
| | - Dorthe Overgaard
- Institution of Nursing, Metropolitan University College, Tagensvej 86, 2200 Copenhagen, Denmark.
| | | | - Janet F Jensen
- Department of Anesthesiology, Holbæk Hospital, Smedelundsgade 60, 4300 Holbæk and Nordsjællands Hospital, University of Copenhagen, Dyrehavevej 29, 3400 Hilleroed, Denmark.
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Alfheim HB, Småstuen MC, Hofsø K, Tøien K, Rosseland LA, Rustøen T. Quality of life in family caregivers of patients in the intensive care unit: A longitudinal study. Aust Crit Care 2018; 32:479-485. [PMID: 30503245 DOI: 10.1016/j.aucc.2018.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 08/27/2018] [Accepted: 09/29/2018] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Family caregivers of patients in the intensive care unit (ICU) experience impairments in the quality of life. Previous studies report that psychological quality of life improves over time, but there has been limited longitudinal research, and measurement points have differed. Factors such as age, gender, and posttraumatic stress symptoms have been found to be associated with the quality of life, but level of hope and its associations with the quality of life have not been investigated. OBJECTIVES The objective of this study was (1) to evaluate changes in the quality of life in family caregivers during the first year after a patient's admission to the ICU and (2) to identify associations between patients' and family caregivers' background characteristics, posttraumatic stress symptoms, hope, and quality of life. METHODS A longitudinal study design with five measurement points was used. Family caregivers completed study questionnaires at enrolment into the study and at 1, 3, 6, and 12 months after the patient's admission to the ICU. The quality of life was measured with the 12-Item Short Form Health Survey. RESULTS Family caregivers (N = 211) reported improved psychological quality of life during the first year after the patient's admission to the ICU, but it was still lower than the psychological quality of life reported in norm-based data. Being on sick leave, consulting healthcare professionals (e.g., general practitioner), and increased level of posttraumatic stress symptoms were significantly associated with psychological quality of life, whereas hope was not. Reported physical quality of life was comparable to norm-based data. CONCLUSION Family caregivers of patients in the ICU reported impairments in quality of life during the first year after the patient's admission to the ICU. Being on sick leave, consulting healthcare professionals, and reduced posttraumatic stress symptoms may improve mental quality of life.
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Affiliation(s)
- Hanne Birgit Alfheim
- Postoperative and Intensive Care and Department, Division of Emergencies and Critical Care, Oslo University Hospital Norway, P. O. Box 4950 Nydalen N-0424 Oslo, Norway; Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital Norway, P. O. Box 4950 Nydalen N-0424 Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O.Box 1078 Blindern NO-0316 Oslo, Norway.
| | - Milada Cvancarova Småstuen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital Norway, P. O. Box 4950 Nydalen N-0424 Oslo, Norway; Department of Public Health, Faculty of Nursing Science Oslo and Akershus University College of Applied Sciences Norway, P.O. Box 4 St. Olavs Plass N-0130 OSLO, Norway.
| | - Kristin Hofsø
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital Norway, P. O. Box 4950 Nydalen N-0424 Oslo, Norway; Lovisenberg Diaconal University College, Oslo Norway, Lovisenberggt. 15b, 0456 Oslo, Norway.
| | - Kirsti Tøien
- Postoperative and Intensive Care and Department, Division of Emergencies and Critical Care, Oslo University Hospital Norway, P. O. Box 4950 Nydalen N-0424 Oslo, Norway; Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital Norway, P. O. Box 4950 Nydalen N-0424 Oslo, Norway.
| | - Leiv Arne Rosseland
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital Norway, P. O. Box 4950 Nydalen N-0424 Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O.Box 1078 Blindern NO-0316 Oslo, Norway.
| | - Tone Rustøen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital Norway, P. O. Box 4950 Nydalen N-0424 Oslo, Norway; Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O.Box 1078 Blindern NO-0316 Oslo, Norway.
