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Zhao J, Zhu H, Zhu D, Chang F, Liu C, Yang Y, Han T. Effectiveness of identity-building interventions on recovery identity and patient-reported health outcomes in chronic diseases: A meta-analysis. J Health Psychol 2024:13591053241249636. [PMID: 38819962 DOI: 10.1177/13591053241249636] [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: 06/02/2024] Open
Abstract
This meta-analysis aimed to assess the impact of identity-building interventions on recovery identity and patient-reported health outcomes in chronic disease patients. We identified 15 relevant empirical studies (comprising 2261 patients) from 989 records through extensive keyword searches and manual screening conducted between March 2nd and March 13th, 2023. Utilizing the Cochrane tool, meta-regression, and the GRADE approach, we evaluated these studies for their characteristics, findings, and quality. The analysis revealed that identity-building interventions, encompassing recovery-oriented group, interest group, and linguistic approaches, positively influenced identity synthesis and had varying effects on health outcomes. Notably, multiple regression analysis demonstrated that identity synthesis significantly predicted health outcomes. However, the study identified mild heterogeneity, a high attrition bias risk, and insufficient data on selection and detection bias as limitations. Overall, identity-building interventions proved influential in enhancing recovery identity, a vital predictor of patient-reported health outcomes in chronic disease patients.
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Affiliation(s)
| | | | - Dian Zhu
- Shanghai Jiao Tong University, China
| | | | | | - Yan Yang
- Shanghai Jiao Tong University, China
| | - Ting Han
- Shanghai Jiao Tong University, China
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Elbourn E, Brassel S, Steel J, Togher L. Perceptions of communication recovery following traumatic brain injury: A qualitative investigation across 2 years. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024; 59:463-482. [PMID: 36239151 DOI: 10.1111/1460-6984.12795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Exploring the perceptions of individuals with traumatic brain injury (TBI) towards their brain injury recovery across the continuum of care may offer insights to support engagement with rehabilitation services. Illness narratives are a potentially valuable avenue for examining perceptions of recovery that may influence engagement. AIMS The aim of this study is to explore the perspective of individuals with severe TBI towards their communication, brain injury and recovery experiences at 6 months, 1 year and 2 years post-injury. METHODS & PROCEDURES Discourse samples were obtained from 12 participants with severe TBI at 6 months, 1 year and 2 years following injury. A standardised protocol was used to elicit responses relating to perceptions of communication, the brain injury narrative, and perceptions of recovery facilitators. A thematic analysis of the discourse samples was completed. OUTCOMES & RESULTS Three overarching themes were identified: experiences of communication recovery are diverse (Theme 1), varied experiences of recovery and rehabilitation (Theme 2), and continuous and lifelong journey of recovery (Theme 3). Primary communication concerns included presence of anomia, dysarthria, conversational topic difficulties, impacts of fatigue and memory difficulties. Illness narratives revealed the importance of re-establishing a sense of self and the perceived importance of a strong social network post-injury. CONCLUSIONS & IMPLICATIONS The varied nature of communication challenges and recovery after TBI highlights the need for holistic, multidisciplinary support as well as inclusion of family and friends in the recovery process. Social communication intervention is a perceived priority area for individuals with TBI. Illness narratives may also play a valuable role in therapy and help to shape post-injury identity. Managing the impacts of fatigue on communication and encouraging individuals to take ownership over their recovery and treatment may also help to improve patient outcomes. Supporting individuals to construct positive brain injury narratives that reaffirm a sense of self and include perspectives of family and friends may offer a potential future avenue for rehabilitation. Tailored but flexible, team-based service delivery models for individuals with TBI that span from acute to long-term care are warranted. WHAT THIS STUDY ADDS?: What is already known on this subject Communication recovery from traumatic brain injury (TBI) is complex and multifaceted. The perceptions of individuals with TBI toward their communication recovery is largely unknown. To establish rehabilitation services that meet the needs of these individuals, we need to understand how they experience communication recovery. What this paper adds to existing knowledge Social communication interventions were perceived as a priority for intervention by individuals with TBI. Fatigue was identified as perceived barrier to communication recovery. Taking ownership over one's recovery process was revealed as a facilitator of recovery. Illness narratives were found to strengthen post-injury identity over time. What are the potential or actual clinical implications of this work? Speech pathologists should prioritise social communication interventions and fatigue management for communication. Facilitating ownership of the recovery process and offering long-term supports are key aspects of treatment. Supporting positive illness narratives as part of treatment may facilitate post-injury identity construction.
