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Ahmed A, Smith M, Mandal S, Bushnik T. Who enrolls and why? Examining center-specific underlying patterns behind enrollment: a New York City-based traumatic brain injury model systems study. Brain Inj 2024; 38:19-25. [PMID: 38219046 DOI: 10.1080/02699052.2024.2304863] [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: 06/17/2022] [Accepted: 01/09/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND To elucidate the sociodemographic and study factors involved in enrollment in the Traumatic Brain Injury Model System (TBIMS) database, this study examined the effect of a variety of variables on enrollment at a local TBIMS center. METHODS A sample of 654 individuals from the local TBIMS center was studied examining enrollment by age, gender, race, ethnicity, homelessness status at date of injury, history of homelessness, health insurance status, presence of social support, primary language, consenting in hospital or after discharge, and the need for an interpreter. Binary logistic regression was conducted to identify variables that predict center-based enrollment into TBIMS. RESULTS Results demonstrated that older age was associated with decreasing enrollment (OR = 0.99, p = 0.01), needing an interpreter made enrollment less likely (OR = 0.33, p < 0.01), being primarily Spanish speaking predicted enrollment (OR = 3.20, p = 0.02), Hispanic ethnicity predicted enrollment (OR = 7.31, p = 0.03), and approaching individuals in the hospital predicted enrollment (OR = 6.94, p < 0.01). Here, OR denotes the odds ratio estimate from a logistic regression model and P denotes the corresponding p-value. CONCLUSIONS These results can be useful in driving enrollment strategies at this center for other similar TBI research, and to contribute a representative TBI sample to the national database.
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Affiliation(s)
- Asim Ahmed
- Rusk Rehabilitation at NYU Langone Health, Department of Rehabilitation, New York, NY, United States
- New York Medical College, School of Medicine, Valhalla, NY, United States
| | - Michelle Smith
- Rusk Rehabilitation at NYU Langone Health, Department of Rehabilitation, New York, NY, United States
| | - Soutrik Mandal
- NYU Grossman School of Medicine Department of Population Health, New York, NY, United States
| | - Tamara Bushnik
- Rusk Rehabilitation at NYU Langone Health, Department of Rehabilitation, New York, NY, United States
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2
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Klang A, Molero Y, Lichtenstein P, Larsson H, D’Onofrio BM, Marklund N, Oldenburg C, Rostami E. Access to Rehabilitation After Hospitalization for Traumatic Brain Injury: A National Longitudinal Cohort Study in Sweden. Neurorehabil Neural Repair 2023; 37:763-774. [PMID: 37953612 PMCID: PMC10685696 DOI: 10.1177/15459683231209315] [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: 11/14/2023]
Abstract
BACKGROUND Rehabilitation is suggested to improve outcomes following traumatic brain injury (TBI), however, the extent of access to rehabilitation among TBI patients remains unclear. OBJECTIVE To examine the level of access to rehabilitation after TBI, and its association with health and sociodemographic factors. METHOD We conducted a longitudinal cohort study using Swedish nationwide healthcare and sociodemographic registers. We identified 15 880 TBI patients ≥18 years hospitalized ≥3 days from 2008 to 2012 who were stratified into 3 severity groups; grade I (n = 1366; most severe), grade II (n = 5228), and grade III (n = 9268; least severe). We examined registered contacts with specialized rehabilitation or geriatric care (for patients ≥65 years) during the hospital stay, and/or within 1 year post-discharge. We performed a generalized linear model analysis to estimate the risk ratio (RR) for receiving specialized rehabilitation or geriatric care after a TBI based on sociodemographic and health factors. RESULTS Among TBI patients, 46/35% (grade I), 14/40% (grade II), and 5/18% (grade III) received specialized rehabilitation or geriatric care, respectively. Being currently employed or studying was positively associated (RR 1.7, 2.3), while living outside of a city area was negatively associated (RR 0.36, 0.79) with receiving specialized rehabilitation or geriatric care. Older age and a prior substance use disorder were negatively associated with receiving specialized rehabilitation (RR 0.51 and 0.81). CONCLUSION Our results suggest insufficient and unequal access to rehabilitation for TBI patients, highlighting the importance of organizing and standardizing post-TBI rehabilitation to meet the needs of patients, regardless of their age, socioeconomic status, or living area.
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Affiliation(s)
- Andrea Klang
- Department of Medical Sciences, Rehabilitation Medicine, Uppsala University, Uppsala, Sweden
| | - Yasmina Molero
- Department of Clinical Neuroscience, Karolinska Institutet Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Sciences, Örebro University, Örebro, Sweden
| | - Brian Matthew D’Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Niklas Marklund
- Department of Medical Sciences, Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Christian Oldenburg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Elham Rostami
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Sciences Lund, Neurosurgery, Lund University, Skåne University Hospital, Lund, Sweden
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3
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Young M, Peterson AH. Neuroethics across the Disorders of Consciousness Care Continuum. Semin Neurol 2022; 42:375-392. [PMID: 35738293 DOI: 10.1055/a-1883-0701] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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4
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Wilson L, Horton L, Polinder S, Newcombe V, von Steinbuechel N, Maas A, Menon D. Tailoring multidimensional outcomes to level of functional recovery after traumatic brain injury. J Neurotrauma 2022; 39:1363-1381. [PMID: 35607855 DOI: 10.1089/neu.2022.0013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
There is increasing emphasis on multi-dimensional outcomes in traumatic brain injury (TBI), but achieving this aim is hampered by a plethora of overlapping assessment tools. There is a clear need for advice on the choice of outcomes and we examine level of functional recovery as a framework to guide selection of assessments. In this cohort study we analysed cross-sectional data from 2604 patients enrolled in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) project. Patients were followed up 6 months after injury and assessed on the Glasgow Outcome Scale-Extended (GOSE), cognitive tests, and patient-reported outcomes. We describe assessment completeness and prevalence of impairment. Relationships between outcomes were visualized using UpSet plots and hierarchical cluster analysis. GOSE categories varied markedly for both completion rates, 34-91% for patient reported outcomes and 9-81% for cognitive tests, and prevalence of impairment, 3-82% for patient reported outcomes and 9-59% for cognitive tests. In complete case samples, the GOSE identified impairment in 59-61%, while the most impaired patient reported outcome was the Short-Form 12 Physical Component Summary (28% overall), and the most impaired cognitive test was Trail Making Test Part A (19% overall). The findings show that degree of disability is a key context of use for cognitive tests and patient reported outcomes. Level of functional recovery provides a guide to the feasibility of different types of assessment and the likelihood of impairment, and can help tailor suitable assessment approaches to individuals and groups.