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Arnould A, Rochat L, Azouvi P, Van der Linden M. Longitudinal Course and Predictors of Apathetic Symptoms after Severe Traumatic Brain Injury. Arch Clin Neuropsychol 2018; 33:808-820. [PMID: 29244062 DOI: 10.1093/arclin/acx122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 11/22/2017] [Indexed: 11/14/2022] Open
Abstract
Objectives Apathy is one of the most common behavioral symptoms encountered after traumatic brain injury (TBI). However, very little is known about the longitudinal course and predictors of apathetic manifestations. The aims of the present study were to examine how apathy changes and the predictive value of cognitive factors (memory, attention/executive mechanisms, and multitasking) and personal identity factors (self-esteem and self-efficacy beliefs) for apathy over a period of 10 months. Method To this end, 68 participants (32 patients with severe TBI matched with 36 control participants) living in the community were enrolled. At Time 1, participants were given three questionnaires to assess self-esteem, self-efficacy beliefs, anxiety and depression symptoms, and five tasks to assess cognitive processes. Simultaneously, a close relative of each participant completed a questionnaire that assessed lack of initiative/initiative. At Time 2, all questionnaires were re-administered to each patient and their relatives. Results Patients displayed a significant lack of initiative/interest at all post-injury assessments. At the individual level, the results revealed that a majority of patients had no change in their apathetic symptoms over the 10-month follow-up, whereas in the others, apathetic symptoms mostly increased. Furthermore, impaired memory was the only mechanism that significantly predicted later apathetic manifestations. Complementary profile analyses indicated that patients with worsening symptoms over the follow-up period showed higher inaccurate memory at Time 1 than patients with stable symptoms. Conclusions These results provide valuable insight into the longitudinal evolution and predictors of apathy after TBI, which opens interesting prospects for psychological interventions.
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Affiliation(s)
- Annabelle Arnould
- Cognitive Psychopathology and Neuropsychology Unit, University of Geneva, Geneva, Switzerland.,AP-HP, Department of Physical Medicine and Rehabilitation, Raymond Poincaré Hospital, Garches, France.,EA 4047, HANDIReSP, University of Versailles-Saint Quentin en Yvelines, Montigny-le-Bretonneux, France
| | - Lucien Rochat
- Cognitive Psychopathology and Neuropsychology Unit, University of Geneva, Geneva, Switzerland.,Swiss Centre for Affective Sciences, University of Geneva, Geneva, Switzerland
| | - Philippe Azouvi
- AP-HP, Department of Physical Medicine and Rehabilitation, Raymond Poincaré Hospital, Garches, France.,EA 4047, HANDIReSP, University of Versailles-Saint Quentin en Yvelines, Montigny-le-Bretonneux, France
| | - Martial Van der Linden
- Cognitive Psychopathology and Neuropsychology Unit, University of Geneva, Geneva, Switzerland.,Swiss Centre for Affective Sciences, University of Geneva, Geneva, Switzerland.,Cognitive Psychopathology Unit, University of Liège, Liège, Belgium
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Kreitzer N, Kurowski BG, Bakas T. Systematic Review of Caregiver and Dyad Interventions After Adult Traumatic Brain Injury. Arch Phys Med Rehabil 2018; 99:2342-2354. [PMID: 29752909 PMCID: PMC8730799 DOI: 10.1016/j.apmr.2018.04.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/13/2018] [Accepted: 04/14/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To describe and synthesize the literature on adult traumatic brain injury (TBI) family caregiver and dyad intervention. TBI is a common injury that has a significant long-term impact, and is sometimes even characterized as a chronic condition. Informal (ie, unpaid) family caregivers of adults with TBI experience high rates of burnout, depression, fatigue, anxiety, lower subjective well-being, and poorer levels of physical health compared to noncaregivers. This study addresses the critical gap in the understanding of interventions designed to address the impact of TBI on adult patients and their family caregivers. DATA SOURCES PubMed and MEDLINE. STUDY SELECTION Studies selected for review had to be written in English and be quasi-experimental or experimental in design, report on TBI caregivers, survivors with heavy involvement of caregivers, or caregiver dyads, involve moderate and severe TBI, and describe an intervention implemented during some portion of the TBI care continuum. DATA EXTRACTION The search identified 2171 articles, of which 14 met our criteria for inclusion. Of the identified studies, 10 were randomized clinical trials and 4 were nonrandomized quasi-experimental studies. A secondary search to describe studies that included individuals with other forms of acquired brain injury in addition to TBI resulted in 852 additional titles, of which 5 met our inclusion criteria. DATA SYNTHESIS Interventions that targeted the caregiver primarily were more likely to provide benefit than those that targeted caregiver/survivor dyad or the survivor only. Many of the studies were limited by poor fidelity, low sample sizes, and high risk for bias based on randomization techniques. CONCLUSIONS Future studies of TBI caregivers should enroll a more generalizable number of participants and ensure adequate fidelity to properly compare interventions.