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Affiliation(s)
- Elise Elbourn
- The University of Sydney, Sydney, New South Wales, Australia
| | - Sophie Brassel
- The University of Sydney, Sydney, New South Wales, Australia
| | - Joanne Steel
- The University of Newcastle, Newcastle, New South Wales, Australia
| | - Leanne Togher
- The University of Sydney, Sydney, New South Wales, Australia
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Ruiz-Burga E, Tariq S, Touloumi G, Gill J, Nicholls EJ, Sabin C, Mussini C, Meyer L, Volny Anne A, Carlander C, Grabar S, Jarrin I, Van der Valk M, Wittkop L, Spire B, Pantazis N, Burns FM, Porter K. CASCADE protocol: exploring current viral and host characteristics, measuring clinical and patient-reported outcomes, and understanding the lived experiences and needs of individuals with recently acquired HIV infection through a multicentre mixed-methods observational study in Europe and Canada. BMJ Open 2023; 13:e070837. [PMID: 37169505 DOI: 10.1136/bmjopen-2022-070837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
INTRODUCTION Despite the availability of pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART), 21 793 people were newly diagnosed with HIV in Europe in 2019. The Concerted action on seroconversion to AIDS and death in Europe study aims to understand current drivers of the HIV epidemic; factors associated with access to, and uptake of prevention methods and ART initiation; and the experiences, needs and outcomes of people with recently acquired HIV. METHODS AND ANALYSIS This longitudinal observational study is recruiting participants aged ≥16 years with documented laboratory evidence of HIV seroconversion from clinics in Canada and six European countries. We will analyse data from medical records, self-administered questionnaires, semistructured interviews and participatory photography. We will assess temporal trends in transmitted drug resistance and viral subtype and examine outcomes following early ART initiation. We will investigate patient-reported outcomes, well-being, and experiences of, knowledge of, and attitudes to HIV preventions, including PrEP. We will analyse qualitative data thematically and triangulate quantitative and qualitative findings. As patient public involvement is central to this work, we have convened a community advisory board (CAB) comprising people living with HIV. ETHICS AND DISSEMINATION All respective research ethics committees have approval for data to contribute to international collaborations. Written informed consent is required to take part. A dissemination strategy will be developed in collaboration with CAB and the scientific committee. It will include peer-reviewed publications, conference presentations and accessible summaries of findings on the study's website, social media and via community organisations.