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Affiliation(s)
- Lindsay Wilson
- University of Stirling, Psychology, University of Stirling, Stirling, United Kingdom of Great Britain and Northern Ireland, FK9 4LA;
| | - Lindsay Horton
- University of Stirling, Psychology, Stirling, United Kingdom of Great Britain and Northern Ireland;
| | - Suzanne Polinder
- Erasmus MC, University Medical Center Rotterdam, Public Health, PO box 1738, Rotterdam, Netherlands, 3000 DR;
| | - Virginia Newcombe
- University of Cambridge, Division of Anaesthesia, Addenbrookes Hospital, Cambridge, Cambs, United Kingdom of Great Britain and Northern Ireland, cb2 0qq;
| | - Nicole von Steinbuechel
- University Medical Center Goettingen, Department of Medical Psychology and Medical Sociology, Waldweg 37, Goettingen, Germany, 37073;
| | - Andrew Maas
- University Hospital Antwerp, Neurosurgery, Wilrijkstraat 10, Edegem, Belgium, 2650.,Netherlands;
| | - David Menon
- University of Cambridge, Head, Division of Anaesthesia, Box 93, Addenbrooke's Hospital, Hills Road, Cambridge, Cambs, United Kingdom of Great Britain and Northern Ireland, CB2 2QQ;
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5
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Vos L, Williams MW, Spielman L, Ochoa A, Ngan E, Leon-Novelo L, Sherer M. Understanding loss to follow-up in a longitudinal study of people with traumatic brain injury. Brain Inj 2021; 35:1349-1357. [PMID: 34403276 DOI: 10.1080/02699052.2021.1963474] [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: 10/20/2022]
Abstract
OBJECTIVE To examine factors related to attrition in a traumatic brain injury (TBI) study sample assessed up to 15 years after injury. PARTICIPANTS One thousand twenty-eight participants with TBI who completed the year 1 follow-up assessment at a TBI Model Systems Center between 1992 and 2018. METHOD Secondary analysis of data from a prospective longitudinal cohort study considering follow-up data collection completion status at years 1, 2, 5, 10, and 15. RESULTS In univariable analyses, multiple factors were associated with loss to follow-up (LOFU) including being a member of a socially disadvantaged group, substance use history, residence, payor, cause of injury, and results of earlier follow-up attempts. In a multiple logistic regression analysis examining the prediction of follow-up condition at 10 or 15 years post-injury, only payor and race/ethnicity were significant predictors. Hispanic ethnicity was associated with higher odds of LOFU, and these participants often spoke Spanish and were born outside of the United States. CONCLUSIONS The findings suggest a need to understand sociodemographic variables and their influence on participant attrition in longitudinal TBI research. With a better understanding of these predictors, procedures can be developed to address retention of participants who are identified as being at increased risk for study drop out.
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Affiliation(s)
- Leia Vos
- Acute Mental Health, Zablocki VA Medical Center, Milwaukee, WI, United States of America.,Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Michael W Williams
- Department of Psychology, University of Houston, Houston, TX, United States of America.,Brain Injury Research Center, TIRR Memorial Hermann, Houston, TX, United States of America
| | - Lisa Spielman
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Andrea Ochoa
- Department of Psychology, University of Houston, Houston, TX, United States of America
| | - Esther Ngan
- Department of Biostatistics and Data Science, University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Luis Leon-Novelo
- Department of Biostatistics and Data Science, University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Mark Sherer
- Brain Injury Research Center, TIRR Memorial Hermann, Houston, TX, United States of America.,Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, United States of America
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Weber MW, Nie JZ, Watson VL, Nordmann NJ, Bernard J, Michael AP, Wellman E, Delfino KR, Espinosa JA. Utility of Head Computed Tomography Scans Before Outpatient Follow-up for Low-Risk Mild Traumatic Brain Injury. World Neurosurg 2021; 151:e565-e570. [PMID: 33940271 DOI: 10.1016/j.wneu.2021.04.087] [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] [Received: 12/28/2020] [Revised: 04/17/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Neurosurgeons are frequently consulted for traumatic brain injuries (TBIs) resulting in intracranial hemorrhage (ICH). After inpatient confirmation of hemorrhage stability, outpatient head computed tomography (CT) is often performed to assess for hemorrhage resolution. Our objective was to assess the practice patterns and clinical utility of routine outpatient head CT scans for patients with mild TBI (mTBI). MATERIALS AND METHODS A retrospective review was performed on all adult mTBI patients with ICH who presented to a level I trauma center over a 4-year period. A combination of the patient's initial clinical evaluation and CT findings was used to identify mTBI patients at low risk for neurologic deterioration and neurosurgical intervention. Findings from the outpatient follow-up clinical evaluation and head CT were assessed. Patients without outpatient follow-up within 3 months were excluded. RESULTS Forty-nine patients met inclusion criteria for the study. Thirty-two had an outpatient head CT before their follow-up appointment. Twenty-one patients had at least 1 neurologic finding at the earliest follow-up appointment. All patients except those with a subdural hematoma (SDH) had smaller or resolving ICH on outpatient CT scans. Seven patients with an SDH had unchanged or expanded hemorrhage on outpatient imaging, 2 of whom had traumatic brain injury-related hospitalizations and 1 of whom underwent neurosurgical intervention due to an enlarging SDH. CONCLUSIONS Routine outpatient head CT scans before follow-up for low-risk mTBI patients without an SDH appears to have limited clinical utility. In low-risk mTBI patients with an SDH, obtaining an outpatient head CT is reasonable to monitor for resolution.
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Affiliation(s)
- Matthew W Weber
- Division of Neurosurgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA.
| | - Jeffrey Z Nie
- Division of Neurosurgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Victoria L Watson
- Division of Neurosurgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Nathan J Nordmann
- Division of Neurosurgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Joseph Bernard
- Division of Neurosurgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Alex P Michael
- Division of Neurosurgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Elek Wellman
- Division of Neurosurgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Kristin R Delfino
- Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Jose A Espinosa
- Division of Neurosurgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
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7
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Three methods for examining trajectories in neuropsychological performance across the first 4 years after mild Traumatic Brain Injury. BRAIN IMPAIR 2019. [DOI: 10.1017/brimp.2019.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractBackground:Emerging data suggest that recovery from mild traumatic brain injury (mTBI) takes longer than previously thought. This paper examines trajectories for cognitive recovery up to 48 months post-mTBI, presenting these visually using a Sankey diagram and growth curve analysis.Methods:This sample (n = 301) represents adults (≥16 years) from a population-based Brain Injury Outcomes in the New Zealand Community study over a 4-year follow-up on the CNS-Vital Signs neuropsychological test. Data were collected within 2 weeks of injury, and then at 1, 6, 12 and 48 months post-injury.Results:Significant improvement in cognitive functioning was seen up to 6 months post-injury. Using growth curve modelling, we found significant improvements in overall neurocognition from baseline to 6 months, on average participants improved one point per month (0.9; 95% CI 0.42–1.39) p < 0.001. No change in neurocognition was found within the time periods 6–12 months or 12–48 months. The Sankey highlighted that at each time point, a small proportion of participants remained unchanged or declined. Proportionally, few show any improvement after the first 6 months.Conclusion:Most individuals remained stable or improved over time to 6 months post-injury. Summary statistics are informative regarding overall trends, but can mask differing trajectories for recovery. The Sankey diagram indicates that not all improve, as well as the potential impact of individuals moving in and out of the study. The Sankey diagram also indicated the level of functioning of those most likely to withdraw, allowing targeting of retention strategies.
