E. Jean C. Hay-Smith

A systematic review of psychological treatments for mild traumatic brain injury: An update on the evidence

Mild traumatic brain injury (MTBI) is common and results in persisting disability for a minority of cases. Evidence guiding clinical management of this more complex group is lacking. This study systematically reviews psychological/neuropsychological treatments for adults with MTBI, with an emphasis on external validity. A total of 8 further studies were found adding to 10 from previous reviews. Although the methodological quality remains poor, mild supportive evidence was found for educational interventions provided early following injury. However, the routine provision of interventions for all MTBI cases may not be effective. Continuing and novel research efforts are needed to identify factors associated with poor outcomes to enable efficient targeting of healthcare resources.

Associations between illness perceptions, coping styles and outcome after mild traumatic brain injury: Preliminary results from a cohort study

Purpose: The objective of this study was to examine associations between injury perceptions, coping, distress and outcome after mild traumatic brain injury (MTBI). Design: A prospective observational study with repeated measures. This study reports results from the first of two study visits. Participants: Participants (n = 147) were recruited within 3 months following presentation to a concussion clinic or an emergency department setting. Methods: Clinical and demographic information was collected and participants completed a range of questionnaires (Revised Illness Perceptions Questionnaire, Brief COPE, Rivermead Post-Concussion Symptoms Questionnaire, Rivermead Follow-Up Questionnaire and HADS). Associations between independent variables and outcome were examined using odds ratios and 95% confidence intervals. Results: Preliminary results suggested participants endorsing stronger beliefs about the injury identity (p < 0.05) and emotional impact (p < 0.01) had significantly greater odds of poor outcome at 3 months. There were also associations between higher educational attainment (p < 0.05), using active coping strategies (p < 0.06) and poor outcome. Conclusions: These variables appeared important determinants of outcome early after MTBI and may help identify those at risk for slow recovery. Current reassurance-based interventions may be improved by targeting such variables.

Incontinence-specific quality of life measures used in trials of treatments for female urinary incontinence: a systematic review

This systematic review examined the use of incontinence-specific quality of life (QOL) measures in clinical trials of female incontinence treatments, and systematically evaluated their quality using a standard checklist. Of 61 trials included in the review, 58 (95.1%) used an incontinence-specific QOL measure. The most commonly used were IIQ (19 papers), I-QoL (12 papers) and UDI (9 papers). Eleven papers (18.0%) used measures which were not referenced or were developed specifically for the study. The eight QOL measures identified had good clinical face validity and measurement properties. We advise researchers to evaluate carefully the needs of their specific study, and select the QOL measure that is most appropriate in terms of validity, utility and relevance, and discourage the development of new measures. Until better evidence is available on the validity and comparability of measures, we recommend that researchers consider using IIQ or I-QOL with or without UDI in trials of incontinence treatments.

Pelvic floor muscle training for prevention and treatment of urinary and fecal incontinence in antenatal and postnatal women: a short version Cochrane review.

Pelvic floor muscle training (PFMT) is commonly recommended during pregnancy and after birth both for prevention and the treatment of incontinence.

The final piece of the puzzle to fit in: an interpretative phenomenological analysis of the return to employment in New Zealand after spinal cord injury

Purpose: Little is known about employment experience after spinal cord injury (SCI) because most research to date concentrates on employment predictors. We explored the experiences of people with SCI, and vocational rehabilitation (VR) professionals working for a VR programme, in pursuing a return to employment in New Zealand (NZ) post-SCI. Methods: Twelve people with SCI (four employed, three job-seeking, five unemployed) and six VR professionals were interviewed, and the transcripts subjected to an Interpretative Phenomenological Analysis. Results: The core meaning of employment post-SCI was to live a normal life. Work advantages were social connectedness, a sense of self-worth, earning a living, and being occupied. Employment was the zenith of rehabilitation but not the first priority post-SCI. Employment barriers and facilitators were congruent with those found in similar studies. The role of VR was to sow the seeds of return to employment and to partner with the SCI client. Conclusions: For persons employed pre-SCI, we posit that employment identity modification is part of the return to employment process, alongside a supportive social context and networks, and adapted work environments. VR professionals may facilitate return to employment through understanding and fostering the process of employment identity modification and supporting clients to find work opportunities congruent with employment identity. Implications for Rehabilitation Employment rates after spinal cord injury (SCI) vary considerably; the average is about 35%. Being employed post-SCI is a sign to self and others of living a normal life. For previously employed persons, adaptation of employment identity is part of the return to work process. Vocational rehabilitation practice can support adaptation of employment identity and help match this with work opportunities.

Examination of outcome after mild traumatic brain injury: The contribution of injury beliefs and Leventhal's Common Sense Model

Associations between components of Leventhals common sense model of health behaviour (injury beliefs, coping, distress) and outcome after mild traumatic brain injury (MTBI) were examined. Participants (n = 147) were recruited within three months following MTBI and assessed six months later, completing study questionnaires at both visits (Illness Perceptions Questionnaire Revised, Brief COPE, Hospital Anxiety and Depression Scale). Outcome measures included the Rivermead Post-Concussion Symptoms Questionnaire and Rivermead Head Injury Follow-Up Questionnaire. Univariate and multivariate (logistic regression) analyses examined associations between injury beliefs, coping and distress at baseline, and later outcome. Participants endorsing stronger injury identity beliefs (p < .01), expectations of lasting severe consequences (p < .01), and distress (p < .01) at time one, had greater odds of poor outcome at time two. Coping styles were also associated with later outcome although variability in findings limited interpretability. Associations between psychological variables and outcome were examined and 76.5% of cases were correctly classified by the model. Consistent with Leventhals model, participant beliefs about their injury and recovery had significant associations with outcome over time. Coping also appeared to have important associations with outcome but more research is required to examine these. Current reassurance-based interventions may be improved by targeting variables such as injury beliefs, coping and adjustment soon after injury.