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Affiliation(s)
- Elisa Ruiz-Burga
- Institute for Global Health, University College London, London, UK
| | - Shema Tariq
- Institute for Global Health, University College London, London, UK
- Central and Northwest London NHS Foundation Trust, Mortimer Market Centre, London, UK
| | - Giota Touloumi
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece
| | - John Gill
- Southern Alberta HIV Clinic, Calgary, Alberta, Canada
| | | | - Caroline Sabin
- Institute for Global Health, University College London, London, UK
| | - Cristina Mussini
- Department of Surgical, Medical, Dental and Morphological Sciences with Interest Transplant, University of Modena and Reggio Emilia, Modena, Italy
| | - Laurence Meyer
- INSERM CESP U1018, APHP Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris-Saclay University, Gif-sur-Yvette, France
| | | | - Christina Carlander
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Sophie Grabar
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, AP-HP, Hôpital St Antoine, Paris, France
| | - Inma Jarrin
- National Centre of Epidemiology, Carlos III Health Institute, Madrid, Spain
- Centro de Investigación Biomédica en Red Enfermedades Infecciosas, Madrid, Spain
| | - Marc Van der Valk
- Department of Infectious Diseases, Amsterdam Infection & Immunity Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
- HIV Monitoring Foundation, Amsterdam, Netherlands
| | - Linda Wittkop
- INSERM, BPH, U1219, CIC-EC 1401, Universite Bordeaux, Bordeaux, France
- INRIA SISTM Team, Talence, France
| | - Bruno Spire
- Inserm, IRD, SESSTIM, ISSPAM, Aix-Marseille Université, Marseille, France
| | - Nikos Pantazis
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece
| | - Fiona M Burns
- Institute for Global Health, University College London, London, UK
| | - Kholoud Porter
- Institute for Global Health, University College London, London, UK
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Darries Z, Soeker MS. Exploring the experiences of women with acquired brain injury on return to work and entrepreneurial skills development in the Western Cape Metropolitan, South Africa. Work 2023; 76:381-391. [PMID: 36872837 DOI: 10.3233/wor-220576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Acquired brain injury (ABI) is an important public health problem. Individuals with ABI experience greater challenges with community reintegration and successful return to work (RTW) due to both personal and environmental factors. Empirical evidence has shown that women with brain injury are vulnerable to poorer functional outcomes and have demonstrated lower RTW rates post-injury. Therefore, further research is needed to gain greater insight on women with acquired brain injury's functional and work abilities as well as their experiences of RTW and entrepreneurial skills development. OBJECTIVE This study aimed to explore and describe women with acquired brain injury's experiences during their rehabilitation process, their resumption of their worker role, and entrepreneurial skills development. This qualitative exploration formed part of a study that resulted in an occupational therapy practice model to enhance the entrepreneurial skills of women with acquired brain injury living in the Cape Metropolitan, Western Cape, South Africa. METHODS Semi-structured interviews were conducted with ten females with acquired brain injury. A qualitative approach was employed to thematically analyse the data. RESULTS Three themes emerged from the study: (1) Barriers within the rehabilitation process, 2) ABI causes loss of a sense of self and financial strain, 3) Entrepreneurship and education as a strategy to empowerment. CONCLUSION Unmet individual needs related to occupational engagement results in RTW challenges for women with ABI. ABI sequelae cause activity limitations and hinder gainful occupational participation. A holistic client-centred entrepreneurial skills development approach is a viable and needed strategy to facilitate economic empowerment for women with ABI.
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Affiliation(s)
- Zareena Darries
- Occupational Therapy Department, University of the Western Cape, Cape Town, South Africa
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Panday J, Velikonja D, Moll SE, Harris JE. Experiences of inpatient rehabilitation from the perspective of persons with acquired brain injury. Disabil Rehabil 2021; 44:5539-5548. [PMID: 34166176 DOI: 10.1080/09638288.2021.1938706] [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: 10/21/2022]
Abstract
BACKGROUND Perspectives of individuals with acquired brain injury (ABI) regarding inpatient rehabilitation experiences can inform patient-centered care; however, these voices are under-represented in the literature. PURPOSE To explore the experiences, needs, and preferences of patients from an ABI inpatient rehabilitation program in Ontario. METHODS Using an interpretive description approach, we interviewed 12 participants and analyzed the transcripts inductively to generate themes. FINDINGS We identified three major themes: (1) Life Rerouted - participants felt their lives diverted due to ABI, with rehabilitation seen as a way to return to pre-injury life, (2) Autonomy within Rehab highlighted the perceived importance of personal autonomy in decision-making within rehabilitation, and (3) Life (and Recovery) Go On reflected an ongoing recovery process after discharge - leading to mixed emotions. An overall message, "re-establishing personal identity is important to the recovery process," reflected theories of biographical disruption and relational autonomy. IMPLICATIONS Our findings provide a patient perspective for clinicians and administrators to consider. We found that ABI was significantly disruptive to personal identity - resulting in tensions in autonomy while attempting to reclaim a sense of identity. We suggest counseling services and strategies supporting post-injury adjustment, along with ways for rehabilitation professionals to enhance patient autonomy where possible.Implications for rehabilitationSustaining an ABI can significantly disrupt personal identity and sense of autonomy - especially as persons occupy the role of "patient" while in inpatient rehabilitation.Psychological support is recommended to address the impacts of ABI on patients' sense of identity, as well as on family members.Strategies of support might include, providing formal psychotherapy, as well as creating opportunities for patients and family members to discuss the changes they are experiencing, and to establish their personal narratives (e.g., through writing or art) or peer mentorship programs between discharged and current patients.Clinicians can enhance patient autonomy by increasing opportunities for communication with patients about choice; educating patients and family members on the rehabilitation team's decision-making process, and other methods that increase communication and provide consistent up-to-date information to patients and their family members.