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8
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Bouzat P, Ageron FX, Thomas M, Vallot C, Hautefeuille S, Schilte C, Payen JF. Modeling the Influence of Age on Neurological Outcome and Quality of Life One Year after Traumatic Brain Injury: A Prospective Multi-Center Cohort Study. J Neurotrauma 2019; 36:2506-2512. [DOI: 10.1089/neu.2019.6432] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Pierre Bouzat
- Department of Anesthesiology and Intensive Care Medicine, Grenoble Alps Trauma Center, Grenoble University Hospital, Grenoble, France
- INSERM 1216, Grenoble Neuroscience Institute, Grenoble Alps University, Grenoble, France
| | - François-Xavier Ageron
- Public Health Department, RENAU Northern French Alps Emergency Network, Annecy Hospital, Annecy, France
- Department of Intensive Care, Annecy Hospital, Annecy, France
| | - Marine Thomas
- Department of Anesthesiology and Intensive Care Medicine, Grenoble Alps Trauma Center, Grenoble University Hospital, Grenoble, France
| | - Cécile Vallot
- Public Health Department, RENAU Northern French Alps Emergency Network, Annecy Hospital, Annecy, France
- Department of Intensive Care, Annecy Hospital, Annecy, France
| | | | - Clotilde Schilte
- Department of Anesthesiology and Intensive Care Medicine, Grenoble Alps Trauma Center, Grenoble University Hospital, Grenoble, France
| | - Jean-François Payen
- Department of Anesthesiology and Intensive Care Medicine, Grenoble Alps Trauma Center, Grenoble University Hospital, Grenoble, France
- INSERM 1216, Grenoble Neuroscience Institute, Grenoble Alps University, Grenoble, France
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9
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Predicting mood outcome following traumatic brain injury (TBI): PTA & demographic variables. BRAIN IMPAIR 2019. [DOI: 10.1017/brimp.2019.13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackground and aims:Mood disturbance is frequent after traumatic brain injury (TBI), often assessed using the Hospital Anxiety and Depression Scale (HADS). Research supports a three-factor HADS structure (anxiety, depression, and psychomotor), although this has not been used to investigate demographic variables and mood outcome post-TBI. This study examined severity of TBI, demographic variables [age, gender, estimated premorbid IQ (EIQ), relationship status, employment status, socio-economic status (SES)], and mood outcome, using HADS factor scores from a large adult population sample in Tasmania.Method:HADS factor scores were calculated for an initial sample of 596 adults. The sample sizes varied according to those attending at 1, 6, 12 and 24 months post-TBI and the available data for each dependent variable.Results:Significantly higher anxiety, depression, and psychomotor scores were reported at most follow-ups by females, the middle-aged, and those with lower IQs. Longer post-traumatic amnesia (PTA) was associated with significantly greater mood problems. Occasional significant findings at earlier follow-ups for the factors were noted for those unemployed. Other variables were rarely significant. PTA, premorbid IQ, and Age were included in most Multiple Regression equations predicting outcome for the factors, with Gender included for Anxiety and depression at 6 months after injury.Conclusions:Key demographic variables and PTA severity relate to mood post-TBI, and contribute to predicting mood outcome. Differences in findings for the three factors support their use in clinical practice.
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10
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Radford K, Sutton C, Sach T, Holmes J, Watkins C, Forshaw D, Jones T, Hoffman K, O'Connor R, Tyerman R, Merchán-Baeza JA, Morris R, McManus E, Drummond A, Walker M, Duley L, Shakespeare D, Hammond A, Phillips J. Early, specialist vocational rehabilitation to facilitate return to work after traumatic brain injury: the FRESH feasibility RCT. Health Technol Assess 2019; 22:1-124. [PMID: 29863459 DOI: 10.3310/hta22330] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Up to 160,000 people incur traumatic brain injury (TBI) each year in the UK. TBI can have profound effects on many areas of human functioning, including participation in work. There is limited evidence of the clinical effectiveness and cost-effectiveness of vocational rehabilitation (VR) after injury to promote early return to work (RTW) following TBI. OBJECTIVE To assess the feasibility of a definitive, multicentre, randomised controlled trial (RCT) of the clinical effectiveness and cost-effectiveness of early, specialist VR plus usual care (UC) compared with UC alone on work retention 12 months post TBI. DESIGN A multicentre, feasibility, parallel-group RCT with a feasibility economic evaluation and an embedded mixed-methods process evaluation. Randomisation was by remote computer-generated allocation. SETTING Three NHS major trauma centres (MTCs) in England. PARTICIPANTS Adults with TBI admitted for > 48 hours and working or studying prior to injury. INTERVENTIONS Early specialist TBI VR delivered by occupational therapists (OTs) in the community using a case co-ordination model. MAIN OUTCOME MEASURES Self-reported RTW 12 months post randomisation, mood, functional ability, participation, work self-efficacy, quality of life and work ability. Feasibility outcomes included recruitment and retention rates. Follow-up was by postal questionnaires in two centres and face to face in one centre. Those collecting data were blind to treatment allocation. RESULTS Out of 102 target participants, 78 were recruited (39 randomised to each arm), representing 39% of those eligible and 5% of those screened. Approximately 2.2 patients were recruited per site per month. Of those, 56% had mild injuries, 18% had moderate injuries and 26% had severe injuries. A total of 32 out of 45 nominated carers were recruited. A total of 52 out of 78 (67%) TBI participants responded at 12 months (UC, n = 23; intervention, n = 29), completing 90% of the work questions; 21 out of 23 (91%) UC respondents and 20 out of 29 (69%) intervention participants returned to work at 12 months. Two participants disengaged from the intervention. Face-to-face follow-up was no more effective than postal follow-up. RTW was most strongly related to social participation and work self-efficacy. It is feasible to assess the cost-effectiveness of VR. Intervention was delivered as intended and valued by participants. Factors likely to affect a definitive trial include deploying experienced OTs, no clear TBI definition or TBI registers, and repatriation of more severe TBI from MTCs, affecting recruitment of those most likely to benefit/least likely to drop out. LIMITATIONS Target recruitment was not reached, but mechanisms to achieve this in future studies were identified. Retention was lower than expected, particularly in UC, potentially biasing estimates of the 12-month RTW rate. CONCLUSIONS This study met most feasibility objectives. The intervention was delivered with high fidelity. When objectives were not met, strategies to ensure feasibility of a full trial were identified. Future work should test two-stage recruitment and include resources to recruit from 'spokes'. A broader measure covering work ability, self-efficacy and participation may be a more sensitive outcome. TRIAL REGISTRATION Current Controlled Trials ISRCTN38581822. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 33. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kate Radford
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Chris Sutton
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Tracey Sach
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Jain Holmes
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Caroline Watkins
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Denise Forshaw
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Trevor Jones
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Karen Hoffman
- Centre for Trauma Sciences, Queen Mary University of London, London, UK
| | - Rory O'Connor
- Academic Department of Rehabilitation Medicine, School of Medicine, University of Leeds, Leeds, UK
| | - Ruth Tyerman
- Community Head Injury Service, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
| | | | - Richard Morris
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Emma McManus
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Avril Drummond
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Marion Walker
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Lelia Duley
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Alison Hammond
- Health Sciences Research Centre, University of Salford, Salford, UK
| | - Julie Phillips
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
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11
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Troup GA, Thomas MD, Skilbeck CE. The factor structure of the Quality of Life Inventory (QOLI) following traumatic brain injury. Neuropsychol Rehabil 2019; 30:1129-1149. [PMID: 30616440 DOI: 10.1080/09602011.2018.1564674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Quality of life is a key indicator of outcome following traumatic brain injury (TBI). Research has reported several different factor structures for the Quality of Life Inventory (QOLI, Frisch, 1994). We compared the fit of existing factor models and examined the clinical utility of the QOLI's factors in a sample of Australian adults with TBI. Archival data from 901 participants were provided by the Neurotrauma Register of Tasmania. Participants were aged 16-80 years and 63% were male. Approximately 69% had mild TBI (PTA < 24 h), approximately 24% had moderate TBI (PTA >1 day, <7 days) and 7% had severe TBI. Both cross sectional and longitudinal analyses were utilized, as participants provided data at one or more of seven time-points, up to 3 years following injury. The results showed the data best fitted a three-factor model, comprising Self-functioning and activity, Self-actualization and Family and environment factors, and a second order Overall QOL factor. Differences in the trajectory of recovery were noted between the QOLI factor scores over time and in relation to demographic and injury variables. In conclusion, the three-factor structure of the QOLI provided useful clinical information about the recovery of patients' subjective quality of life following TBI.