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Affiliation(s)
- Natalie Kreitzer
- Department of Emergency Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States; Division of Neurocritical Care, College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States.
| | - Brad G Kurowski
- Department of Pediatrics, Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, United States
| | - Tamilyn Bakas
- College of Nursing, University of Cincinnati, Cincinnati, Ohio, United States
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Labbé D, Rushton PW, Mortenson WB, Demers L, Miller WC. Longitudinal Outcomes Among Family Caregivers of Power Mobility Users. Arch Phys Med Rehabil 2018; 100:656-662. [PMID: 30914119 DOI: 10.1016/j.apmr.2018.08.194] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 06/30/2018] [Accepted: 08/08/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To examine the change over 1 year in the burden, wheelchair skills, social support, social participation, and mental health of family caregivers providing assistance to older adult powered wheelchair users. DESIGN Longitudinal study. SETTING Community. PARTICIPANTS Participants (N=35) included family caregivers (mean age ± SD=63.7±10.2y) who provided at least 2 hours of general care per week for a powered wheelchair user. INTERVENTION Not applicable. MAIN OUTCOME MEASURES The Power Mobility Caregiver Assistive Technology Outcome Measure (frequency of care and subjective burden), the Wheelchair Skills Test Questionnaire for caregivers (wheelchair skills), the Interpersonal Support Evaluation List-6 (social support), the Late-Life Function and Disability Instrument (social participation), the Hospital Anxiety and Depression Scale (mental health). Measures were taken at baseline, 1, 3, 6, and 12 months. Descriptive statistics were calculated, and a linear mixed model was used to assess changes over time in the outcomes. RESULTS The results showed that the caregivers helped on average with 3 powered wheelchair-related activities and 10 other caregiving activities. They also experienced moderate subjective burden and social participation and were within the normal range for depression and anxiety. Moreover, those outcomes remained stable over the 1-year study period. However, the wheelchair skills scores showed significant changes over time, as the scores improved during the first 6 months of the study. CONCLUSION Given that previous research indicated that subjective burden tends to decline over time among caregivers, the findings of stability in this study may reflect increasing needs among this population of caregivers, who may benefit from additional support and interventions. This would need further consideration.
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Affiliation(s)
- Delphine Labbé
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada; Rehabilitation Research Program, GF Strong Rehabilitation Center, Vancouver, British Columbia, Canada.
| | - Paula W Rushton
- School of Rehabilitation, University of Montréal, Montréal, Québec, Canada; CHU St-Justine Research Center, Montréal, Québec, Canada
| | - W Ben Mortenson
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada; Rehabilitation Research Program, GF Strong Rehabilitation Center, Vancouver, British Columbia, Canada
| | - Louise Demers
- School of Rehabilitation, University of Montréal, Montréal, Québec, Canada; Centre de recherche de l'institut universitaire de gériatrie de Montréal, Montréal, Québec, Canada
| | - William C Miller
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada; Rehabilitation Research Program, GF Strong Rehabilitation Center, Vancouver, British Columbia, Canada
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Bai X, Liu C, Baladon L, Rubio-Valera M. Multidimensional determinants of the caregiving burden among Chinese male caregivers of older family members in Hong Kong. Aging Ment Health 2018; 22:980-989. [PMID: 28541777 DOI: 10.1080/13607863.2017.1330872] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES The objective of this study was to examine multidimensional determinants of the caregiving burden among Chinese male caregivers of older family members in Hong Kong. Based on a modified stress process model, this study explored how background and contextual factors (demographic characteristics and mental health status of caregivers, caregiving-related factors, and support and services), primary stressors (degree of care dependency and special care needs), and secondary stressors (self-efficacy and gender role conflict) might affect the caregiving burden among male caregivers. METHOD A questionnaire survey was completed by 204 male caregivers who considered themselves as primary caregivers for older family members with care needs aged 60 and over. Descriptive, bivariate, and multivariate analyses were conducted. RESULTS Being the son of the care receiver, the presence of depressive symptoms, a higher degree of gender role conflict, a lower degree of caregiving self-efficacy, and the use of support and services all predicted greater caregiving burden among male caregivers. CONCLUSION This study established a modified stress process model specifically for male caregivers. Gender role conflict and caregiving self-efficacy were introduced into the model as secondary stressors and found to be significantly associated with the degree of caregiving burden. The findings of this study could inform the development of services and interventions to reduce the caregiving burden among male caregivers.
