ABSTRACT
OBJECTIVES: To document service utilization by people with a traumatic brain injury at different times postinjury and to identify factors that predict service use. DESIGN: Cross-sectional study design. Four groups of subjects were randomly selected from a regional database, according to their time postinjury: 6-18 months; 2-4 years; 6-9 years; and 10-17 years. SUBJECTS: A total of 119 adults with a traumatic brain injury (TBI). SETTING: Hospital and community-based clients in Sydney, Australia. OUTCOME MEASURES: Glasgow Outcome Scale, Disability Rating Scale; Functional Independence Measure; Lidcombe Psychosocial Disability Scale; number, type, and frequency of services used in the previous 12 months. RESULTS: Subjects in all four groups used a variety of services. The mean number of services used was 4.2, and there was only a moderate decline in service use over time. The use of medical and allied health services remained high in all four groups. Severity of injury, physical and cognitive disability, and psychosocial disability were all predictors of service utilization. Psychosocial disability was strongly associated with ongoing service utilization. CONCLUSION: In this study, people with TBI used services well beyond the early stage of recovery. Psychosocial disability may be a better predictor of service use than physical and cognitive disability alone.
Subject(s)
Brain Injuries/therapy , Health Services/statistics & numerical data , Activities of Daily Living , Adult , Cross-Sectional Studies , Disabled Persons , Female , Forecasting , Glasgow Outcome Scale , Health Care Surveys , Humans , Injury Severity Score , Male , Needs Assessment , New South Wales , Regression Analysis , Time FactorsABSTRACT
OBJECTIVES: To determine the psychometric properties of the Sydney Psychosocial Reintegration Scale (SPRS), an instrument developed to quantify disability and handicap in persons with traumatic brain injury (TBI). DESIGN: Descriptive correlational study. SETTING: Brain Injury Rehabilitation Unit and Brain Injury Outpatient Clinic. PARTICIPANTS: Two samples, a "subacute" group (n = 20) and a "long-term" group (n = 40), were studied to examine responsiveness (subacute group), reliability, and validity (long-term group) of the SPRS. MAIN OUTCOME MEASURE: The SPRS is a 12-item questionnaire measuring three domains of everyday living commonly disrupted after severe TBI: occupational activities, interpersonal relationships, and independent living skills. PROCEDURE: Patients in the subacute group were rated with the SPRS by a clinician at admission to the rehabilitation unit and again three months later or at discharge from the unit (whichever occurred first). For individuals from the long-term group attending the outpatient clinic, a close relative was interviewed with the SPRS and other validating measures. The SPRS was readministered one month later. RESULTS: Internal consistency of the SPRS was high (alpha coefficient = .90), as was agreement between raters and stability over a one-month period (r(i) = .95 and .90, respectively). Reliability and stability coefficients for the three domains of the scale were also high, ranging from.86 to.94 for reliability and.77 to.93 for stability. Preliminary evidence for construct validity was established with a number of standard instruments, with evidence of both convergent and discriminant construct validity from the Sickness Impact Profile (SIP). The SPRS was sensitive to group differences on the Glasgow Outcome Scale (GOS) and to changes occurring during the period of active recovery. CONCLUSIONS: The results suggest that the SPRS has sound psychometric properties, being a reliable, stable, sensitive, and valid instrument. It is potentially useful in both clinical and research settings.