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Affiliation(s)
- G A Troup
- School of Psychology, Charles Sturt University, Bathurst, Australia
| | - M D Thomas
- School of Psychology, Charles Sturt University, Bathurst, Australia
| | - C E Skilbeck
- School of Psychology, University of Tasmania, Sandy Bay, Australia
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12
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Teague S, Youssef GJ, Macdonald JA, Sciberras E, Shatte A, Fuller-Tyszkiewicz M, Greenwood C, McIntosh J, Olsson CA, Hutchinson D. Retention strategies in longitudinal cohort studies: a systematic review and meta-analysis. BMC Med Res Methodol 2018; 18:151. [PMID: 30477443 PMCID: PMC6258319 DOI: 10.1186/s12874-018-0586-7] [Citation(s) in RCA: 203] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 10/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Participant retention strategies that minimise attrition in longitudinal cohort studies have evolved considerably in recent years. This study aimed to assess, via systematic review and meta-analysis, the effectiveness of both traditional strategies and contemporary innovations for retention adopted by longitudinal cohort studies in the past decade. METHODS Health research databases were searched for retention strategies used within longitudinal cohort studies published in the 10-years prior, with 143 eligible longitudinal cohort studies identified (141 articles; sample size range: 30 to 61,895). Details on retention strategies and rates, research designs, and participant demographics were extracted. Meta-analyses of retained proportions were performed to examine the association between cohort retention rate and individual and thematically grouped retention strategies. RESULTS Results identified 95 retention strategies, broadly classed as either: barrier-reduction, community-building, follow-up/reminder, or tracing strategies. Forty-four of these strategies had not been identified in previous reviews. Meta-regressions indicated that studies using barrier-reduction strategies retained 10% more of their sample (95%CI [0.13 to 1.08]; p = .01); however, studies using follow-up/reminder strategies lost an additional 10% of their sample (95%CI [- 1.19 to - 0.21]; p = .02). The overall number of strategies employed was not associated with retention. CONCLUSIONS Employing a larger number of retention strategies may not be associated with improved retention in longitudinal cohort studies, contrary to earlier narrative reviews. Results suggest that strategies that aim to reduce participant burden (e.g., flexibility in data collection methods) might be most effective in maximising cohort retention.
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Affiliation(s)
- Samantha Teague
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Burwood, Geelong, Victoria, 3125, Australia
| | - George J Youssef
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Burwood, Geelong, Victoria, 3125, Australia.,Murdoch Children's Research Institute, Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia
| | - Jacqui A Macdonald
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Burwood, Geelong, Victoria, 3125, Australia.,Murdoch Children's Research Institute, Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, Royal Children's Hospital, University of Melbourne, Melbourne, Australia
| | - Emma Sciberras
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Burwood, Geelong, Victoria, 3125, Australia.,Murdoch Children's Research Institute, Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia
| | - Adrian Shatte
- School of Engineering & Information Technology, Faculty of Science & Technology, Federation University, Melbourne, Australia
| | - Matthew Fuller-Tyszkiewicz
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Burwood, Geelong, Victoria, 3125, Australia
| | - Chris Greenwood
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Burwood, Geelong, Victoria, 3125, Australia
| | - Jennifer McIntosh
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Burwood, Geelong, Victoria, 3125, Australia.,Murdoch Children's Research Institute, Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia
| | - Craig A Olsson
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Burwood, Geelong, Victoria, 3125, Australia.,Murdoch Children's Research Institute, Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, Royal Children's Hospital, University of Melbourne, Melbourne, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Australia
| | - Delyse Hutchinson
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Burwood, Geelong, Victoria, 3125, Australia. .,Murdoch Children's Research Institute, Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia. .,Department of Paediatrics, Royal Children's Hospital, University of Melbourne, Melbourne, Australia. .,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
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13
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Reynolds M, Driver S, Bennett M, Patel S, Rainey E, Warren AM. Examining the relationship between obesity and mental health outcomes among individuals admitted to a level I trauma centre. Clin Obes 2018; 8:337-344. [PMID: 30066450 DOI: 10.1111/cob.12264] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 05/22/2018] [Accepted: 05/29/2018] [Indexed: 11/28/2022]
Abstract
The increased incidence of obesity in the general population translates into clinicians caring for an increased number of trauma patients with obesity. Previous research has documented the unique anatomical and physiological challenges that clinicians face when caring for trauma patients with obesity; however, little is known about psychological challenges that trauma patients with obesity may also experience in the months following injury. The aim of this study is to determine the relationship between obesity and (i) mental health, (ii) demographic and injury-related variables and (iii) quality-of-life outcomes among trauma patients between hospitalization and 3-months post-injury. This is a prospective, longitudinal study conducted between March 2012 and May 2014 at a single, level I trauma centre in the southwest United States. Inclusion criteria for this convenience sample consisted of patients who were admitted to the trauma or orthopaedic trauma service ≥24 h, medically stable, spoke English or Spanish and ≥18 years of age. In total, 455 eligible patients were consented and enrolled; 343 (70.87%) completed 3-month follow-up. The objective of this study is to investigate the relationship between obesity and mental health among trauma patients in the months following injury. Demographic and injury-related data were also collected; patients' height and weight were used to determine body mass index. Health outcomes were assessed during initial hospitalization and at 3-month follow-up and included depression, post-traumatic stress symptoms, pain and return to work. Prior to data collection, it was hypothesized that obesity would have a negative effect on mental health outcomes among patients 3 months post-injury. The final sample consisted of 343 participants; average age was 46.4 ± 17.3 years; majority male (n = 213, 63%) and Caucasian (n = 231, 69%). Patients with obesity had higher odds of screening positive for depression (odds ratio [OR] = 2.36, P = 0.02) and overweight patients had lower odds of returning to work (OR = 0.31, P = 0.01) 3 months post-injury compared to patients of normal weight (65% vs. 40%). No other significant differences were found. Results of the current study are novel in that they identify psychological challenges that overweight and trauma patients with obesity may experience. These results demonstrate the need for mental health professionals to be involved in follow-up care to extending in the months following injury.
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Affiliation(s)
- M Reynolds
- Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, Texas, USA
| | - S Driver
- Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, Texas, USA
| | - M Bennett
- Center for Clinical Effectiveness, Baylor Scott and White Health, Dallas, Texas, USA
| | - S Patel
- Physical Medicine and Rehabilitation, Salem Health Hospitals and Clinics, Salem, Oregon, USA
| | - E Rainey
- Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, Texas, USA
| | - A M Warren
- Division of Trauma, Critical Care and Acute Care, Baylor University Medical Center, Dallas, Texas, USA
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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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15
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The Structure of the Rivermead Post-Concussion Symptoms Questionnaire in Australian Adults with Traumatic Brain Injury. BRAIN IMPAIR 2017. [DOI: 10.1017/brimp.2017.26] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background and aims: Many sustaining traumatic brain injury (TBI) suffer ongoing post-concussion symptoms (PCS). The Rivermead Post-Concussion Symptoms Questionnaire (RPQ) is widely used, although there is disagreement about its structure. This study compared the fit of published RPQ structures with a four-factor structure derived from a large adult sample with TBI in Tasmania.Method: 661 adults with TBI completed the RPQ at approximately one month post injury. Exploratory factor analysis (EFA), using the first half of the sample (n = 330), suggested a four-factor solution. This was compared with models reported in the literature with the second half of the sample (n = 331), using structural equation modelling. Trajectory of recovery across these factors was examined within subsamples at 1, 3, 6 and 12 months following TBI.Results: Inter-correlations between items were strongest for somatic, cognitive and emotional functioning items and the EFA identified a four-factor model. Fit was examined utilising bootstrapping for model comparison. The data at 1 month following TBI best fitted the four-factor model (CFI = .95, RMSEA = .060 (.049–.071) and factors had adequate internal consistency (r = .61–.89). This model appeared a good fit and clinically useful across time points to 12 months post injury.Conclusions: Data best fitted a four-factor model, identified using a rigorous statistical approach. Clinicians and clinical researchers may use this preferred model to provide more specific measurement of the severity of PCS. Future research could attempt replication within international samples.
