The predictors of proxy- and self-reported quality of life among individuals with acquired brain injury.

PURPOSE: Acquired brain injury (ABI) diminishes quality of life (QoL) of affected individuals and their families. Fortunately, new multidimensional instruments such as the calidad de vida en daño cerebral (CAVIDACE) scale are available. However, differences in self- and proxy-reported QoL remain unclear. Therefore, this study examined these differences and identified predictors of QoL among individuals with ABI. MATERIALS AND METHODS: This cross-sectional study comprised 393 adults with ABI (men: 60%; Mage= 54.65, SD = 14.51). Self-, family-, and professional-reported QoL were assessed using the CAVIDACE scale. Other personal and social variables were assessed as predictors of QoL. RESULTS: Professionals had the lowest QoL scores (M = 1.88, SD = 0.45), followed by family members (M = 2.02, SD = 0.44) and individuals with ABI (M = 2.10, SD = 0.43). Significant differences were found for almost all QoL domains, finding the highest correlations between family and professional proxy measures (r = 0.63). Hierarchical regression analysis revealed that sociodemographic, clinical, rehabilitation, personal, and social variables were significant predictors of QoL. CONCLUSIONS: It is necessary to use both self- and proxy-report measures of QoL. Additionally, the identification of the variables that impact QoL permits us to modify the interventions that are offered to these individuals accordingly.Implications for rehabilitationAcquired brain injury (ABI) causes significant levels of disability and affects several domains of functioning, which in turn can adversely affect quality of life (QoL).QoL is a multidimensional construct that is affected by numerous factors: sociodemographic, clinical, personal, social, etc; and also, with aspects related to the rehabilitation they receive after ABI.Rehabilitation programs should address the different domains of functioning that have been affected by ABI.Based on research findings about the QoL's predictors, modifications could be made in the rehabilitation process; paying special attention to the depressive- and anosognosia process, as well as the importance of promoting social support, community integration, and resilience.

Longitudinal study of quality of life in acquired brain injury: A self- and proxy-report evaluation / Estudio longitudinal de la calidad de vida en daño cerebral adquirido: autoinforme e informe de otros

After an acquired brain injury (ABI), the person remains with several impairments and disabilities that cause a decrease in his/her quality of life (QoL), which could change over time. The objective of the study was to analyse the evolution patterns of QoL in a sample of persons with ABI for one-year as well as the differences in proxy- and self-report versions of a QoL instrument. Method: The sample comprised 402 persons with ABI with ages ranging between 18 and 91 years, whom 36.20% had had the accident recently (i.e., three years or less). Patients, professionals and relatives responded at three evaluation points to the CAVIDACE scale, an ABI-specific QoL tool. Results: ANOVAs showed an improvement in QoL in the two follow-ups; the improvement was especially significant in the period between baseline and six months. The respondent factor did not interact with the evaluation time, but significant differences were found between respondents, with scores of patients higher than that for proxies. Finally, the QoL’s evolution interacts with the time elapsed since injury, showing significant improvements in the most recent group (i.e., three years or less). Conclusions: QoL must be considered from the earliest moments after ABI to obtain more significant improvements. (AU)

Después del daño cerebral adquirido (DCA), la persona permanece con secuelas y discapacidades severas que pueden causar una disminución de su calidad de vida (CV) variable a lo largo del tiempo. El objetivo de este estudio es analizar los cambios en la CV a lo largo de un año, así como las diferencias entre las versiones autoinforme y heteroinforme de un instrumento de CV. Método: La muestra estuvo compuesta por 402 personas con DCA, con edades entre 18 y 91 años, de quiénes el 36,20% había tenido el accidente recientemente (tres años o menos). Pacientes, profesionales y familiares respondieron en los tres momentos de evaluación a la escala CAVIDACE, un instrumento específico para DCA. Resultados: Los ANOVAs mostraron una mejoría en muchas de las dimensiones de CV en ambos seguimientos, especialmente significativa entre la línea base y los seis meses. Los pacientes puntuaron más alto que el resto de evaluadores, pero este factor no mostró interacción con el momento de evaluación. Finalmente, la evolución de la CV interactuó con el tiempo transcurrido desde el DCA, encontrándose mejorías en el grupo con menor recorrido. Conclusiones: La CV debe ser tenida en cuenta desde los primeros momentos tras el DCA para obtener mejorías más significativas. (AU)

Longitudinal study of quality of life in acquired brain injury: A self- and proxy-report evaluation.

