Goal Attainment in an Individually Tailored and Home-Based Intervention in the Chronic Phase after Traumatic Brain Injury

Borgen, Iren; Hauger, Solveig Lægreid; Forslund, Marit V.; Kleffelgård, Ingerid; Brunborg, Cathrine; Anđelić, Nada; Sveen, Unni; Søberg, Helene Lundgaard; Sigurðardóttir, Sólrún; Røe, Cecilie; Løvstad, Marianne

doi:10.3390/jcm11040958

Cited by 7 publications

(3 citation statements)

References 85 publications

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“…There were no sex/gender differences in either type of goal set or in their attainment in each ICF category. This is inconsistent with some previous research into TBI in which women demonstrated significantly higher goal attainment ( 39 ). However this previous study evaluated a home-based intervention, and most goals were attained, at odds with the post-acute setting and lower rates of attainment seen in the current cohort.…”

Section: Discussioncontrasting

confidence: 99%

Sex/gender differences in service use patterns, clinical outcomes and mortality risk for adults with acquired brain injury: a retrospective cohort study (ABI-restart)

Mann,

Troeung,

Martini

2023

JRM

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Objective: To identify sex/gender differences in functional, psychosocial and service use patterns in community-based post-acute care for acquired brain injury. Design: Retrospective cohort study. Subjects/patients: Adults with acquired brain injury enrolled in post-acute neurorehabilitation and disability support in Western Australia (n = 1,011). Methods: UK Functional Independence Measure and Functional Assessment Measure (FIM + FAM), Mayo-Portland Adaptability Inventory-4, goal attainment, length of stay (LOS), number of episodes of care and deaths were evaluated using routinely collected clinical and linked administrative data. Results: At admission, women were older (p < 0.001) and displayed poorer functional independence (FIM + FAM; p < 0.05) compared with men. At discharge, there were no differences in goal attainment, psychosocial function or functional independence between men and women. Both groups demonstrated functional gains; however, women demonstrated clinically significant gains (+ 15.1, p < 0.001) and men did not (+ 13.7, p < 0.001). Women and men had equivalent LOS (p = 0.205). Aboriginal and/or Torres Strait Islander status predicted longer LOS for women but not for men. Being partnered predicted reduced LOS for women but not men. Women had a higher risk of multiple episodes of care (p < 0.001), but not death (p = 0.409), compared with that of men. Conclusion: At admission to rehabilitation and disability support services for acquired brain injury, women have poorer functional independence and higher risk of multiple episodes of care, compared with men, suggesting greater disability in the community. By the time of discharge from these services, women and men make equivalent functional and psychosocial gains. The higher risk of multiple episodes of care for women relative to men suggest women may need additional post-discharge support, to avoid readmission.

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Section: Discussioncontrasting

confidence: 99%

Sex/gender differences in service use patterns, clinical outcomes and mortality risk for adults with acquired brain injury: a retrospective cohort study (ABI-restart)

Mann,

Troeung,

Martini

2023

JRM

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“…Finally, 47% of the rehabilitation cohort achieved their goals at the expected level or greater at discharge, which was significantly lower than the overall control cohort (60%), but comparable to TAP (44%). Our goal attainment rate is also higher than reported for a German post-acute inpatient rehabilitation program (31%) ( 32 ) but lower than a Norwegian home-based rehabilitation program for TBI (93%) ( 33 ). GAS scoring guidelines indicate that a goal attainment rate around 50% (or mean score of 50) is expected in large clinical populations ( 17 ), with significantly higher attainment rates suggesting that the initial goals set were too easy.…”

Section: Discussioncontrasting

confidence: 74%

Rehabilitation outcomes at discharge from staged community-based brain injury rehabilitation: A retrospective cohort study (ABI-RESTaRT), Western Australia, 2011–2020

Troeung¹,

Mann²,

Cullinan

et al. 2022

Front. Neurol.

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ObjectiveTo evaluate change in functional independence, psychosocial functioning, and goal attainment at discharge from a slow-stream Staged Community-Based Brain Injury Rehabilitation (SCBIR) service in Western Australia, 2011–2020.MethodsRetrospective cohort study of n = 323 adults with acquired brain injury (ABI) enrolled in a post-acute SCBIR service compared against a control cohort of n = 312 with ABI admitted to three non-rehabilitation programs. Outcome measures were the UK Functional Independence Measure and Functional Assessment Measure (FIM+FAM), Mayo Portland Adaptability Inventory-4 (MPAI-4), and Goal Attainment Scale. Change in FIM+FAM and MPAI-4 scores and predictors of goal attainment at discharge were evaluated using multilevel mixed-effects regression.ResultsMedian SCBIR length of stay was 20.5 months. Rehabilitation clients demonstrated clinically significant functional gains at discharge, adjusted mean change = +20.3, p < 0.001 (FIM+FAM). Peak gains of +32.3 were observed after 24–30 months and clinically significant gains were observed 5 years post-admission. Individuals discharged ≤6 months had the smallest functional gains (+12.7). Small psychosocial improvements were evidenced at discharge, mean reduction = −2.9T, p < 0.001 (MPAI-4) but not clinically significant. 47% of rehabilitation clients achieved their goals at the expected level or higher at discharge. Compared to the control, rehabilitation clients evidenced significantly greater functional gains and psychosocial improvement but lower goal attainment. Significant predictors of goal attainment at discharge were >2 years since injury, higher cognitive function and higher emotional adjustment at admission.ConclusionsFunctional recovery after ABI is a gradual and ongoing process. SCBIR is effective for functional rehabilitation post-injury but can be improved to achieve clinically meaningful psychosocial improvement.