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Affiliation(s)
- Xue Bai
- a Department of Applied Social Sciences , The Hong Kong Polytechnic University , Hong Kong.,b Personal Social Services Research Unit , London School of Economics and Political Science , UK
| | - Chang Liu
- a Department of Applied Social Sciences , The Hong Kong Polytechnic University , Hong Kong
| | - Luisa Baladon
- c Adults Mental Health Centre of Garraf , Parc Sanitari Sant Joan De Déu , Barcelona , Spain
| | - Maria Rubio-Valera
- d Research and Teaching Unit , Fundació Sant Joan de Déu , Spain.,e Centre For Biomedical Research in Epidemiology and Public Health, CIBERESP , Madrid , Spain.,f School of Pharmacy , Universitat de Barcelona , Barcelona , Spain
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Late Functional Changes Post-Severe Traumatic Brain Injury Are Related to Community Reentry Support: Results From the PariS-TBI Cohort. J Head Trauma Rehabil 2018; 32:E26-E34. [PMID: 28060204 DOI: 10.1097/htr.0000000000000276] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To explore late functional changes after a traumatic brain injury and their relation to patients' characteristics and reentry support. DESIGN Prospective follow-up of an inception cohort of adults with severe traumatic brain injury recruited in 2005-2007 in the Parisian area, France. One and 4-year assessments were performed by trained neuropsychologists. One-to-4-year change in the Glasgow Outcome Scale-Extended defined 3 groups: "improvement," "stability," and "worsening." Relationships between these groups and patients' characteristics were analyzed. RESULTS Among 504 recruited patients and 245 four-year survivors, 93 participated in both evaluations. Overall Glasgow Outcome Scale-Extended improved by 0.4. Forty percent of the sample improved, 44% were stable, and 16% worsened. Being in a more unfavorable group was related to preinjury alcohol abuse and to higher anxiety and depression at 4 years. Attendance to a specialized community reentry unit was related to higher chances of being in the "improvement" group in univariate analyses and after adjustment for age, time to follow command, preinjury alcohol and occupation, and mood disorders (adjusted odds ratio [OR] = 4.6 [1.1-20]). CONCLUSION Late functional changes were related to psychosocial variables and to reentry support. The effect of reentry support on late recovery needs to be confirmed by further investigations.
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Bohart S, Egerod I, Bestle MH, Overgaard D, Christensen DF, Jensen JF. Recovery programme for ICU survivors has no effect on relatives' quality of life: Secondary analysis of the RAPIT-study. Intensive Crit Care Nurs 2018; 47:39-45. [PMID: 29606480 DOI: 10.1016/j.iccn.2018.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 02/21/2018] [Accepted: 03/04/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Relatives of intensive care patients are at risk of developing symptoms of anxiety, depression and posttraumatic stress resulting in reduced health-related quality of life. Recovery programmes for patients have been implemented, but their effect on relatives is uncertain. AIM To determine whether relatives benefit from a recovery programme intended for intensive care survivors. RESEARCH DESIGN A randomised controlled trial of 181 adult relatives: intervention group (n = 87), control group (n = 94). SETTING Ten intensive care units in Denmark. MAIN OUTCOME MEASURES Primary outcome: health-related quality of life (HRQOL). SECONDARY OUTCOMES Sense of coherence (SOC), and symptoms of anxiety, depression and posttraumatic stress, compared to standard care at 12 months after intensive care discharge. RESULTS No difference in HRQOL between groups was observed at 12 months (mean difference in mental component summary score, 1.35 [CI 95%: -3.13; 5.82], p = 0.55; and physical component summery score, 1.86 [CI 95%: -1.88; 5.59], p = 0.33). No differences were found in secondary outcomes. CONCLUSION The recovery programme intended for intensive care survivors did not have an effect on the relatives. Future recovery programmes should be targeted to help both patient and family, and future research should be conducted on a larger scale to make conclusions with higher probability.
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Affiliation(s)
- Søs Bohart
- Department of Anesthesiology, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, 2730 Herlev, Denmark.
| | - Ingrid Egerod
- Health & Medical Sciences, University of Copenhagen, and Intensive Care Unit 4131, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Morten H Bestle
- Nordsjællands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark.
| | - Dorthe Overgaard
- Institution of Nursing, Metropolitan University College, Tagensvej 86, 2200 Copenhagen, Denmark.
| | | | - Janet F Jensen
- Department of Anesthesiology, Holbæk Hospital, Smedelundsgade 60, 4300 Holbæk and Nordsjællands Hospital, University of Copenhagen, Dyrehavevej 29, 3400 Hilleroed, Denmark.