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16
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Ruet A, Jourdan C, Bayen E, Darnoux E, Sahridj D, Ghout I, Azerad S, Pradat Diehl P, Aegerter P, Charanton J, Vallat Azouvi C, Azouvi P. Employment outcome four years after a severe traumatic brain injury: results of the Paris severe traumatic brain injury study. Disabil Rehabil 2017; 40:2200-2207. [PMID: 28521527 DOI: 10.1080/09638288.2017.1327992] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To describe employment outcome four years after a severe traumatic brain injury by the assessment of individual patients' preinjury sociodemographic data, injury-related and postinjury factors. DESIGN A prospective, multicenter inception cohort of 133 adult patients in the Paris area (France) who had received a severe traumatic brain injury were followed up postinjury at one and four years. Sociodemographic data, factors related to injury severity and one-year functional and cognitive outcomes were prospectively collected. METHODS The main outcome measure was employment status. Potential predictors of employment status were assessed by univariate and multivariate analysis. RESULTS At the four-year follow-up, 38% of patients were in paid employment. The following factors were independent predictors of unemployment: being unemployed or studying before traumatic brain injury, traumatic brain injury severity (i.e., a lower Glasgow Coma Scale score upon admission and a longer stay in intensive care) and a lower one-year Glasgow Outcome Scale-Extended score. CONCLUSION This study confirmed the low rate of long-term employment amongst patients after a severe traumatic brain injury. The results illustrated the multiple determinants of employment outcome and suggested that students who had received a traumatic brain injury were particularly likely to be unemployed, thus we propose that they may require specific support to help them find work. Implications for rehabilitation Traumatic brain injury is a leading cause of persistent disablity and can associate cognitive, emotional, physical and sensory impairments, which often result in quality-of-life reduction and job loss. Predictors of post-traumatic brain injury unemployment and job loss remains unclear in the particular population of severe traumatic brain injury patients. The present study highlights the post-traumatic brain injury student population require a close follow-up and vocational rehabilitation. The study suggests that return to work post-severe traumatic brain injury is frequently unstable and workers often experience difficulties that caregivers have to consider.
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Affiliation(s)
- Alexis Ruet
- a Service de Médecine Physique et de Réadaptation , CHU de Caen , France.,b U1077, INSERM , Caen , France
| | - Claire Jourdan
- c Service de Médecine Physique et de Réadaptation , APHP, Hôpital Raymond Poincaré , Garches , France.,d EA 4047 HANDIReSP , Université de Versailles Saint-Quentin , France
| | - Eléonore Bayen
- e Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière , Service de Médecine Physique et Réadaptation, Paris, France, Université Pierre et Marie Curie , Paris , France
| | - Emmanuelle Darnoux
- f Assistance Publique-Hôpitaux de Paris , Hôpital Ambroise Paré, Unité de Recherche Clinique (URC) , Boulogne , France.,g Centre Ressources Francilien du Traumatisme Crânien (CRFTC) , Paris , France
| | - Dalila Sahridj
- c Service de Médecine Physique et de Réadaptation , APHP, Hôpital Raymond Poincaré , Garches , France
| | - Idir Ghout
- f Assistance Publique-Hôpitaux de Paris , Hôpital Ambroise Paré, Unité de Recherche Clinique (URC) , Boulogne , France
| | - Sylvie Azerad
- f Assistance Publique-Hôpitaux de Paris , Hôpital Ambroise Paré, Unité de Recherche Clinique (URC) , Boulogne , France
| | - Pascale Pradat Diehl
- e Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière , Service de Médecine Physique et Réadaptation, Paris, France, Université Pierre et Marie Curie , Paris , France
| | - Philippe Aegerter
- f Assistance Publique-Hôpitaux de Paris , Hôpital Ambroise Paré, Unité de Recherche Clinique (URC) , Boulogne , France
| | - James Charanton
- g Centre Ressources Francilien du Traumatisme Crânien (CRFTC) , Paris , France
| | - Claire Vallat Azouvi
- d EA 4047 HANDIReSP , Université de Versailles Saint-Quentin , France.,h Antenne UEROS-SAMSAH 92-UGECAM IDF , Hôpital Raymond Poincaré , Garches , France
| | - Philippe Azouvi
- c Service de Médecine Physique et de Réadaptation , APHP, Hôpital Raymond Poincaré , Garches , France.,d EA 4047 HANDIReSP , Université de Versailles Saint-Quentin , France
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Scheenen ME, van der Horn HJ, de Koning ME, van der Naalt J, Spikman JM. Stability of coping and the role of self-efficacy in the first year following mild traumatic brain injury. Soc Sci Med 2017; 181:184-190. [DOI: 10.1016/j.socscimed.2017.03.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 03/06/2017] [Accepted: 03/12/2017] [Indexed: 10/19/2022]
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18
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The Nature and Clinical Significance of Preinjury Recall Bias Following Mild Traumatic Brain Injury. J Head Trauma Rehabil 2016; 31:388-396. [DOI: 10.1097/htr.0000000000000198] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Boulter JH, Lovasik BP, Baum GR, Frerich JM, Allen JW, Grossberg JA, Pradilla G, Ahmad FU. Implications of Isolated Transverse Process Fractures: Is Spine Service Consultation Necessary? World Neurosurg 2016; 95:285-291. [DOI: 10.1016/j.wneu.2016.08.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 08/06/2016] [Accepted: 08/08/2016] [Indexed: 10/21/2022]
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20
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Ritter AC, Wagner AK, Fabio A, Pugh MJ, Walker WC, Szaflarski JP, Zafonte RD, Brown AW, Hammond FM, Bushnik T, Johnson-Greene D, Shea T, Krellman JW, Rosenthal JA, Dreer LE. Incidence and risk factors of posttraumatic seizures following traumatic brain injury: A Traumatic Brain Injury Model Systems Study. Epilepsia 2016; 57:1968-1977. [PMID: 27739577 DOI: 10.1111/epi.13582] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2016] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Determine incidence of posttraumatic seizure (PTS) following traumatic brain injury (TBI) among individuals with moderate-to-severe TBI requiring rehabilitation and surviving at least 5 years. METHODS Using the prospective TBI Model Systems National Database, we calculated PTS incidence during acute hospitalization, and at years 1, 2, and 5 postinjury in a continuously followed cohort enrolled from 1989 to 2000 (n = 795). Incidence rates were stratified by risk factors, and adjusted relative risk (RR) was calculated. Late PTS associations with immediate (<24 h), early (24 h-7 day), or late seizures (>7 day) versus no seizure prior to discharge from acute hospitalization was also examined. RESULTS PTS incidence during acute hospitalization was highest immediately (<24 h) post-TBI (8.9%). New onset PTS incidence was greatest between discharge from inpatient rehabilitation and year 1 (9.2%). Late PTS cumulative incidence from injury to year 1 was 11.9%, and reached 20.5% by year 5. Immediate/early PTS RR (2.04) was increased for those undergoing surgical evacuation procedures. Late PTS RR was significantly greater for individuals who self-identified as a race other than black/white (year 1 RR = 2.22), and for black individuals (year 5 RR = 3.02) versus white individuals. Late PTS was greater for individuals with subarachnoid hemorrhage (year 1 RR = 2.06) and individuals age 23-32 (year 5 RR = 2.43) and 33-44 (year 5 RR = 3.02). Late PTS RR years 1 and 5 was significantly higher for those undergoing surgical evacuation procedures (RR: 3.05 and 2.72, respectively). SIGNIFICANCE In this prospective, longitudinal, observational study, PTS incidence was similar to that in studies published previously. Individuals with immediate/late seizures during acute hospitalization have increased late PTS risk. Race, intracranial pathologies, and neurosurgical procedures also influenced PTS RR. Further studies are needed to examine the impact of seizure prophylaxis in high-risk subgroups and to delineate contributors to race/age associations on long-term seizure outcomes.
