Employment and accommodation needs and the effect of COVID-19 on men and women with traumatic brain injury.

BACKGROUND: Traumatic brain injury (TBI) impacts an individual's workforce involvement post-injury. Support services and workplace accommodations that can help with work re-integration post-TBI may differ based on a person's sex and gender. The added impact of COVID-19 remains under-explored. OBJECTIVE: We aimed to investigate the support services and workplace accommodation needs and the impact of COVID-19 on work and mental health for persons with TBI, considering sex and gender. METHODS: A cross-sectional online survey was distributed. Descriptive and regression analyses were applied to uncover sex and gender differences, along with content analysis for open-ended responses. RESULTS: Thirty-two persons with TBI (62% women, 38% men) participated. Physiotherapy, occupational therapy, and counselling services were indicated as the most needed services by women and men. Modified hours/days and modified/different duties were the most needed workplace accommodations. Mental challenges impacting well-being was a highlighted concern for both men and women. Women scored poorer on the daily activity domain of the Quality of Life after Brain Injury - Overall Scale (p = 0.02). Assistance with daily activities was highlighted by women for a successful transition to work, including housekeeping and caregiving. Men were more likely than women to experience change in employment status because of COVID-19 (p = 0.02). Further, a higher percentage of men expressed concern about the inability to pay for living accommodations, losing their job, and not having future job prospects. CONCLUSION: Findings reveal important differences between men and women when transitioning to work post-TBI and emphasize the need for sex and gender considerations.

Addressing Transition To Work Needs For Men and Women Following Traumatic Brain Injury and COVID-19...American Congress of Rehabilitation Medicine (ACRM) Annual Conference, November 8-11, 2022, Chicago, Illinois

To investigate across sex (i.e., biological attributes) and gender (i.e., roles and responsibilities), the support services and workplace accommodation needs for men and women with traumatic brain injury (TBI), and the impact of COVID-19 on work and mental well-being. A cross-sectional study design with an online survey. Descriptive and regression analyses were completed for sex and gender differences. Open-ended responses were analyzed through a content analysis approach. Research Electronic Data Capture application of a research teaching hospital in Ontario, Canada. Adult persons with TBI were recruited nationally. Not applicable. Differences between men and women in domains of quality of life after brain injury-overall scale (QOLIBRI-OS), health support service needs, workplace accommodations, and change in employment status and mental health due to COVID-19. Thirty-two persons with TBI (62% women;38% men) completed the study. The most needed services by women and men were physiotherapy, occupational therapy, and counselling services. The most needed workplace accommodations for men and women were modified hours/days and modified/different duties. Women expressed needing help with housekeeping and caregiving to transition to work effectively. Women also scored poorer on the daily activity domain of the QOLIBRI-OS. Women were more likely to experience no change in employment status because of COVID-19, whereas men expressed concern over job security and finances. Mental well-being was a concern for both men and women. Results revealed noteworthy differences between men and women's needs post-TBI, including during the pandemic. Rehabilitation professionals can better support men and women with TBI through awareness of their specific workplace accommodation needs. No conflict to disclose.

Addressing Transition To Work Needs For Men and Women Following Traumatic Brain Injury and COVID-19

Research Objectives To investigate across sex (i.e., biological attributes) and gender (i.e., roles and responsibilities), the support services and workplace accommodation needs for men and women with traumatic brain injury (TBI), and the impact of COVID-19 on work and mental well-being. Design A cross-sectional study design with an online survey. Descriptive and regression analyses were completed for sex and gender differences. Open-ended responses were analyzed through a content analysis approach. Setting Research Electronic Data Capture application of a research teaching hospital in Ontario, Canada. Participants Adult persons with TBI were recruited nationally. Interventions Not applicable. Main Outcome Measures Differences between men and women in domains of quality of life after brain injury-overall scale (QOLIBRI-OS), health support service needs, workplace accommodations, and change in employment status and mental health due to COVID-19. Results Thirty-two persons with TBI (62% women;38% men) completed the study. The most needed services by women and men were physiotherapy, occupational therapy, and counselling services. The most needed workplace accommodations for men and women were modified hours/days and modified/different duties. Women expressed needing help with housekeeping and caregiving to transition to work effectively. Women also scored poorer on the daily activity domain of the QOLIBRI-OS. Women were more likely to experience no change in employment status because of COVID-19, whereas men expressed concern over job security and finances. Mental well-being was a concern for both men and women. Conclusions Results revealed noteworthy differences between men and women's needs post-TBI, including during the pandemic. Rehabilitation professionals can better support men and women with TBI through awareness of their specific workplace accommodation needs. Author(s) Disclosures No conflict to disclose.