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Objective and Subjective Burden of Informal Caregivers 4 Years After a Severe Traumatic Brain Injury: Results From the PariS-TBI Study. J Head Trauma Rehabil 2018; 31:E59-67. [PMID: 24992640 DOI: 10.1097/htr.0000000000000079] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Prospective assessment of informal caregiver (IC) burden 4 years after the traumatic brain injury of a relative. SETTING Longitudinal cohort study (metropolitan Paris, France). PARTICIPANTS Home dwelling adults (N = 98) with initially severe traumatic brain injury and their primary ICs. MAIN OUTCOME MEASURES Informal caregiver objective burden (Resource Utilization in Dementia measuring Informal Care Time [ICT]), subjective burden (Zarit Burden Inventory), monetary self-valuation of ICT (Willingness-to-pay, Willingness-to-accept). RESULTS Informal caregivers were women (81%) assisting men (80%) of mean age of 37 years. Fifty-five ICs reported no objective burden (ICT = 0) and no/low subjective burden (average Zarit Burden Inventory = 12.1). Forty-three ICs reported a major objective burden (average ICT = 5.6 h/d) and a moderate/severe subjective burden (average Zarit Burden Inventory = 30.3). In multivariate analyses, higher objective burden was associated with poorer Glasgow Outcome Scale-Extended scores, with more severe cognitive disorders (Neurobehavioral Rating Scale-revised) and with no coresidency status; higher subjective burden was associated with poorer Glasgow Outcome Scale-Extended scores, more Neurobehavioral Rating Scale-revised disorders, drug-alcohol abuse, and involvement in litigation. Economic valuation showed that on average, ICs did not value their ICT as free and preferred to pay a mean Willingness-to-pay = &OV0556;17 per hour to be replaced instead of being paid for providing care themselves (Willingness-to-accept = &OV0556;12). CONCLUSION Four years after a severe traumatic brain injury, 44% of ICs experienced a heavy multidimensional burden.
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Loss to Follow-Up and Social Background in an Inception Cohort of Patients With Severe Traumatic Brain Injury: Results From the PariS-TBI Study. J Head Trauma Rehabil 2018; 31:E42-8. [PMID: 26098257 DOI: 10.1097/htr.0000000000000147] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess determinants of loss to follow-up (FU) at 2 time points of an inception traumatic brain injury (TBI) cohort. DESIGN AND PARTICIPANTS The PariS-TBI study consecutively included 504 adults with severe TBI on the accident scene (76% male, mean age 42 years, mean Glasgow Coma Scale 5). No exclusion criteria were used. MAIN MEASURE Loss to FU at 1 and 4 years was defined among survivors as having no outcome data other than survival status. RESULTS Among 257 1-year survivors, 118 (47%) were lost to FU at 1 year and 98 (40%) at 4 years. Main reasons for loss to FU were impossibility to achieve contact (109 at 1 year, 52 at 4 years) and refusal to participate (respectively 5 and 24). At 1 year, individuals not working preinjury or with nonaccidental traumas were more often lost to FU in univariate and multivariable analyses. At 4 years, loss to FU was significantly associated with preinjury alcohol abuse and unemployment. Relationship with injury severity was not significant. CONCLUSIONS Socially disadvantaged persons are underrepresented in TBI outcome research. It could result in overestimation of outcome and biased estimates of sociodemographic characteristics' effects. These persons, particularly unemployed individuals, require special attention in clinical practice.
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Chesnel C, Jourdan C, Bayen E, Ghout I, Darnoux E, Azerad S, Charanton J, Aegerter P, Pradat-Diehl P, Ruet A, Azouvi P, Vallat-Azouvi C. Self-awareness four years after severe traumatic brain injury: discordance between the patient’s and relative’s complaints. Results from the PariS-TBI study. Clin Rehabil 2017; 32:692-704. [DOI: 10.1177/0269215517734294] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objective: To evaluate the patient’s awareness of his or her difficulties in the chronic phase of severe traumatic brain injury (TBI) and to determine the factors related to poor awareness. Design/Setting/Subjects: This study was part of a larger prospective inception cohort study of patients with severe TBI in the Parisian region (PariS-TBI study). Intervention/Main measures: Evaluation was carried out at four years and included the Brain Injury Complaint Questionnaire (BICoQ) completed by the patient and his or her relative as well as the evaluation of impairments, disability and quality of life. Results: A total of 90 patient-relative pairs were included. Lack of awareness was measured using the unawareness index that corresponded to the number of discordant results between the patient and relative in the direction of under evaluation of difficulties by the patient. The only significant relationship found with lack of awareness was the subjective burden perceived by the relative (Zarit Burden Inventory) ( r = 0.5; P < 0.00001). There was no significant relationship between lack of awareness and injury severity, pre-injury socio-demographic data, cognitive impairments, mood disorders, functional independence (Barthel index), global disability (Glasgow Outcome Scale), return to work at four years or quality of life (Quality Of Life after Brain Injury scale (QOLIBRI)). Conclusion: Lack of awareness four years post severe TBI was not related to the severity of the initial trauma, sociodemographic data, the severity of impairments, limitations of activity and participation, or the patient’s quality of life. However, poor awareness did significantly influence the weight of the burden perceived by the relative.