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Affiliation(s)
- Anne C Ritter
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.,Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Amy K Wagner
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.,Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.,Department of Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.,Center for Neuroscience at University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Anthony Fabio
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Mary Jo Pugh
- South Texas Veterans Health Care System Polytrauma Rehabilitation Center, San Antonio, Texas, U.S.A.,Department of Epidemiology and Biostatistics, University of Texas Health Science Center San Antonio, San Antonio, Texas, U.S.A
| | - William C Walker
- Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, U.S.A
| | - Jerzy P Szaflarski
- Department of Neurology, UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - Ross D Zafonte
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Allen W Brown
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Flora M Hammond
- Carolinas Rehabilitation, Charlotte, North Carolina, U.S.A.,Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - Tamara Bushnik
- Rusk Rehabilitation, New York University School of Medicine, New York, New York, U.S.A
| | | | - Timothy Shea
- Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, Ohio, U.S.A
| | - Jason W Krellman
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Joseph A Rosenthal
- Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, Ohio, U.S.A
| | - Laura E Dreer
- Departments of Physical Medicine and Rehabilitation and Ophthalmology, The University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
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21
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Do Missing Domain Scores Compromise the Validity of the Quality of Life Inventory? BRAIN IMPAIR 2016. [DOI: 10.1017/brimp.2016.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background and aims: The Quality of Life Inventory (QOLI, Frisch, 1994) manual states that in most cases QOLI total scores are invalid when two or more of the 16-domain scores are missing. The current study aimed to investigate this guideline.Methods: Two samples were utilised consisting of 259 community-dwelling adults and 144 adults surveyed 12 months following traumatic brain injury (TBI). First, the domains of the QOLI were regressed against Quality of Life Index (QLI) total scores. Second, a series of Receiver Operator Curve analyses systematically investigated the sensitivity of QOLI scores in detecting depression, as identified by the HADS and DASS.Results: The final model predicting QLI scores comprised seven of the 16-QOLI domains, R2 = .57, and accounted for equivalent variance to the full 16-domain model, R2 = .59. With as few as seven domains, the sensitivity of QOLI scores in identifying participants with depression was very good and equivalent to the complete 16-QOLI domain total score (>76%). Similar results were observed when these analyses were replicated within the sample with TBI.Conclusions: These findings showed the QOLI was more robust to missing domain scores than the current validity guidelines stated in the scale's manual suggest. Future research could determine the core domains of the QOLI in a range of samples including adolescents and specific clinical groups.
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Multicenter validation of the Quality of Trauma Care Patient-Reported Experience Measure (QTAC-PREM). J Trauma Acute Care Surg 2016; 80:111-8. [PMID: 26683397 DOI: 10.1097/ta.0000000000000879] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Incorporating patient and family perspectives into injury care quality assessment is a necessary part of comprehensive quality improvement. However, tools to measure patient and family perspectives of injury care are lacking. Therefore, our objective was to assess the psychometric properties of the Quality of Trauma Care Patient-Reported Experience Measure (QTAC-PREM), the first measure developed to assess patient experiences with overall injury care. METHODS We conducted a prospective multicenter cohort study of adult injury patients recruited from three trauma centers. Patients or surrogates completed an acute care survey measure in the hospital and a post-acute care survey measure after hospital discharge. RESULTS Four hundred participants (78%) completed the acute care measure, and 207 (59%) completed the post-acute care measure. We identified three subscales on the acute measure and two subscales on the post-acute measure. All subscales and items had evidence of construct validity. Four subscales had good internal consistency, and three were independent predictors of participants' overall ratings of injury care quality. The majority of items demonstrated suitable test-retest reliability. Comparison of QTAC-PREM scores with those of an existing patient experience tool, the Hospital version of the Consumer Assessment of Healthcare Providers and Systems (HCAHPS), demonstrated evidence of appropriate divergent and convergent validity. CONCLUSION This study demonstrates that the QTAC-PREM is feasible to implement at trauma centers and provides evidence of validity and reliability. The tool may be useful to incorporate patient perspectives into trauma care quality measurement and improvement.
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23
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Factors influencing attrition in a multisite, randomized, clinical trial following traumatic brain injury in adolescence. J Head Trauma Rehabil 2016; 30:E33-40. [PMID: 24842589 DOI: 10.1097/htr.0000000000000059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Attrition in longitudinal research negatively affects statistical power, disrupts statistical stability, and can produce unwanted bias. OBJECTIVE To investigate factors associated with shorter length of study participation and lower rates of study completion (ie, attrition) in a large, multisite, longitudinal, randomized, clinical trial examining the efficacy of a Web-based family problem-solving treatment following traumatic brain injury (TBI) in adolescence. SETTING Five major trauma centers in the central and western regions of the United States. PARTICIPANTS Children (N = 132) aged 12 to 17 years hospitalized for complicated mild to severe TBI within the previous 6 months. RESULTS Completers had a higher primary caregiver education and higher family income than noncompleters, whereas ethnicity, latency to baseline assessment, and intervention group were not significantly associated with study completion. CONCLUSION This is the first study that has specifically examined factors of attrition in a pediatric TBI population. The results suggest that research on pediatric TBI populations may be biased toward higher-income families and highlights the importance of designing studies with increased awareness of the impact of participant demographic factors.