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Affiliation(s)
- Janelle Panday
- School of Rehabilitation Science, McMaster University, Institute for Applied Health Sciences, Hamilton, Canada
| | - Diana Velikonja
- Hamilton Health Sciences, Regional Rehabilitation Centre, Hamilton, Canada.,Department of Psychology and Behavioural Neurosciences, DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Sandra E Moll
- School of Rehabilitation Science, McMaster University, Institute for Applied Health Sciences, Hamilton, Canada
| | - Jocelyn E Harris
- School of Rehabilitation Science, McMaster University, Institute for Applied Health Sciences, Hamilton, Canada
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Families' Experiences Living with Acquired Brain Injury: "Thinking Family"-A Nursing Pathway for Family-Centered Care. Nurs Res Pract 2020; 2020:8866534. [PMID: 32832151 PMCID: PMC7422354 DOI: 10.1155/2020/8866534] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/10/2020] [Accepted: 07/20/2020] [Indexed: 11/17/2022] Open
Abstract
The objective of this study was to examine families' experiences living with acquired brain injury (ABI) using a research approach that included both the affected individual family member and the family together as a family group. A narrative inquiry study, informed by the life-stage approach of Lieblich, Tuval-Mashiach, and Zilber, was used to obtain family stories. Families experiencing an ABI event were purposefully selected from different regions in a western Canadian province. Centered on the life stages of before the ABI event, now living with the ABI, and the future, thematic findings included: Families, a grounding force; Losses, individual and family; Family adaptive capacities; Experiences with the healthcare system-hospital to home; and A patchwork future-entering the unknown. Themes affirmed the significant impacts of ABI on individual and family members and acknowledged ABI as an ambiguous loss event. The findings also illuminated families' strengths and resiliencies in coping with living with ABI. The study results suggest by “thinking family” nurses can contribute towards a healthcare model that focuses on “family” as the central unit of care.
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Knight E, Norman A, Simpson GK. Living with suicidality following traumatic brain injury: a qualitative study. Brain Inj 2020; 34:1010-1019. [PMID: 32529858 DOI: 10.1080/02699052.2020.1763463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Numbers of traumatic brain injury (TBI) are increasing, and with suicidality post-injury presenting at 3-4 times higher than in the general population, understanding this is crucial in reducing a devastating outcome. Given the lack of literature, this study investigated the experiences of living with suicidality after TBI. METHODS Interview data from nineteen participants with TBI from a Brain Injury Rehabilitation Unit (BIRU) in New South Wales (NSW), Australia were collected and thematically analyzed. FINDINGS The participants (predominantly male) sustained extremely severe injuries (median PTA 60 [IQR 81.0] days) and were in the chronic phase post-injury (median 8.0 [IQR 9.0] years). Six main themes were identified; Loss of sense of self, TBI as a hidden disability, Chronic but transient suicidality, Reliance, Protective factors, and Hope. Tentative relationships between themes and subthemes were identified. CONCLUSION Chronic suicidality after TBI was demonstrated consistently regardless of receiving long-term support. However, their engagement with protective factors such as social support, spirituality and positive personal qualities was identified. Implementing these as coping strategies during long-term rehabilitation may reduce the levels of suicidal distress. Implications, methodological considerations and future research were discussed, with the aim of improving experiences of individuals with TBI to reduce suicidality.
