Community integration and health-related quality-of-life following acquired brain injury for persons living at home.

PRIMARY OBJECTIVE: To study predictors of community integration (CI) and health-related quality-of-life (HRQoL) in a sample of Canadian adult, urban, multi-ethnic persons with acquired brain injury (ABI) receiving publicly-funded community services. Hypothesis 1 examined the predictive utility of age, ratings of disability, functioning and cognition for CI and HRQoL. Hypothesis 2 examined the correlation between CI and HRQoL. RESEARCH DESIGN: Cohort study. METHODS AND PROCEDURES: A convenience sample of community-residing clients completed measures with their care co-ordinators: Resident Assessment Instrument-Home Care (RAI-HC), Disability Rating Scale (DRS), Community Integration Questionnaire (CIQ) and the Quality-of-Life after Brain Injury Instrument (QOLIBRI). RESULTS: Regression analysis showed DRS scores explained significant variance in CIQ and QOLIBRI. Correlations also showed that cognitive skill and ADL/IADL functioning are strongly related to CI and the Daily life and autonomy QOLIBRI sub-scale. The CIQ Total was not correlated with QOLIBRI Total, although there were some significant correlations between the CIQ social sub-scale and QOLIBRI. CONCLUSIONS: Lesser degree of disability is a key predictor of greater CI and QoL. The present findings suggest that rehabilitation efforts should focus on minimizing disability and promoting social integration and involvement to avoid adverse long-term effects of ABI for community-resident persons.

Participation in a social and recreational day programme increases community integration and reduces family burden of persons with acquired brain injury.

PRIMARY OBJECTIVE: To describe and evaluate a new day programme for persons living with an acquired brain injury (ABI), including persons exhibiting challenging behaviours. Activities were designed to reduce participants' social isolation, increase participation in community activities and increase social and leisure skills. It was expected that community integration would increase and challenging behaviours and family burden would decrease for day programme participants. METHODS AND PROCEDURES: Pre-post convenience sample design. Sixty-one participants and family members completed questionnaires before starting the day programme and after 6-month participation. MEASURES: Community Integration Questionnaire, Overt Behaviour Scale, Burden Assessment Scale, Goal Attainment Scaling. RESULTS: Participants had increased community integration (p = 0.000) and decreased family burden (p = 0.006). There was a trend to decreased severity of challenging behaviour. Participants and family members were very satisfied. Results suggest that the programme was effective in reducing participants' social isolation and increasing appropriate interpersonal behaviours. CONCLUSIONS: Participation increased community integration and reduced burden on family caregivers. ABI day programmes help fill the void left after other rehabilitation services end and provide survivors with opportunities to engage in a variety of activities. Persons living with ABI have need for ongoing social, recreational and life skill coaching services after formal rehabilitation has been completed.

Differential profiles for patients with traumatic and non-traumatic brain injury.

OBJECTIVE: To profile the demographic, clinical and environmental characteristics of persons with acquired brain injury receiving inpatient rehabilitation services in Canada. DESIGN: This study utilizes data from the Canadian Institute for Health Information's National Rehabilitation Reporting System, between April 2001 and March 2006. The data were collected from publicly insured institutions providing inpatient rehabilitation across Canada. The main outcome measures examined were demographic and clinical characteristics. PARTICIPANTS: Adults with brain injury by traumatic (n=2675) vs non-traumatic causes (n=2759). RESULTS: Approximately half of acquired brain injury patients receiving inpatient rehabilitation had non-traumatic causes of brain injury. Traumatic brain injury patients were more likely to be younger, male, from rural areas, and to make greater gains in rehabilitation. Differences were found in the types and numbers of comorbidities. However, patients from these 2 groups had similar lengths of rehabilitation stay. CONCLUSION: These findings support a differential profile of patients by brain injury aetiology. This has relevance for staff training, resource allocation and future research.

Who waits for inpatient rehabilitation services in Canada after neurotrauma? A population based-study.

OBJECTIVE: This study examined characteristics of patients with acquired brain injury associated with wait times for inpatient rehabilitation compared with a control population of patients with acquired spinal cord injury. METHODS: This cross-sectional study was based on 9458 patients captured in the National Rehabilitation Reporting System in Canada. RESULTS: Waiting for inpatient rehabilitation was found to be associated with language, geographical location, informal support, pre-admission living arrangement and payer source. The median differences in wait time, however, were at most a few days. Persons already receiving care had the longest median wait times. CONCLUSION: The data reflect only the perspective of providers, and further research needs to examine days to inpatient admission using data from acute care.

Family caregivers' support needs after brain injury: a synthesis of perspectives from caregivers, programs, and researchers.

There is a dearth of support for family members who assume caregiving responsibilities following acquired brain injury (ABI). This qualitative study broadens the understanding of ABI caregiver support needs through data triangulation from multiple interview sources across different settings. Thirty-nine caregivers across urban and rural settings in Ontario participated in focus groups. Interviews focused on ABI support services received, their utility, access barriers, needed supports, and suggestions for service delivery. Key informant interviews were also held with four US researchers funded through the TBI Model Systems, one Canadian provincial government health official, and representatives from 11 Ontario ABI programs including two brain injury associations. Interviews focused on existing or proposed caregiver programs and gaps in services. A coding framework was developed through content analysis, centring on five themes: coping, supports that worked, supports needed, barriers, and ideal world recommendations. Perspectives from those involved in receiving, providing and researching caregiver interventions following ABI were synthesized to provide a thorough, detailed depiction of the ongoing support needs of caregivers. This convergence of evidence underscores that caregiver support needs transcend geographical boundaries and must be comprehensive, accessible, long-term, and encompass education, emotional, and instrumental support. Recommendations for ABI caregiver support services are offered.