After an acquired brain injury (ABI), the person remains with several impairments and disabilities that cause a decrease in his/her quality of life (QoL), which could change over time. The objective of the study was to analyse the evolution patterns of QoL in a sample of persons with ABI for one-year as well as the differences in proxy- and self-report versions of a QoL instrument. METHOD: The sample comprised 402 persons with ABI with ages ranging between 18 and 91 years, whom 36.20% had had the accident recently (i.e., three years or less). Patients, professionals and relatives responded at three evaluation points to the CAVIDACE scale, an ABI-specific QoL tool. RESULTS: ANOVAs showed an improvement in QoL in the two follow-ups; the improvement was especially significant in the period between baseline and six months. The respondent factor did not interact with the evaluation time, but significant differences were found between respondents, with scores of patients higher than that for proxies. Finally, the QoL's evolution interacts with the time elapsed since injury, showing significant improvements in the most recent group (i.e., three years or less). CONCLUSIONS: QoL must be considered from the earliest moments after ABI to obtain more significant improvements.

Después del daño cerebral adquirido (DCA), la persona permanece con secuelas y discapacidades severas que pueden causar una disminución de su calidad de vida (CV) variable a lo largo del tiempo. El objetivo de este estudio es analizar los cambios en la CV a lo largo de un año, así como las diferencias entre las versiones autoinforme y heteroinforme de un instrumento de CV. Método: La muestra estuvo compuesta por 402 personas con DCA, con edades entre 18 y 91 años, de quiénes el 36,20% había tenido el accidente recientemente (tres años o menos). Pacientes, profesionales y familiares respondieron en los tres momentos de evaluación a la escala CAVIDACE, un instrumento específico para DCA. Resultados: Los ANOVAs mostraron una mejoría en muchas de las dimensiones de CV en ambos seguimientos, especialmente significativa entre la línea base y los seis meses. Los pacientes puntuaron más alto que el resto de evaluadores, pero este factor no mostró interacción con el momento de evaluación. Finalmente, la evolución de la CV interactuó con el tiempo transcurrido desde el DCA, encontrándose mejorías en el grupo con menor recorrido. Conclusiones: La CV debe ser tenida en cuenta desde los primeros momentos tras el DCA para obtener mejorías más significativas.

Predictive Factors of Self-Reported Quality of Life in Acquired Brain Injury: One-Year Follow-Up.

Background: The sequelae and disabilities that follow an acquired brain injury (ABI) may negatively affect quality of life (QoL). The main objective of the study is to describe the QoL after an ABI and identify the predictors of a better QoL. Methods: Prospective cohort study with follow-up measurement after one-year. The sample comprised 203 adults with ABIs (64% male) aged 18-86 years (M = 53.01, SD = 14.44). Stroke was the main etiology of the injury (55.7%), followed by a TBI (32.8%), and the average time since injury was 8 years (M = 8.25, SD = 7.83, range = 0.5-47.5). Patients assessed their QoL through the scale Calidad de Vida en Daño Cerebral (CAVIDACE self-reported version; "quality of life in brain injury" in English), an ABI-specific tool based on the eight-domain QoL model. Other variables measured were: depression, self-awareness, community integration, resilience, and social support at baseline and one-year follow-up. Results: The studied factors showed few significant changes over time. The analyses showed statistically significant differences in QoL scores in several sociodemographic (age, civil status, education, legal capacity, and dependency), injury-related (time, location, and comorbidity), rehabilitation, and personal-social variables (self-awareness, depression, social support, resilience, and community integration). The levels of dependency, depression, and satisfaction with social support were independent predictors of the total QoL score one-year follow-up. Conclusions: QoL after ABI depends on multiple elements that must be considered. There are factors such as satisfaction with social support, depression, community integration, and resilience that must be monitored throughout the rehabilitation process.