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Affiliation(s)
- Camille Chesnel
- Service de Médecine Physique et de Réadaptation, APHP – Hôpital Raymond Poincaré, Garches, France
| | - Claire Jourdan
- Service de Médecine Physique et de Réadaptation, APHP – Hôpital Raymond Poincaré, Garches, France
- HANDIReSP EA 4047, Université de Versailles Saint-Quentin, Montigny-Le-Bretonneux, France
| | - Eleonore Bayen
- Laboratoire d’Économie et de Gestion des Organisations de Santé (LEDa-LEGOS), Université Paris-Dauphine, Paris, France
- Université Pierre et Marie Curie, Paris, France
- Service de Médecine Physique et de Réadaptation, APHP – Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Paris, France
| | - Idir Ghout
- Unité de Recherche Clinique (URC), APHP – Hôpital Ambroise Paré, Boulogne, France
| | - Emmanuelle Darnoux
- Centre Ressources Francilien du Traumatisme Crânien (CRFTC), Paris, France
| | - Sylvie Azerad
- Unité de Recherche Clinique (URC), APHP – Hôpital Ambroise Paré, Boulogne, France
| | - James Charanton
- Centre Ressources Francilien du Traumatisme Crânien (CRFTC), Paris, France
| | - Philippe Aegerter
- Unité de Recherche Clinique (URC), APHP – Hôpital Ambroise Paré, Boulogne, France
- UMR-S 1168, Université de Versailles Saint-Quentin, Versailles, France
| | - Pascale Pradat-Diehl
- Université Pierre et Marie Curie, Paris, France
- Service de Médecine Physique et de Réadaptation, APHP – Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Paris, France
| | - Alexis Ruet
- Service de Médecine Physique et de Réadaptation, APHP – Hôpital Raymond Poincaré, Garches, France
| | - Philippe Azouvi
- Service de Médecine Physique et de Réadaptation, APHP – Hôpital Raymond Poincaré, Garches, France
- HANDIReSP EA 4047, Université de Versailles Saint-Quentin, Montigny-Le-Bretonneux, France
| | - Claire Vallat-Azouvi
- HANDIReSP EA 4047, Université de Versailles Saint-Quentin, Montigny-Le-Bretonneux, France
- Antenne UEROS-SAMSAH92-UGECAM IDF, Hôpital Raymond Poincaré, Garches, France
- EA 2027: Laboratoire de Psychopathologie et Neuropsychologie, Université Paris 8, Saint-Denis, France
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Azouvi P, Arnould A, Dromer E, Vallat-Azouvi C. Neuropsychology of traumatic brain injury: An expert overview. Rev Neurol (Paris) 2017; 173:461-472. [PMID: 28847474 DOI: 10.1016/j.neurol.2017.07.006] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 07/13/2017] [Indexed: 01/12/2023]
Abstract
Traumatic brain injury (TBI) is a serious healthcare problem, and this report is a selective review of recent findings on the epidemiology, pathophysiology and neuropsychological impairments following TBI. Patients who survive moderate-to-severe TBI frequently suffer from a wide range of cognitive deficits and behavioral changes due to diffuse axonal injury. These deficits include slowed information-processing and impaired long-term memory, attention, working memory, executive function, social cognition and self-awareness. Mental fatigue is frequently also associated and can exacerbate the consequences of neuropsychological deficits. Personality and behavioral changes can include combinations of impulsivity and apathy. Even mild TBI raises specific problems: while most patients recover within a few weeks or months, a minority of patients may suffer from long-lasting symptoms (post-concussion syndrome). The pathophysiology of such persistent problems remains a subject of debate, but seems to be due to both injury-related and non-injury-related factors.
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Affiliation(s)
- P Azouvi
- Service de médecine physique et de réadaptation, hôpital Raymond-Poincaré, AP-HP, 104, boulevard Raymond-Poincaré, 92380 Garches, France; HANDIReSP EA 4047, université de Versailles Saint-Quentin, 78423 Montigny-Le-Bretonneux, France.