The Shadow Pandemic: COVID-19 Impact on the Intersection of Intimate Partner Violence and Brain Injury...American Congress of Rehabilitation Medicine (ACRM) Annual Conference, November 8-11, 2022, Chicago, Illinois

Intimate partner violence (IPV) affects up to 1 in 3 women over their lifetime and has intensified during the COVID-19 pandemic. Although most injuries are to the head, face and neck, the intersection of IPV and brain injury (BI) remains largely unrecognized. Our main objective was to explore the impact of the COVID-19 pandemic on survivors and service providers. This project used a qualitative, participatory approach using semi-structured individual or group interviews. Interviews were conducted via videoconferencing, audio recorded, and transcribed. Transcripts were thematically analyzed by the research team to identify themes. The study took place in the general community and included participants from across Canada. Purposeful sampling through the team's national Knowledge-to-Practice (K2P) Network and snowball sampling were used to recruit 24 participants across 4 categories: survivors, executive directors/managers of organizations serving survivors, direct service providers, and employer/union representatives. N/A. N/A. COVID-19 has increased rates and severity of IPV and barriers to services, both in terms of provision and uptake. Three main themes emerged: (1) implications for women survivors of IPV/BI;(2) implications for service delivery and service providers supporting women survivors of IPV/BI;and (3) key priorities. Increased risk, complex challenges to mental health, and the impact on employment were discussed. Adaptability and flexibility of service delivery were identified as significant issues and increased outreach and adaptation of technology-based services were noted as key priorities. The COVID-19 pandemic has intensified IPV/BI, increased challenges for women survivors and service providers, and accentuated the continued lack of IPV/BI awareness. Recommendations for service delivery and uptake are discussed. Nothing to disclose.

The Shadow Pandemic: COVID-19 Impact on the Intersection of Intimate Partner Violence and Brain Injury

Research Objectives Intimate partner violence (IPV) affects up to 1 in 3 women over their lifetime and has intensified during the COVID-19 pandemic. Although most injuries are to the head, face and neck, the intersection of IPV and brain injury (BI) remains largely unrecognized. Our main objective was to explore the impact of the COVID-19 pandemic on survivors and service providers. Design This project used a qualitative, participatory approach using semi-structured individual or group interviews. Interviews were conducted via videoconferencing, audio recorded, and transcribed. Transcripts were thematically analyzed by the research team to identify themes. Setting The study took place in the general community and included participants from across Canada. Participants Purposeful sampling through the team's national Knowledge-to-Practice (K2P) Network and snowball sampling were used to recruit 24 participants across 4 categories: survivors, executive directors/managers of organizations serving survivors, direct service providers, and employer/union representatives. Interventions N/A. Main Outcome Measures N/A. Results COVID-19 has increased rates and severity of IPV and barriers to services, both in terms of provision and uptake. Three main themes emerged: (1) implications for women survivors of IPV/BI;(2) implications for service delivery and service providers supporting women survivors of IPV/BI;and (3) key priorities. Increased risk, complex challenges to mental health, and the impact on employment were discussed. Adaptability and flexibility of service delivery were identified as significant issues and increased outreach and adaptation of technology-based services were noted as key priorities. Conclusions The COVID-19 pandemic has intensified IPV/BI, increased challenges for women survivors and service providers, and accentuated the continued lack of IPV/BI awareness. Recommendations for service delivery and uptake are discussed. Author(s) Disclosures Nothing to disclose.

Feasibility and Acceptability Of An Outdoor Walking-Group Intervention For Adults With Moderate-To-Severe Traumatic Brain Injury