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Affiliation(s)
- Ellie Knight
- Department of Psychology, Hywel Dda University Health Board , Wales, UK
| | - Alyson Norman
- School of Psychology, University of Plymouth , Plymouth, UK
| | - Grahame K Simpson
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research , Sydney, Australia
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Mealings M, Douglas J, Olver J. Is it me or the injury: Students’ perspectives on adjusting to life after traumatic brain injury through participation in study. Neuropsychol Rehabil 2019; 30:1255-1276. [DOI: 10.1080/09602011.2019.1574231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Margaret Mealings
- La Trobe University College of Science Health and Engineering, Bundoora, Australia
- Epworth Healthcare, Richmond, Australia
| | - Jacinta Douglas
- La Trobe University College of Science Health and Engineering, Bundoora, Australia
- Summer Foundation, Box Hill, Australia
| | - John Olver
- Epworth Healthcare, Richmond, Australia
- Epworth Monash Rehabilitation Medicine Unit, Richmond, Australia
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Roddy C, Rickard N, Tamplin J, Lee YEC, Baker FA. Exploring self-concept, wellbeing and distress in therapeutic songwriting participants following acquired brain injury: A case series analysis. Neuropsychol Rehabil 2018; 30:166-186. [PMID: 29560784 DOI: 10.1080/09602011.2018.1448288] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Acquired brain injury (ABI) presents a significant threat to sense of self and necessitates a complex process of psychosocial adjustment. Self-concept changes remain understudied in the early stages of inpatient rehabilitation. The aim of the current study was to examine changes in self-concept, distress, wellbeing and functional skills for five inpatients undertaking a music therapy intervention within a subacute rehabilitation centre in Victoria, Australia. Participants completed a six-week, 12-session therapeutic songwriting programme to produce past-, current- and future-self-focused songs. A range of self-concept, subjective wellbeing and distress measures were completed pre-, mid- and post-intervention. A descriptive case series approach was applied to determine trends in pre-post scores for five individual cases. Participants showing the greatest gains across self-concept and subjective wellbeing indices also showed the greatest functional gains on the Functional Independence Measure (FIM) from admission to discharge. The current study highlights the importance of examining early changes in self-concept, wellbeing and distress in subacute rehabilitation, and suggests that individualised songwriting programmes warrant further research attention in neurological populations.
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Affiliation(s)
- Chantal Roddy
- School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Nikki Rickard
- School of Psychological Sciences, Monash University, Clayton, VIC, Australia.,Graduate School of Education, University of Melbourne, Carlton, VIC, Australia
| | - Jeanette Tamplin
- Faculty of Fine Arts and Music, The University of Melbourne, Southbank, VIC, Australia.,Royal Talbot Rehabilitation Centre, Austin Health, Melbourne, VIC, Australia
| | - Young-Eun C Lee
- Faculty of Fine Arts and Music, The University of Melbourne, Southbank, VIC, Australia
| | - Felicity Anne Baker
- Faculty of Fine Arts and Music, The University of Melbourne, Southbank, VIC, Australia
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Cooper J, Kierans C, Defres S, Easton A, Kneen R, Solomon T. Care beyond the hospital ward: understanding the socio-medical trajectory of herpes simplex virus encephalitis. BMC Health Serv Res 2017; 17:646. [PMID: 28899392 PMCID: PMC5596960 DOI: 10.1186/s12913-017-2608-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 09/08/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Herpes simplex virus (HSV) encephalitis is a life-threatening infection of the brain, which has significant physical, cognitive and social consequences for survivors. Despite increasing recognition of the long-term effects of encephalitis, research and policy remains largely focused on its acute management, meaning there is little understanding of the difficulties people face after discharge from acute care. This paper aims to chart the problems and challenges which people encounter when they return home after treatment for HSV encephalitis. METHODS The paper reports on data from 30 narrative interviews with 45 people affected by HSV encephalitis and their significant others. The study was conducted as part of the ENCEPH-UK programme grant on Understanding and Improving the Outcome of Encephalitis. RESULTS The findings show the diverse challenges which are experienced by people after treatment for HSV encephalitis. We first chart how peoples' everyday lives are fragmented following their discharge from hospital. Second, we document the social consequences which result from the longer-term effects of encephalitis. Finally, we show how the above struggles are exacerbated by the lack of support systems for the post-acute effects of encephalitis, and describe how people are consequently forced to devise their own care routines and strategies for managing their problems. CONCLUSION The paper argues that in order to improve long-term outcomes in encephalitis, it is vital that we develop pathways of support for the condition beyond the acute hospital setting. We conclude by making recommendations to enhance communication and care for the post-acute consequences of encephalitis, to ensure those affected are fully supported through the chronic effects of this devastating disease.