| | - A Arnould
- Service de médecine physique et de réadaptation, hôpital Raymond-Poincaré, AP-HP, 104, boulevard Raymond-Poincaré, 92380 Garches, France; HANDIReSP EA 4047, université de Versailles Saint-Quentin, 78423 Montigny-Le-Bretonneux, France
| | - E Dromer
- Service de médecine physique et de réadaptation, hôpital Raymond-Poincaré, AP-HP, 104, boulevard Raymond-Poincaré, 92380 Garches, France; HANDIReSP EA 4047, université de Versailles Saint-Quentin, 78423 Montigny-Le-Bretonneux, France
| | - C Vallat-Azouvi
- HANDIReSP EA 4047, université de Versailles Saint-Quentin, 78423 Montigny-Le-Bretonneux, France; Laboratoire de psychopathologie et neuropsychologie, EA 2027, université Paris-8-Saint-Denis, 2, rue de la Liberté, 93526 Saint-Denis, France; Antenne UEROS- UGECAMIDF, hôpital Raymond-Poincaré, 104, boulevard Raymond-Poincaré, 92380 Garches, France
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Moore M, Kiatchai T, Ayyagari RC, Vavilala MS. Targeted areas for improving health literacy after traumatic brain injury. Brain Inj 2017; 31:1876-1881. [PMID: 28816517 DOI: 10.1080/02699052.2017.1346291] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To develop a framework to identify targeted areas for improving health literacy for caregivers after traumatic brain injury (TBI). METHOD Qualitative study using inductive and deductive qualitative content analysis was conducted in a large, urban, level I trauma centre. Interviews were conducted with 23 caregivers of persons with TBI. Participants' perspectives on communication and preparation for discharge were explored and understanding of commonly used words and discharge instructions were assessed. RESULTS Four types of communication patterns were identified: formal, informal, indirect and caregiver-initiated. Informal and caregiver-initiated communication were the most common. All caregivers reported confusion about their family member's condition, care plan or discharge plan. Caregivers were not able to define commonly used terms in discharge instructions, and were confused by formatting and medical language. Caregivers were not aware of expected caregiving roles upon discharge. Conceptualizing findings within a family-centred care model, we offer specific strategies to improve health communication and caregiver capacity building to enhance health literacy. CONCLUSIONS Health literacy and caregiver capacity to care for loved ones with TBI after hospital discharge is low. We offer specific target areas for improvement in verbal and written communication and capacity building that take into account provider, patient and family characteristics.
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Affiliation(s)
- Megan Moore
- a School of Social Work, University of Washington , Seattle , WA , USA.,b Harborview Injury Prevention and Research Center, University of Washington , Seattle , WA , USA
| | - Taniga Kiatchai
- b Harborview Injury Prevention and Research Center, University of Washington , Seattle , WA , USA.,c Anesthesiology and Pain Medicine, University of Washington , Seattle , WA , USA
| | - Rajiv C Ayyagari
- b Harborview Injury Prevention and Research Center, University of Washington , Seattle , WA , USA.,d Johns Hopkins University , Baltimore , MD , USA
| | - Monica S Vavilala
- b Harborview Injury Prevention and Research Center, University of Washington , Seattle , WA , USA.,c Anesthesiology and Pain Medicine, University of Washington , Seattle , WA , USA
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Hicks AJ, Gould KR, Hopwood M, Kenardy J, Krivonos I, Ponsford JL. Behaviours of concern following moderate to severe traumatic brain injury in individuals living in the community. Brain Inj 2017; 31:1312-1319. [DOI: 10.1080/02699052.2017.1317361] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- A. J. Hicks
- Monash-Epworth Rehabilitation Research Centre, Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - K. R. Gould
- Monash-Epworth Rehabilitation Research Centre, Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - M. Hopwood
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - J. Kenardy
- Recover Injury Research Centre and School of Psychology, University of Queensland, Brisbane, Australia
| | - I. Krivonos
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - J. L. Ponsford
- Monash-Epworth Rehabilitation Research Centre, Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
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Bayen E, Jourdan C, Ghout I, Pradat-Diehl P, Darnoux E, Nelson G, Vallat-Azouvi C, Charenton J, Aegerter P, Ruet A, Azouvi P. Negative impact of litigation procedures on patient outcomes four years after severe traumatic brain injury: results from the PariS-traumatic brain injury study. Disabil Rehabil 2017; 40:2040-2047. [PMID: 28508698 DOI: 10.1080/09638288.2017.1325522] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To analyze the effect of litigation procedures on long-term outcomes in severe traumatic brain injury. MATERIALS AND METHODS Prospective observational follow-up of an inception cohort including 504 adults with severe traumatic brain injury recruited in 2005-2007 in the Parisian area, France, with initial, one- and four-year outcomes measures. RESULTS Four years after the traumatic brain injury, 147 