Adaptation and validation of the self-report version of the scale for measuring quality of life in people with acquired brain injury (CAVIDACE).

PURPOSE: The disability and resulting dependence after acquired brain injury (ABI) significantly reduces quality of life (QoL), making the correct assessment of QoL important. However, the instruments currently used to assess QoL are either reductionist, including only health-related aspects, or, like the CAVIDACE scale, are based on multidimensional models but ignore the individual's perspective. Therefore, the purpose of this study is to validate the self-report version of the CAVIDACE scale. METHOD: The sample consisted of 345 adults with ABI aged between 18 and 91 years (M = 54.83; SD = 14.91). The participants' QoL was evaluated by professionals and family members and by the participants themselves, using the original version of the CAVIDACE scale and an adapted self-report version. The following complementary variables were also measured: social support, depression, community integration, and resilience. RESULTS: The results supported the internal structure of the scale based on the theoretical model. According to this model, QoL is composed of eight first-order intercorrelated domains (RMSEA = 0.050, CFI = 0.891, TLI = 0.881). The internal consistency, determined by omega rank, was adequate in seven of the eight domains, ranging between 0.66 (PW) and 0.87 (SI). The convergent and discriminant validity of the scale was very good overall. CONCLUSIONS: The self-report version of the CAVIDACE was demonstrated to be a specific instrument with very good psychometric properties and is a very useful complement in the assessment of QoL in people with ABI.

Relationships between leisure participation and quality of life of people with developmental disabilities.

BACKGROUND: Studies of people with developmental disabilities suggest that participation in leisure activities might be a key factor for good quality of life. This study explores the relationships between objective and subjective quality of life and leisure participation of adults with developmental disabilities. MATERIALS AND METHODS: A cross-sectional design was used with a convenience sample of 125 people, aged 17-65, living in the community. Participants completed the subjective scale of Integral Quality Scale and the Leisure Assessment Inventory in the form of an individual interview. Staff completed the GENCAT Scale. RESULTS: No relationship was found between objective quality of life and leisure participation. However, correlations between some leisure participation dimensions and specific subjective quality of life domains were observed. The results establish a predictive relationship between leisure participation and material, emotional, and physical well-being. Personal and environmental variables analyzed were not found to have a moderating effect on the relationship between leisure participation and quality of life. CONCLUSIONS: These findings indicate that some aspects of leisure participation may significantly contribute to enhancing the quality of life of young people and adults with developmental disabilities living in the community.

Vigour and dedication in nursing professionals: towards a better understanding of work engagement.

AIM: This paper analyses the association between nurses' individual characteristics, job features and work engagement. BACKGROUND: Current shortage of nurses and turnover justify more research efforts on job satisfaction. Closely associated with job satisfaction is work engagement, a construct which is composed of vigour, dedication and absorption, and requires more empirical evidence supporting its relevance. Most of the studies focus on organizational features, while reducing the relevance of individual characteristics. METHOD: Survey data for this descriptive, correlational study were collected over a 7-month period (2006-2007) from a convenience sample of 412 Nurses. Measures utilized were the Work Engagement Survey, the General Health Questionnaire, and an ad hoc survey. RESULTS: Concerning psychiatric morbidity, 49% nurses met criteria for somatic symptoms, 65.5% met criteria for anxiety and insomnia, 4.6% met criteria for social dysfunction and 10% met criteria for severe depression. There were no effects for length of service or professional category. Nurse managers scored significantly higher in several job stressors compared with other groups. Concerning engagement, 33% of the nurses experienced high dedication, 20.4% experienced high vigour and 36.7% experienced high absorption. Predictors of vigour and dedication were satisfaction with job position, higher quality of working life, lower social dysfunction and lower stress associated with patient care. CONCLUSIONS: Strategies to promote work engagement should be implemented. More attention should be paid to job environments to guarantee job satisfaction. Organizational strategies to reduce the stress associated with patients' care, and initiatives to improve social and communication skills are also required for nurses to experience vigour and dedication.