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“…The fact that the intervention group showed within-group improvements over time on all outcome measures except the PART-O social subscale supports this interpretation. High goal attainment has been previously documented in this trial, indicating positive intervention effects at an individual level. In a future trial, it would be of interest to include measures of self-efficacy because increased self-efficacy has been proposed to be a primary factor in transfer effects of rehabilitation interventions .…”

Section: Discussionsupporting

confidence: 70%

Effect of an Individually Tailored and Home-Based Intervention in the Chronic Phase of Traumatic Brain Injury

et al. 2023

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ImportanceTraumatic brain injury (TBI) can cause long-lasting and heterogeneous difficulties that require an individually tailored approach to rehabilitation. However, high-quality studies of treatment options in the chronic phase of TBI are lacking.ObjectiveTo evaluate the effect of a home-based, individualized, and goal-oriented rehabilitation intervention in the chronic phase of TBI.Design, Setting, and ParticipantsThis study was an intention-to-treat parallel-group assessor-blinded randomized clinical trial with 1:1 randomization to an intervention or control group. Participants included adults in southeastern Norway who had sustained a TBI more than 2 years earlier, lived at home, and had ongoing TBI-related difficulties. A population-based sample of 555 individuals were invited, and 120 were included. Participants were assessed at baseline, 4 months, and 12 months after inclusion. Specialized rehabilitation therapists provided the intervention in patients’ homes or via video conference and telephone. Data collection was conducted between June 5, 2018, and December 14, 2021.InterventionsThe intervention group received an 8-session individually tailored and goal-oriented rehabilitation program over 4 months. The control group received usual care in their municipality.Main Outcomes and MeasuresPreestablished primary outcomes were disease-specific health-related quality of life (HRQOL; measured by the Quality of Life After Brain Injury [QOLIBRI] overall scale) and social participation (measured by the Participation Assessment With Recombined Tools–Objective [PART-O] social subscale). Preestablished secondary outcomes included generic HRQOL (measured by the EuroQol 5-dimension 5-level [EQ-5D-5L] questionnaire), difficulty with TBI-related problem management (target outcomes; mean severity calculated across 3 main self-identified problem areas that were individually measured using a 4-point Likert scale), TBI symptoms (measured by the Rivermead Post Concussion Symptoms Questionnaire [RPQ]), psychological distress (depression and anxiety; measured by the Patient Health Questionnaire 9-item scale and the Generalized Anxiety Disorder 7-item scale [GAD-7], respectively), and functional competency (measured by the Patient Competency Rating Scale).ResultsAmong 120 participants in the chronic phase of TBI, the median (IQR) age was 47.5 (31.0-55.8) years, and the median (IQR) time since injury was 4 (3-6) years; 85 (70.8%) were male. A total of 60 participants were randomized to the intervention group, and 60 were randomized to the control group. Between baseline and 12 months, no significant between-group effects were found for the primary outcomes of disease-specific HRQOL (QOLIBRI overall scale score: 2.82; 97.5% CI, −3.23 to 8.88; P = .30) or social participation (PART-O social subscale score: 0.12; 97.5% CI, −0.14 to 0.38; P = .29). At 12 months, the intervention group (n = 57) had significantly higher generic HRQOL (EQ-5D-5L score: 0.05; 95% CI, 0.002-0.10; P = .04) and fewer symptoms of TBI (RPQ total score: −3.54; 95% CI, −6.94 to −0.14; P = .04) and anxiety (GAD-7 score: −1.39; 95% CI, −2.60 to −0.19; P = .02) compared with the control group (n = 55). At 4 months only, the intervention group (n = 59) had significantly less difficulty managing TBI-related problems (target outcomes mean severity score: −0.46, 95% CI, −0.76 to −0.15; P = .003) compared with the control group (n = 59). No adverse events were reported.Conclusions and RelevanceIn this study, no significant results were observed for the primary outcomes of disease-specific HRQOL or social participation. However, the intervention group reported improvements in secondary outcomes (generic HRQOL and symptoms of TBI and anxiety) that were maintained at 12-month follow-up. These findings suggest that rehabilitation interventions could help patients even in the chronic phase of TBI.Trial RegistrationClinicalTrials.gov Identifier: NCT03545594

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Goal Attainment in an Individually Tailored and Home-Based Intervention in the Chronic Phase after Traumatic Brain Injury

Cited by 7 publications

References 85 publications

Sex/gender differences in service use patterns, clinical outcomes and mortality risk for adults with acquired brain injury: a retrospective cohort study (ABI-restart)

Sex/gender differences in service use patterns, clinical outcomes and mortality risk for adults with acquired brain injury: a retrospective cohort study (ABI-restart)

Rehabilitation outcomes at discharge from staged community-based brain injury rehabilitation: A retrospective cohort study (ABI-RESTaRT), Western Australia, 2011–2020

Effect of an Individually Tailored and Home-Based Intervention in the Chronic Phase of Traumatic Brain Injury

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