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Radford KA, Phillips J, Jones T, Gibson A, Sutton C, Watkins C, Sach T, Duley L, Walker M, Drummond A, Hoffman K, O'Connor R, Forshaw D, Shakespeare D. Facilitating return to work through early specialist health-based interventions (FRESH): protocol for a feasibility randomised controlled trial. Pilot Feasibility Stud 2015; 1:24. [PMID: 27965803 PMCID: PMC5154052 DOI: 10.1186/s40814-015-0017-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 05/29/2015] [Indexed: 11/29/2022] Open
Abstract
Background Over one million people sustain traumatic brain injury each year in the UK and more than 10 % of these are moderate or severe injuries, resulting in cognitive and psychological problems that affect the ability to work. Returning to work is a primary rehabilitation goal but fewer than half of traumatic brain injury survivors achieve this. Work is a recognised health service outcome, yet UK service provision varies widely and there is little robust evidence to inform rehabilitation practice. A single-centre cohort comparison suggested better work outcomes may be achieved through early occupational therapy targeted at job retention. This study aims to determine whether this intervention can be delivered in three new trauma centres and to conduct a feasibility, randomised controlled trial to determine whether its effects and cost effectiveness can be measured to inform a definitive trial. Methods/design Mixed methods study, including feasibility randomised controlled trial, embedded qualitative studies and feasibility economic evaluation will recruit 102 people with traumatic brain injury and their nominated carers from three English UK National Health Service (NHS) trauma centres. Participants will be randomised to receive either usual NHS rehabilitation or usual rehabilitation plus early specialist traumatic brain injury vocational rehabilitation delivered by an occupational therapist. The primary objective is to assess the feasibility of conducting a definitive trial; secondary objectives include measurement of protocol integrity (inclusion/exclusion criteria, intervention adherence, reasons for non-adherence) recruitment rate, the proportion of eligible patients recruited, reasons for non-recruitment, spectrum of TBI severity, proportion of and reasons for loss to follow-up, completeness of data collection, gains in face-to-face Vs postal data collection and the most appropriate methods of measuring primary outcomes (return to work, retention) to determine the sample size for a larger trial. Discussion To our knowledge, this is the first feasibility randomised controlled trial of a vocational rehabilitation health intervention specific to traumatic brain injury. The results will inform the design of a definitive trial. Trial registration The trial is registered ISRCTN Number 38581822. Electronic supplementary material The online version of this article (doi:10.1186/s40814-015-0017-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kathryn A Radford
- Division of Rehabilitation and Ageing, School of Medicine, Medical School Queen's Medical Centre, B-Floor, Nottingham, NG7 2UH UK
| | - Julie Phillips
- Division of Rehabilitation and Ageing, School of Medicine, Medical School Queen's Medical Centre, B-Floor, Nottingham, NG7 2UH UK
| | | | - Ali Gibson
- Lancashire Clinical Trials Unit, School of Health, University of Central Lancashire, Brook Building, Room 217, Preston, PR1 2HE UK
| | - Chris Sutton
- Lancashire Clinical Trials Unit, School of Health, University of Central Lancashire, Brook Building, Room 217, Preston, PR1 2HE UK
| | - Caroline Watkins
- Lancashire Clinical Trials Unit, School of Health, University of Central Lancashire, Brook Building, Room 217, Preston, PR1 2HE UK
| | - Tracey Sach
- Health Economics Group, Norwich Medical School, University of East Anglia, CD Annex 1.13, Norwich Research Park, Norwich, NR4 7TJ UK
| | - Lelia Duley
- Nottingham Clinical Trials Unit, Nottingham Health Science Partners, C Floor, South Block, QMC, Nottingham, NG7 2UH UK
| | - Marion Walker
- Division of Rehabilitation and Ageing, School of Medicine, Medical School Queen's Medical Centre, B-Floor, Nottingham, NG7 2UH UK
| | - Avril Drummond
- School of Health Sciences, University of Nottingham Queen's Medical Centre (QMC), A Floor, Nottingham, NG7 2UH UK
| | - Karen Hoffman
- Trauma Science, Royal London Hospital, Ward 12D, Whitechapel, E1 1BB London UK
| | - Rory O'Connor
- Academic Department of Rehabilitation Medicine, Leeds Institute of Molecular Medicine, University of Leeds, Level D, Martin Wing, Leeds General Infirmary, Leeds, LS1 3EX UK
| | - Denise Forshaw
- Lancashire Clinical Trials Unit, School of Health, University of Central Lancashire, Brook Building, Room 217, Preston, PR1 2HE UK
| | - David Shakespeare
- Preston Neuro-Rehab Unit, Lancashire Teaching Hospitals NHS Trust, 32A Watling St, Preston, Lancashire PR2 8DY UK
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Riley GA, Hough A, Meader LM, Brennan AJ. The course and impact of family optimism in the post-acute period after acquired brain injury. Brain Inj 2015; 29:804-12. [DOI: 10.3109/02699052.2015.1004754] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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26
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Crandall M, Rink RA, Shaheen AW, Butler B, Unger E, Zollman FS. Patterns and predictors of follow-up in patients with mild traumatic brain injury. Brain Inj 2014; 28:1359-64. [PMID: 24945097 DOI: 10.3109/02699052.2014.919533] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND This study was undertaken to identify factors that influence follow-up for patients with mild traumatic brain injury (MTBI). METHODS One hundred and ninety-nine consecutive inpatients diagnosed with MTBI at a Trauma Centre (or TC) were monitored for establishment of care with a brain injury specialist after discharge. Bivariate statistics were calculated to determine subject characteristics impacting the decision to pursue TBI-related specialty care. RESULTS One hundred and nineteen patients (59.8%) followed up with the TC for routine post-injury care. Patients who followed up were older (age >40: OR = 2.48, p = 0.01, 95% CI = 1.03-8.96) and had longer hospital lengths of stay (LOS > 3 days: OR = 2.99, p < 0.001, 95% CI = 1.33-7.67). Upon follow-up, providers identified 20 patients (16.8%) with persistent neurologic symptoms, seven (3.5%) of whom saw a brain injury specialist. Lack of insurance significantly decreased the likelihood of follow-up with the TC and/or establishment of care with a TBI specialist. (OR = 0.76, p = 0.01, 95% CI = 0.62-0.95). CONCLUSIONS Being insured was strongly predictive for follow-up at the TC and for establishing with a brain injury specialist post-MTBI. The TC post-injury visit identified MTBI patients with persistent symptoms, suggesting post-acute TC follow-up is an important venue for MTBI sequelae screening and referral.
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Affiliation(s)
- Marie Crandall
- Northwestern University Feinberg School of Medicine , Surgery, Chicago, IL , USA
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Schwarzbold ML, Diaz AP, Nunes JC, Sousa DS, Hohl A, Guarnieri R, Linhares MN, Walz R. Validity and screening properties of three depression rating scales in a prospective sample of patients with severe traumatic brain injury. ACTA ACUST UNITED AC 2014; 36:206-12. [PMID: 24770656 DOI: 10.1590/1516-4446-2013-1308] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 11/27/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the validity and utility of the Hamilton Rating Scale for Depression (HAM-D), Beck Depression Inventory (BDI), and Hospital Anxiety and Depression Scale (HADS) as screening tools for depression after severe traumatic brain injury (TBI). METHODS Forty-six consecutive survivors of severe TBI were evaluated at a median of 15 months after injury. Receiver operating characteristic (ROC) analysis was performed using HAM-D, BDI, and HADS as predictors, and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) as gold standard. RESULTS The area under the curve (AUC) for HAM-D was 0.89, and the optimal cutoff point was 7 (sensitivity 92.9%, specificity 78.1%); for the BDI, the AUC was 0.946 and the optimal cutoff point was 14 (sensitivity 92.3%, specificity 96.7%); for the HADS, the AUC was 0.947 and the optimal cutoff point was 9 (sensitivity 100%, specificity 80.7%); and for the HADS depression subscale, the AUC was 0.937 and the optimal cutoff point was 6 (sensitivity 92.9%, specificity 83.9%). There were no statistically significant differences among the AUCs. CONCLUSION Our findings support a high validity and utility for the HAM-D, BDI, and HADS as screening tools for depression in patients with severe TBI, without major changes in standard cutoff points.