Research Objectives Promoting physical activity (PA) after moderate-to-severe traumatic brain injury (TBI) is challenging due to elevated PA barriers (e.g., transportation, accessibility, endurance, self-consciousness) and COVID-19-related restrictions leading to the closure of community fitness centres. There was a need to create an outdoor walking-groups to promote PA participation. Study objectives were to determine the feasibility and acceptability of an outdoor walking-group intervention for adults with moderate-to-severe TBI. Design Mixed-method feasibility study. Setting Community-based outdoor setting during COVID-19. Participants Convenience sample of 18 adults (10 male, 8 female) with moderate-to-severe TBI recruited from a community TBI association. Interventions 6-week walking intervention (60-90-minutes, 2 days per week) with progressively increased walking intensity and telehealth supports (e.g., Zoom meetings, social media page). Main Outcome Measures Feasibility outcomes included program participation, attrition, and safety. Acceptability outcomes included a program satisfaction scale and supplemental qualitative data about program experiences collected through 30-60-minute semi-structured Zoom-facilitated interviews. Results 15/18 (83%) study participants completed ≥ 9 sessions (75%). Two participants were lost to attrition, and one for unrelated medical reasons. No major adverse events were reported. Minor adverse events included fatigue and muscle soreness. All participants reported high satisfaction with the intervention (M = 9.2/10, SD = 0.9) and would recommend the walking group to others. Thematic analyses of the transcribed audio recordings identified three major themes about Program Resources, Program Delivery, and Program Efficacy. Results may be used to optimize the program for the future. Conclusions A 6-week walking-group intervention is feasible and acceptable for adults with moderate-to-severe TBI. Outcomes support the development, implementation, and evaluation of formalized walking-group interventions in the community after moderate-to-severe TBI. Implications for using PA to improve health outcomes after moderate-to-severe TBI are discussed. Author(s) Disclosures Authors have no conflicts of interest to disclose.

The Intersection of Intimate Partner Violence and Traumatic Brain Injury: Findings From an Emergency Summit Addressing System-Level Changes to Better Support Women Survivors.

BACKGROUND: Traumatic brain injury (TBI) occurring during intimate partner violence (IPV) is a largely unrecognized but significant public health crisis. One in 3 women will experience IPV in their lifetime, up to 75% of whom will sustain a TBI as a result. This article reports on the systems-level findings from a national summit to address barriers, needs, and priorities related to healthcare and support services for women survivors of IPV-TBI. OBJECTIVES: (1) To identify key needs, facilitators, and barriers to care for women survivors of IPV presenting with TBI; and (2) to cocreate ideas for resources and principles for identification, clinical care, and support for healthcare practitioners who treat women exposed to IPV and TBI. METHODS: Using a community-based participatory research approach, we engaged 30 stakeholders-drawn from a national IPV-TBI Knowledge-to-Practice (K2P) Network including diverse women survivors, service providers, researchers, and decision makers-in 2 half-day virtual meetings. Data were gathered through small group breakout sessions using semistructured discussion guides. Sessions were recorded, transcribed verbatim, and analyzed using thematic analysis techniques. Stakeholders contributed to the analysis and knowledge translation through member-checking activities. Ethics approval was obtained through the University of Toronto. FINDINGS: Three main systems-level themes arose during these discussions: (1) the need for trauma-informed, anti-racist, and equitable health and social care systems; (2) the need for cross-pollination of knowledge between disciplines; and (3) the need for systems-level support for integrated and coordinated care. This article explores these needs and provides recommendations and suggestions for paths forward. CONCLUSIONS: The findings of this project enhance understanding of system-level needs among women survivors and provide a template for a national agenda for IPV-TBI research and practice.

The Shadow Pandemic: A Qualitative Exploration of the Impacts of COVID-19 on Service Providers and Women Survivors of Intimate Partner Violence and Brain Injury.

BACKGROUND: Intimate partner violence (IPV) affects up to 1 in 3 women over their lifetime and has intensified during the COVID-19 pandemic. Although most injuries are to the head, face, and neck, the intersection of IPV and brain injury (BI) remains largely unrecognized. This article reports on unexplored COVID-19-related impacts on service providers and women survivors of IPV/BI. OBJECTIVES: To explore the impact of the COVID-19 pandemic on survivors and service providers. PARTICIPANTS: Purposeful sampling through the team's national Knowledge-to-Practice (K2P) network and snowball sampling were used to recruit 24 participants across 4 categories: survivors, executive directors/managers of organizations serving survivors, direct service providers, and employer/union representatives. DESIGN: This project used a qualitative, participatory approach using semistructured individual or group interviews. Interviews were conducted via videoconferencing, audio-recorded, and transcribed. Transcripts were thematically analyzed by the research team to identify themes. FINDINGS: COVID-19 has increased rates and severity of IPV and barriers to services in terms of both provision and uptake. Three main themes emerged: (1) implications for women survivors of IPV/BI; (2) implications for service delivery and service providers supporting women survivors of IPV/BI; and (3) key priorities. Increased risk, complex challenges to mental health, and the impact on employment were discussed. Adaptability and flexibility of service delivery were identified as significant issues, and increased outreach and adaptation of technology-based services were noted as key priorities. CONCLUSIONS: The COVID-19 pandemic has intensified IPV/BI, increased challenges for women survivors and service providers, and accentuated the continued lack of IPV/BI awareness. Recommendations for service delivery and uptake are discussed.