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Affiliation(s)
- Jessie Cooper
- Division of Health Services Research & Management, City, University of London, London, UK
| | - Ciara Kierans
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Sylviane Defres
- Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
- Tropical and infectious diseases Unit, The Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, UK
- NIHR HPRU in Emerging and Zoonotic Infections, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Ava Easton
- Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
- The Encephalitis Society, Malton, North Yorkshire, UK
| | - Rachel Kneen
- Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
- Department of Neurology, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Tom Solomon
- Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
- NIHR HPRU in Emerging and Zoonotic Infections, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
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Lorenz LS, Charrette AL, O'Neil-Pirozzi TM, Doucett JM, Fong J. Healthy body, healthy mind: A mixed methods study of outcomes, barriers and supports for exercise by people who have chronic moderate-to-severe acquired brain injury. Disabil Health J 2017; 11:70-78. [PMID: 28870419 DOI: 10.1016/j.dhjo.2017.08.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 08/02/2017] [Accepted: 08/18/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Few people with chronic moderate-to-severe brain injury are following recommended physical activity guidelines. OBJECTIVE Investigate effects of planned, systematic physical activity while cultivating social and emotional well-being of people with chronic moderate-to-severe brain injury. HYPOTHESIS Moderate-to-intensive physical activity would be associated with improvements in impairment and activity limitation measures (endurance, mobility, gait speed) immediately post-intervention and six weeks later (study week 12). METHODS The intervention was a single group pre-/post-intervention study with 14 people with chronic moderate-to-severe brain injury who live in brain injury group homes and exercised 60-90 min, 3 days per week for 6 weeks at a maximum heart rate of 50-80%. Pre-post measures (administered weeks 0, 6 and 12) were the 6 Minute Walk Test, High-level Mobility Assessment Tool and 10 Meter Walk Test. The qualitative component used a brief survey and semi-structured interview guide with participants, family members, and staff. RESULTS Following program completion, post-intervention group changes were noted on all outcome measures and greater than minimal detectable change for people with brain injury. Three transitioned from low to high ambulatory status and maintained this change at 12 weeks. During interviews, participants agreed the program was stimulating. More than eighty percent liked working out in a group and felt better being active. CONCLUSIONS Program impact included physical, cognitive and social/emotional aspects. Social aspects (group format, trainers) were highly motivating and supported by residents, family, and staff. Investments in transportation and recruiting and training interns to assist participants are critical to program sustainability and expansion.
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Affiliation(s)
- Laura S Lorenz
- Supportive Living Inc. Research Council, Brain Injury Wellness Center, 7 Oakland Street, Lexington, MA 02420, USA; Brandeis University, The Heller School for Social Policy and Management, 415 South Street, Waltham, MA 02453, USA. http://www.supportivelivinginc.org
| | - Ann L Charrette
- Supportive Living Inc. Research Council, Brain Injury Wellness Center, 7 Oakland Street, Lexington, MA 02420, USA; Doctor of Physical Therapy Department, MCPHS University, 10 Lincoln Square, Worcester, MA 01541, USA.