Factor Structure of the Brief COPE in People With Mild Traumatic Brain Injury

Objective:To investigate the factor structure and internal consistency of the Brief COPE, adapted for use with adults with mild traumatic brain injury (MTBI). Design:Prospective cohort study. Setting:Hospital based emergency department and concussion clinic. Participants:A total of 147 adults meeting diagnostic criteria for MTBI. Main Measure:Brief COPE. Analyses:The previously reported 9-factor structure of the Brief COPE was tested by using confirmatory factor analysis (CFA) and then exploratory factor analysis (EFA). The Cronbach &agr; was computed for both the original subscales and those derived from EFA. Results:The CFA provided a less than satisfactory fit for the 9-factor model. While the EFA solution was very similar to that of the original scale, the reliability of some derived subscales was low. Further analyses identified improved internal consistency with a 3-factor model reflecting approach, avoidance, and help-seeking coping styles. Conclusions:The Brief COPE has satisfactory psychometric properties for use in MTBI but may be more reliably and meaningfully interpreted using 3 dimensions/subscales rather than 9.

An examination of the factor structure of the Revised Illness Perception Questionnaire modified for adults with mild traumatic brain injury

Objective: Factors influencing outcome after mild traumatic brain injury (MTBI) remain poorly understood. In other health conditions patient illness perceptions have been associated with outcome and have provided targets for effective interventions. These have not been systematically explored in MTBI and identifying reliable and valid measures of illness perceptions in MTBI is a first step before such concepts can be explored in clinical and research settings. Method: This study investigated the factor structure and internal consistency reliability of the Illness Perceptions Questionnaire-Revised (IPQ-R) modified for MTBI in a sample of 147 adults recruited within 3 months of injury. Results: The results demonstrated a close replication of the original factor structure although there were notable exceptions likely to be specific to MTBI and potentially other acutely injured populations. Final scales showed good internal consistency although factors relating to causal attribution were less so. Conclusion: The IPQ-R (MTBI) provides an acceptable measure of key components of injury perceptions after MTBI. Minor refinements appear required if this measure is to make a contribution to research and clinical practice in injury-based populations such as MTBI.

Musculoskeletal pain and treatment choice: an exploration of illness perceptions and choices of conventional or complementary therapies

Purpose. This study explored experiences of receiving treatment for musculoskeletal pain (MSKP), particularly choices of complementary and alternative medicine (CAM) and/or conventional treatment, using the illness perception dimension of Leventhals Self-Regulatory Model as the underpinning model within the broader biopsychosocial framework of the International Classification of Functioning, Disability and Health. Method. A mixed-method study was conducted involving 17 people with MSKP. Data were collected in semi-structured interviews, using a phased approach that included the Brief Illness Perception Questionnaire and open-ended questions about experiences of managing and seeking treatment for MSKP. Questionnaire data were analysed descriptively; interview data were transcribed verbatim and analysed using the principles of Interpretative Phenomenological Analysis. Results. Analysis points to health professionals and participants as gatekeepers to treatment, with gatekeeping based on matters of power, searching for solutions, and managing day to day. The themes Role of the Gatekeeper, Swing of the Interminable Pendulum, and Solution of Soldiering On are discussed in relation to literature about health beliefs and choices of CAM or conventional treatments. Conclusions. Future research could include mixed-method designs to further explore issues of knowledge, beliefs, and control that feed into the role of gatekeepers to treatment, as well as comparing CAM choices between public and privately-funded healthcare.

The contribution of psychological factors to recovery after mild traumatic brain injury: is cluster analysis a useful approach?

Abstract Objectives: Outcomes after mild traumatic brain injury (MTBI) vary, with slow or incomplete recovery for a significant minority. This study examines whether groups of cases with shared psychological factors but with different injury outcomes could be identified using cluster analysis. Method: This is a prospective observational study following 147 adults presenting to a hospital-based emergency department or concussion services in Christchurch, New Zealand. This study examined associations between baseline demographic, clinical, psychological variables (distress, injury beliefs and symptom burden) and outcome 6 months later. A two-step approach to cluster analysis was applied (Ward’s method to identify clusters, K-means to refine results). Results: Three meaningful clusters emerged (high-adapters, medium-adapters, low-adapters). Baseline cluster-group membership was significantly associated with outcomes over time. High-adapters appeared recovered by 6-weeks and medium-adapters revealed improvements by 6-months. The low-adapters continued to endorse many symptoms, negative recovery expectations and distress, being significantly at risk for poor outcome more than 6-months after injury (OR (good outcome) = 0.12; CI = 0.03–0.53; p < 0.01). Conclusions: Cluster analysis supported the notion that groups could be identified early post-injury based on psychological factors, with group membership associated with differing outcomes over time. Implications for clinical care providers regarding therapy targets and cases that may benefit from different intensities of intervention are discussed.