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Affiliation(s)
- Marcelo L Schwarzbold
- Center of Applied Neurosciences (CeNAp), Hospital Universitário da Universidade Federal de Santa Catarina (HU-UFSC), Florianópolis, SC, Brazil
| | - Alexandre P Diaz
- Center of Applied Neurosciences (CeNAp), Hospital Universitário da Universidade Federal de Santa Catarina (HU-UFSC), Florianópolis, SC, Brazil
| | - Jean C Nunes
- Center of Applied Neurosciences (CeNAp), Hospital Universitário da Universidade Federal de Santa Catarina (HU-UFSC), Florianópolis, SC, Brazil
| | - Daniel S Sousa
- Center of Applied Neurosciences (CeNAp), Hospital Universitário da Universidade Federal de Santa Catarina (HU-UFSC), Florianópolis, SC, Brazil
| | - Alexandre Hohl
- Center of Applied Neurosciences (CeNAp), Hospital Universitário da Universidade Federal de Santa Catarina (HU-UFSC), Florianópolis, SC, Brazil
| | - Ricardo Guarnieri
- Center of Applied Neurosciences (CeNAp), Hospital Universitário da Universidade Federal de Santa Catarina (HU-UFSC), Florianópolis, SC, Brazil
| | - Marcelo N Linhares
- Center of Applied Neurosciences (CeNAp), Hospital Universitário da Universidade Federal de Santa Catarina (HU-UFSC), Florianópolis, SC, Brazil
| | - Roger Walz
- Center of Applied Neurosciences (CeNAp), Hospital Universitário da Universidade Federal de Santa Catarina (HU-UFSC), Florianópolis, SC, Brazil
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Formaini N, Taylor BC, Backes J, Bramwell TJ. Superior versus anteroinferior plating of clavicle fractures. Orthopedics 2013; 36:e898-904. [PMID: 23823047 DOI: 10.3928/01477447-20130624-20] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Plate fixation of displaced clavicle fractures has proven to be reliable and reproducible, leading to high union rates and a low rate of associated complications. However, the decision of whether to place the plate superiorly or anteroinferiorly on the clavicle has remained controversial. The authors performed a retrospective review on a consecutive series of patients who underwent plate fixation for a displaced midshaft clavicle fracture at a Level I urban trauma center. A review of surgical records identified 138 patients with a displaced midshaft clavicle fracture requiring operative stabilization. A total of 105 patients who met the inclusion criteria were included in the analysis. Both superior and anteroinferior techniques resulted in a similar time to radiographic union (12.6±4.8 vs 11.3±5.2 weeks, respectively) and identical union rates (95%). At final follow-up, patient-reported implant prominence was nearly double in patients with a retained superior plate (54% vs 29%, respectively; P=.04). No significant difference existed in mean visual analog scale score at a mean of 2.77 years postoperatively, although a significant difference existed in the Oxford Shoulder Score questionnaire, with a mean score of 41.4 in the superior group and 44.4 in the anteroinferior group (P=.008). Implant removal occurred more frequently after superior plating but was not significant. Both superior and anteroinferior clavicle plating are safe treatment methods for displaced clavicle fractures. Superior plating leads to an increased rate of patient-reported implant prominence and may prompt more requests for implant removal.
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Affiliation(s)
- Nathan Formaini
- Department of Orthopaedic Surgery, Grant Medical Center, Columbus, Ohio 43215, USA
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Skilbeck C, Dean T, Thomas M, Slatyer M. Impaired National Adult Reading Test (NART) performance in traumatic brain injury. Neuropsychol Rehabil 2013; 23:234-55. [DOI: 10.1080/09602011.2012.747968] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Langley JD, Lilley R, Wilson S, Derrett S, Samaranayaka A, Davie G, Ameratunga SN, Wyeth EH, Hansen P, Hokowhitu B. Factors associated with non-participation in one or two follow-up phases in a cohort study of injured adults. Inj Prev 2013; 19:428-33. [DOI: 10.1136/injuryprev-2012-040685] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Radford K, Phillips J, Drummond A, Sach T, Walker M, Tyerman A, Haboubi N, Jones T. Return to work after traumatic brain injury: Cohort comparison and economic evaluation. Brain Inj 2013; 27:507-20. [DOI: 10.3109/02699052.2013.766929] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Geurtsen GJ, van Heugten CM, Martina JD, Rietveld AC, Meijer R, Geurts AC. Three-year follow-up results of a residential community reintegration program for patients with chronic acquired brain injury. Arch Phys Med Rehabil 2012; 93:908-11. [PMID: 22440483 DOI: 10.1016/j.apmr.2011.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 12/05/2011] [Accepted: 12/08/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate outcomes of a residential community reintegration program 3 years after treatment on independent living, societal participation, emotional well-being, and quality of life in patients with chronic acquired brain injury and psychosocial problems hampering societal participation. DESIGN A follow-up assessment 3 years after treatment was compared with the 1-year follow-up assessment in a prospective cohort study. SETTING A tertiary rehabilitation center for acquired brain injury. PARTICIPANTS Of the 67 patients assessed at the 1-year follow-up, 63 subjects (94%; 42 men; mean age at admission to treatment 24.7y; mean time postonset 5.1y) were available at the 3-year follow-up and taken into account in the analyses. INTERVENTION A structured residential treatment program directed at improving independence in domestic life, work, leisure time, and social interactions. MAIN OUTCOME MEASURES Community Integration Questionnaire, Employability Rating Scale, living situation, school, work situation, work hours, Center for Epidemiological Studies-Depression scale, and the World Health Organization Quality of Life Scale Abbreviated (5 scales). RESULTS There were no significant differences for any of the outcome measures between the 1-year and 3-year follow-up assessment. CONCLUSIONS These results indicate that the established significant and clinically relevant improvements after a residential community reintegration program remain stable in the long term.
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Affiliation(s)
- Gert J Geurtsen
- Department for Acquired Brain Injury, Rehabilitation Medical Center Groot Klimmendaal, Arnhem, The Netherlands.
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Theadom A, Barker-Collo S, Feigin VL, Starkey NJ, Jones K, Jones A, Ameratunga S, Barber PA. The spectrum captured: a methodological approach to studying incidence and outcomes of traumatic brain injury on a population level. Neuroepidemiology 2011; 38:18-29. [PMID: 22179412 DOI: 10.1159/000334746] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 11/01/2011] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Drawing on the experience of conducting the Brain Injury Incidence and Outcomes New Zealand in the Community study, this article aims to identify the issues arising from the implementation of proposed guidelines for population-based studies of incidence and outcomes in traumatic brain injury (TBI). STUDY DESIGN AND SETTING All new cases of TBI (all ages and severities) were ascertained over a 1-year period, using overlapping prospective and retrospective sources of case ascertainment in New Zealand. All eligible TBI cases were invited to participate in a comprehensive assessment at baseline and at 1-month follow-up. RESULTS Our experience to date has revealed the feasibility of case ascertainment methods. Consultation with community health services and professionals resulted in feasible referral pathways to support the identification of TBI cases. 'Hot pursuit' methods of recruitment were essential to ensure complete case ascertainment for this population with few additional cases of TBI identified through cross-checks. CONCLUSION This review of proposed guidelines in relation to practical study methodology provides a framework for future comparable population-based epidemiological studies of TBI incidence and outcomes in developed countries.
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Affiliation(s)
- A Theadom
- National Institute for Stroke and Applied Neuroscience, School of Rehabilitation and Occupation Studies, Auckland University of Technology, Auckland, New Zealand.
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