| | - Therese M O'Neil-Pirozzi
- Supportive Living Inc. Research Council, Brain Injury Wellness Center, 7 Oakland Street, Lexington, MA 02420, USA; Northeastern University, Department of Communication Sciences and Disorders, 360 Huntington Avenue, Boston, MA 02115, USA; Spaulding/Harvard Traumatic Brain Injury Model System, 300 1st Avenue, Charlestown, MA 02129, USA.
| | - Julia M Doucett
- Community Rehab Care, 51 Water Street, #205, Watertown, MA 02472, USA.
| | - Jeffrey Fong
- School of Pharmacy, MCPHS University, Worcester, MA, USA
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Gelech J, Bayly M, Desjardins M. Constructing robust selves after brain injury: positive identity work among members of a female self-help group. Neuropsychol Rehabil 2017; 29:456-476. [PMID: 28393594 DOI: 10.1080/09602011.2017.1308872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Despite common experiences of identity damage, decline, and deterioration, many brain injury survivors succeed in reconstructing robust identities in the wake of injury. Yet, while this accomplishment greatly benefits survivors' quality of life, little is known about how positive identity work might be facilitated or enhanced in therapeutic institutions. Drawing on data from a women's self-help group, we argue that an egalitarian, reflective, strength-focused, and gender-segregated environment can provide female ABI (acquired brain injury) survivors with a fertile scene for identity enhancement and offer unique opportunities for collective identity development. Sociolinguistic interactional analysis revealed four types of positive identity work undertaken within the group: constructing competent selves; tempering the threat of loss and impairment; resisting infantilisation and delegitimisation; and asserting a collective gender identity. This identity work was facilitated by specific programme attributes and activities and contributed to the global project of decentring disability and destigmatising impairments and losses. We call for increased attention to identity issues in brain injury rehabilitation and argue that gender-segregated programming can provide a unique space for female survivors to construct empowering individual and collective identities after injury.
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Affiliation(s)
- Jan Gelech
- a Department of Psychology , University of Saskatchewan , Saskatoon , Canada
| | - Melanie Bayly
- a Department of Psychology , University of Saskatchewan , Saskatoon , Canada
| | - Michel Desjardins
- a Department of Psychology , University of Saskatchewan , Saskatoon , Canada
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Teti M, Conserve D, Zhang N, Gerkovich M. Another Way to Talk: Exploring Photovoice as a Strategy to Support Safe Disclosure Among Men and Women With HIV. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2016; 28:43-58. [PMID: 26829256 DOI: 10.1521/aeap.2016.28.1.43] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
HIV status disclosure can reduce stigma and facilitate medication adherence and safer sex among people living with HIV (PLH). Effective disclosure interventions are limited, however, and new strategies are necessary. We conducted a pilot Photovoice-based project with 38 PLH in four cities in the Midwest and Northeast U.S. and explored how the project affected disclosure perspectives and experiences. Participants attended three group Photovoice sessions, one individual session, and an optional photo exhibit. Qualitative strategies of theme and narrative analysis of photos and session transcripts revealed that participants discussed three categories of disclosures to others: fearful, reluctant, and open. The project supported all disclosure types, helping fearful participants manage their emotions, reluctant participants plan for more effective disclosures, and open participants share their HIV status. Pilot findings suggest that Photovoice should be further developed and studied as a safe and powerful strategy to improve disclosure and subsequent health and prevention outcomes among PLH.
