Outcomes of participation objective, participation subjective (POPS) measure following traumatic brain injury

Quality of life, community integration, service needs and clinical outcomes of people with traumatic brain injury in urban, regional and remote areas of Queensland, Australia

OBJECTIVE

To understand and explore the traumatic brain injury (TBI) outcomes for people returning to urban versus rural communities post-injury, and if geographical location plays a role in those outcomes.

DESIGN

Cross-sectional mail-out survey of TBI patients, using standardised, quantitative measures.

SETTING

Data were drawn from three Accessibility Remoteness Index of Australia (ARIA) areas in Queensland to model the contribution of these areas and other factors to TBI outcomes.

PARTICIPANTS

Using hospital records, 662 people with mild to severe TBI were identified. These people were sent a survey, postdischarge. Usable surveys were returned by 91 individuals, 6- to 18-months post-injury. Location was coded using the ARIA (urban n = 22, rural n = 43, remote n = 26).

MAIN OUTCOME MEASURES

TBI-related symptoms, quality of life, service obstacles, unmet needs, mental health and community integration.

RESULTS

No group differences in TBI outcomes due to location were found. While the participant's gender, age, and injury severity were significant independent predictors of five of the six outcomes, location did not play a role.

CONCLUSION

Consistent with previous findings, geographical remoteness did not affect self-reported TBI outcomes. Older people, women and those with severe TBI had worse outcomes and required additional supports, and men require community integration assistance. An Australia-wide study with regular follow-ups is strongly recommended to support direct regional comparisons and improve service planning.

Current practices and beliefs regarding supporting dating skills in rehabilitation for traumatic brain injury: a survey study

BACKGROUND

Relationships are important to quality of life after traumatic brain injury (TBI). However, there has been limited research into how to support dating skills or how professionals view this area.

METHOD

An online 52-item survey was developed and sent to professionals in the UK involved in rehabilitation after TBI. Recruitment was through professional networks, special interest groups and social media.

RESULTS

125 participants from a range of professions completed the survey. Many agreed that dating skills are important in rehabilitation (81.6%), but fewer (51.2%) reported engaging in this work. Psychologists, SLTs and OTs were identified as well placed to address dating skills. Case managers also appeared aware of this work. Participants reported using a range of activities to address dating skills, including managing disinhibited behavior and teaching interaction skills. Perceived barriers were both personal and professional, including lack of resources and feeling embarrassed.

CONCLUSION

This study has highlighted an awareness of the importance of dating in brain injury, but professionals face multiple barriers to supporting dating skills. It is possible to draw on recommendations from related areas, including rehabilitation for cognitive communication difficulties and sexual dysfunction with further research to specifically link these areas to dating skills.

Interventions that support adults with brain injuries, learning disabilities and autistic spectrum disorders in dating or romantic relationships: a systematic review

PURPOSE

To evaluate the current evidence on dating interventions, their theoretical underpinnings and effectiveness for adult neuro-atypical populations.

METHODS

A literature search was completed using CINAHL, Communication Source, PsycARTICLES, PsycINFO, SocINDEX, MEDLINE, Embase, AMED and EMB Reviews (all), for English-language, peer-reviewed studies into interventions for relationships or dating among adults with acquired brain injuries (ABI), learning disabilities or autistic spectrum disorder (ASD). Demographic data and intervention details were extracted for all included studies. Standard checklists were used for methodological quality and intervention description. Narrative synthesis for studies rating above poor quality.

RESULTS

A total of 11 studies (13 articles) were eligible, ABI (n = 6), learning disability (n = 4), ASD (n = 1). These comprised five comparison or control group studies, two pre-post studies and four case studies. The methodological quality was varied, but intervention descriptions were generally poor. While all studies reported positive outcomes, firm conclusions on their effectiveness are difficult due to the high number of before-after analyses and variation in content and outcome measures used.

CONCLUSIONS

More high-quality studies are needed to assess the effectiveness of interventions. Also, greater consensus is needed on the key behaviors for dating and relationships and the measures to assess these.IMPLICATIONS FOR REHABILITATIONIntimate relationships are important to quality of life, but challenging for many people in neuro-atypical populations.There are a small number of researched interventions to support dating or marital relationships among adults with ABI, ASD or learning disabilities.Rehabilitation professionals should ask about dating and relationships and support people if this area is identified as important.Rehabilitation professionals should consider different interventions for dating skills and marital relationships.

Testing and development of an instrument for self-report of participation and related environmental factors - Your Ideas about Participation and Environment (YIPE) among adults with brain injury

PURPOSE

To examine the usability of the self-report instrument, Your Ideas about Participation and Environment (YIPE), among adults with a brain injury by exploring the value and acceptability of the instrument.

METHODS

A qualitative descriptive research design was used for the purpose of testing and developing the YIPE for use among adults with a brain injury. The study involved administering the YIPE followed by in-depth interviewing about the experience of taking the instrument with seven adults with a brain injury, recruited through a community-based support service organization. A descriptive thematic approach was used to analyse the content of the interview data, categorize common ideas and identify areas for improvement within the instrument.

RESULTS

Participants were generally positive about the importance of the participation and environment topics and willing to engage in self report. The YIPE (2012), resulting from changes made to the language and structure, was found to be more useable, valued and accepted by these participants than the previous version, YIPE (2011).

CONCLUSIONS

The YIPE was found to be a useful tool among study participants. The YIPE topics were found to have importance and relevance when considering participants' satisfaction with areas of life and aspects of environment requiring change. More development of the tool is required in terms of the wording, format and method of administration to improve the overall usability of the instrument. Implications for Rehabilitation The preliminary results from this small sample study illustrated that people with brain injury were able to use an International Classification of Functioning, Disability and Health-based tool, and confirmed the importance of considering both participation and the environment together. People with cognitive impairments associated with brain injury reported on areas of everyday life where they were satisfied or dissatisfied. They related their satisfaction to environmental factors that were facilitators or barriers to valued everyday activities. The opportunity to choose important life areas promotes individuals' motivation to engage and enables service providers to tailor rehabilitation. In the course of the two stages of research, it was necessary to make minor modifications to the language, structure and scoring system of the tool, to simplify the task and shorten the time to interview participants.