patients, out of 257 who survived the acute phase, were assessed. Among these patients, 53 patients declared being litigants and 78 nonlitigants (litigation status was unknown in 16 cases). Sociodemographic characteristics, type of injury and initial severity did not differ significantly between litigants and nonlitigants, except for Injury Severity Score (worse in litigants) and the proportion of road traffic accidents (higher in litigants). One- and four-year outcomes were significantly worse in litigants for autonomy, participation, psychiatric and cognitive function but not quality of life (measured with the Glasgow Outcome Scale-Extended, the working activity status, the Brain Injury Community Rehabilitation Outcome, the Hospital Anxiety and Depression scale, the Neurobehavioral Rating Scale-revised and the Quality of Life after Brain Injury, respectively). Multivariate analyses highlighted litigation procedure as an independent significant predictor of lower autonomy, participation and psychiatric function and tended to predict lower cognitive function, but not lower quality of life, after adjustment for pretrauma characteristics, Injury Severity Score, road traffic accidents and work-related accident status. CONCLUSIONS Patients with severe traumatic brain injury have a worse prognosis when involved in a litigation procedure and require special attention in clinical practice. Implications for rehabilitation The influence of litigation procedure on health and social outcomes in severe traumatic brain injury is a major issue that entail numerous levels of complexities. A wide range of interactions and factors related to the prolonged process of litigation against a third party may influence recovery. Results from the PariS-Traumatic Brain Injury study suggest that patients with a severe Traumatic Brain Injury who are involved in a litigation procedure within French jurisdiction compensation scheme have a worse prognosis than patients who do not. Health professionals should be aware of the potential adverse effects of litigation procedures on recovery, and provide appropriate interventions and information to patients and families in such cases.
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Affiliation(s)
- Eléonore Bayen
- a Physical Medicine and Rehabilitation Department , Pitie-Salpetriere Hospital, APHP , Paris , France ; Health Economics Department LEDa-LEGOS , University Paris-Dauphine , Paris , France
| | - Claire Jourdan
- b Physical Medicine and Rehabilitation Department , Lapeyronie Hospital, CHRU , Montpellier , France
| | - Idir Ghout
- c Department of Biostatistics , Ambroise Paré Hospital, APHP UVSQ , Boulogne , France ; EA4047 , University of Versailles Saint Quentin , France
| | - Pascale Pradat-Diehl
- d Physical Medicine and Rehabilitation Department , Pitie-Salpetriere Hospital, APHP , Paris , France ; Laboratoire d'Imagerie Biomédicale Inserm U1146 Sorbonne Universités University Pierre et Marie Curie UMCR2 - CNRS UMR7371
| | - Emmanuelle Darnoux
- c Department of Biostatistics , Ambroise Paré Hospital, APHP UVSQ , Boulogne , France ; EA4047 , University of Versailles Saint Quentin , France
| | - Gaëlle Nelson
- c Department of Biostatistics , Ambroise Paré Hospital, APHP UVSQ , Boulogne , France ; EA4047 , University of Versailles Saint Quentin , France
| | - Claire Vallat-Azouvi
- e Physical Medicine and Rehabilitation Department , AP-HP, Raymond-Poincaré Hospital , Garches , France ; EA4047 , University of Versailles Saint Quentin , France
| | - James Charenton
- f Regional Reference Center for Bain Injury in the Parisan area, CRFTC , Paris , France
| | - Philippe Aegerter
- c Department of Biostatistics , Ambroise Paré Hospital, APHP UVSQ , Boulogne , France ; EA4047 , University of Versailles Saint Quentin , France
| | - Alexis Ruet
- g Physical Medicine and Rehabilitation Department , CHU Caen , France and INSERM U1077 , France
| | - Philippe Azouvi
- e Physical Medicine and Rehabilitation Department , AP-HP, Raymond-Poincaré Hospital , Garches , France ; EA4047 , University of Versailles Saint Quentin , France
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Manskow US, Friborg O, Røe C, Braine M, Damsgard E, Anke A. Patterns of change and stability in caregiver burden and life satisfaction from 1 to 2 years after severe traumatic brain injury: A Norwegian longitudinal study. NeuroRehabilitation 2017; 40:211-222. [DOI: 10.3233/nre-161406] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Unn Sollid Manskow
- Department of Rehabilitation, University Hospital of North Norway, Tromso, Norway
- Faculty of Health Sciences, Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Oddgeir Friborg
- Faculty of Health Sciences, Department of Psychology, UiT The Arctic University of Norway, Tromsø, 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
| | - Mary Braine
- School of Nursing and Midwifery, Faculty of Health and Social Care, University of Salford, Salford, UK
| | - Elin Damsgard
- Faculty of Health Sciences, Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Audny Anke
- Department of Rehabilitation, University Hospital of North Norway, Tromso, Norway
- Faculty of Health Sciences, Department of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
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