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Affiliation(s)
- Michelle Teti
- Department of Health Sciences, University of Missouri
| | - Donaldson Conserve
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Ni Zhang
- Department of Health Science and Recreation, San Jose State University, San Jose, California
| | - Mary Gerkovich
- Department of Biomedical and Health Informatics, University of Missouri Kansas City
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14
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Body R, Muskett T, Perkins M, Parker M. Your injury, my accident: talking at cross-purposes in rehabilitation after traumatic brain injury. Brain Inj 2013; 27:1356-63. [PMID: 24070204 DOI: 10.3109/02699052.2013.831125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE To explore how traumatic brain injury (TBI) rehabilitation staff and adults who have sustained TBI refer during clinical interaction to the precipitating event. DESIGN Interviews conducted during the initial assessment phase of TBI rehabilitation were examined using Conversation Analysis. PARTICIPANTS Participants were nine men and one woman, all of whom had sustained TBI of sufficient severity to warrant referral for community rehabilitation. Age range was 24-50 years (mean 35 years). The period between injury and interview was between 9 months and 20 years. MAIN OUTCOMES AND RESULTS Analysis of interactions between rehabilitation staff and people with TBI indicated discrepancies in the way they refer to the original event. Staff tended to use 'head/brain injury' in contrast to the use by people with TBI of 'accident/crash'. There were also differences of expression in terms of 'ownership' (e.g., your injury vs. the injury) and 'agency' (the degree to which the person with TBI was portrayed as having been part of the process of sustaining the TBI). CONCLUSION The implications of these discrepancies are discussed in relation to self-identity and insight after TBI. The possible impact of this terminological tension on the rehabilitation process is also discussed.
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Affiliation(s)
- Richard Body
- Department of Human Communication Sciences, University of Sheffield , Sheffield , UK and
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15
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Abstract
Brain injury patients often face a lack of empathy that leads to feelings of being disrespected and powerless. This article explores the use of photo-elicitation as one way to generate empathy in research (and clinical) relationships with acquired brain injury survivors through a re-examination of the process and products of photo-elicitation research conducted several years ago. The ‘case’ starkly illustrates the limits of researcher empathy and analysis even as the ethics of visual methods create opportunities for participants to share research power, contest research analyses, and present an alternate view that displays health and strength as well as illness. The ‘case’ prompts us to remain vigilant of the ways in which our personal lenses and histories affect what we see and shape our production of knowledge. Practicing empathy by using photos to create discursive spaces in research relationships may help us to learn about ourselves as we learn with patients.
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16
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Abstract
The Institute of Medicine has targeted patient-centeredness as an important area of quality improvement. A major dimension of patient-centeredness is respect for patient's values, preferences, and expressed needs. Yet specific approaches to gaining this understanding and translating it to quality care in the clinical setting are lacking. From a patient perspective quality is not a simple concept but is best understood in terms of five dimensions: technical outcomes; decision-making efficiency; amenities and convenience; information and emotional support; and overall patient satisfaction. Failure to consider quality from this five-pronged perspective results in a focus on medical outcomes, without considering the processes central to quality from the patient's perspective and vital to achieving good outcomes. In this paper, we argue for applying the concept of fair process in clinical settings. Fair process involves using a collaborative approach to exploring diagnostic issues and treatments with patients, explaining the rationale for decisions, setting expectations about roles and responsibilities, and implementing a core plan and ongoing evaluation. Fair process opens the door to bringing patient expertise into the clinical setting and the work of developing health care goals and strategies. This paper provides a step by step illustration of an innovative visual approach, called photovoice or photo-elicitation, to achieve fair process in clinical work with acquired brain injury survivors and others living with chronic health conditions. Applying this visual tool and methodology in the clinical setting will enhance patient-provider communication; engage patients as partners in identifying challenges, strengths, goals, and strategies; and support evaluation of progress over time. Asking patients to bring visuals of their lives into the clinical interaction can help to illuminate gaps in clinical knowledge, forge better therapeutic relationships with patients living with chronic conditions such as brain injury, and identify patient-centered goals and possibilities for healing. The process illustrated here can be used by clinicians, (primary care physicians, rehabilitation therapists, neurologists, neuropsychologists, psychologists, and others) working with people living with chronic conditions such as acquired brain injury, mental illness, physical disabilities, HIV/AIDS, substance abuse, or post-traumatic stress, and by leaders of support groups for the types of patients described above and their family members or caregivers.
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Affiliation(s)
- Laura S Lorenz
- Institute for Behavioral Health, Brandeis University, USA.
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