Leigh Tooth

Prediction of community integration and vocational outcome 2-5 years after traumatic brain injury rehabilitation in Australia

OBJECTIVES To predict community integration and vocational outcomes 2-5 years after traumatic brain injury (TBI). DESIGN Multivariate correlational design incorporating retrospective data collection and questionnaire follow-up. METHODS Four hundred and forty six patients admitted to a Head Injury Unit between 1991 and 1995 were contacted. Data on predictor variables (demographic, injury severity and functional) were retrieved from hospital records. Community integration and vocational outcome was assessed by self-administered questionnaire. Two hundred and nine patients/carers completed and returned the questionnaires. Mean follow-up was 3.5 years. Data were analysed by descriptive statistics, multiple regression and discriminant analysis using SPSS. RESULTS Community integration was predicted by age, disability level and cognition. Length of PTA, cognition, disability levels, GCS, functional status, length of acute stay and prior occupation discriminated those who returned to work. A total of 46.5% returned to work with 74.5% in the same or similar jobs. CONCLUSION Long term outcomes post-TBI can be predicted by demographic, injury severity and functional status variables.

Patterns of community integration 2-5 years post-discharge from brain injury rehabilitation

Outcome after traumatic brain injury (TBI) is characterized by a high degree of variability which has often been difficult to capture in traditional outcome studies. The purpose of this study was to describe patterns of community integration 2-5 years after TBI. Participants were 208 patients admitted to a Brain Injury Rehabilitation Unit between 1991-1995 in Brisbane, Australia. The design comprised retrospective data collection and questionnaire follow-up by mail. Mean follow-up was 3.5 years. Demographic, injury severity and functional status variables were retrieved from hospital records. Community integration was assessed using the Community Integration Questionnaire (CIQ), and vocational status measured by a self administered questionnaire. Data was analysed using cluster analysis which divided the data into meaningful subsets. Based on the CIQ subscale scores of home, social and productive integration, a three cluster solution was selected, with groups labelled as working (n = 78), balanced (n = 46) and poorly integrated (n = 84). Although 38% of the sample returned to a high level of productive activity and 22% achieved a balanced lifestyle, overall community integration was poor for the remainder. This poorly integrated group had more severe injury characterized by longer periods of acute care and post-traumatic amnesia (PTA) and greater functional disability on discharge. These findings have implications for service delivery prior to and during the process of reintegration after brain injury.

Caregiver burden, time spent caring and health status in the first 12 months following stroke

Objective: To quantify time caring, burden and health status in carers of stroke patients after discharge from rehabilitation; to identify the potentially modifiable sociodemographic and clinical characteristics associated with these outcomes. Methods: Patients and carers prospectively interviewed 6 (n = 71) and 12 (n = 57) months after discharge. Relationships of carer and patient variables with burden, health status and time analysed by Gaussian and Poisson regression. Results: Carers showed considerable burden at 6 and 12 months. Carers spent 4.6 and 3.6 hours per day assisting patients with daily activities at 6 and 12 months, respectively. Improved patient motor and cognitive function were associated with reductions of up to 20 minutes per day in time spent in daily activities. Better patient mental health and cognitive function were associated with better carer mental health. Conclusions: Potentially modifiable factors such as these may be able to be targeted by caregiver training, support and education programmes and outpatient therapy for patients.

Weighted multimorbidity indexes predicted mortality, health service use, and health-related quality of life in older women

OBJECTIVE To develop indexes of multimorbidity, based on self-reported data, to predict mortality, health service use, help with activities of daily living (ADL), and health-related quality of life (HRQOL) in older women. STUDY DESIGN AND SETTING Cross-sectional survey of 10,434 women, aged 73-78 years, in the Australian Longitudinal Study of Womens Health in 1999, with mortality follow-up to 2005. For analysis, the sample was equally split into a development and validation sample. Weighted and unweighted multimorbidity indexes were developed and tested. RESULTS Outcomes ranged from 14% for mortality to 47% for specialist doctor visits. Mortality was predicted by heart disease, stroke, low iron, diabetes, cancer (nonskin), bronchitis/emphysema, and Alzheimers disease. Different patterns of morbidities were associated with the other outcomes. Weighted and unweighted multimorbidity index scores were linearly related to increasing risk of each outcome. For each outcome, the weighted scores fitted the data better and had a wider range of possible values. CONCLUSION These multimorbidity indexes predict mortality, health service use, help with ADL, and HRQOL in older women. The indexes could be used as covariates in research with weighted scores having a better chance of discriminating between patient groups than unweighted scores.

Optimal daily total end range time for contracture: resolution in hand splinting.

Reduced passive range of motion (PROM) of the joints of the hand is a common sequela of traumatic upper limb injury. Although mobilizing splinting is a common modality used by hand therapists to improve PROM, limited empirical evidence is available to guide therapist prescription. This study investigated the importance of the timing of splint application per 24-hour period, daily total end range time (TERT), via a prospective sequential clinical trial. A total of 43 subjects with joint contractures of the hand after traumatic upper limb injury were randomly allocated to one of two splint programs. Subjects in group A used their splint for less than 6 hours per day, and subjects in group B used their splint for 6 to 12 hours per day. Daily TERT was recorded by subjects in a splint diary. Passive torque range of motion (TROM) was used to measure the extent of contracture resolution over four weeks of splinting. High intrarater, interrater, and test-retest reliability of the TROM technique was established for this sample (intraclass correlation coefficients 0.993 to 0.998). Sequential analysis showed a statistically significant preference for group B, daily TERT of 6 to 12 hours per day (p < 0.05). Pretreatment joint stiffness (p = 0.162) and joint type (p = 0.463) did not influence final TROM significantly. These findings help to provide some controlled data from which therapists may base future prescription (dose) of daily TERT.

Cohort Profile Update: Australian Longitudinal Study on Women’s Health

In 1996 the Australian Longitudinal Study on Womens Health recruited a nationally representative sample of more than 40,000 women in three age cohorts, born in 1973-78, 1946-51 and 1921-26. At least six waves of 3-yearly surveys have been completed. Although the focus remains on factors affecting the health and well-being of women and their access to and use of health services across urban, rural and remote areas of Australia, the study has now been considerably expanded by linkage to other health data sets. For most women who have ever participated in the study, linked records are now available for: government-subsidized non-hospital services (e.g. all general practitioner visits); pharmaceutical prescriptions filled; national death index, including codes for multiple causes of death; aged care assessments and services; cancer registries; and, for most states and territories, hospital admissions and perinatal data. Additionally, a large cohort of women born in 1989-95 have been recruited. The data are available to approved collaborators, with more than 780 researchers using the data so far. Full details of the study materials and data access procedures are available at [http://www.alswh.org.au/].

Knowledge about pain among newly graduated occupational therapists: relevance for curriculum development.

In recent years there has been a growing awareness amongst health professionals of the need to prepare undergraduate students more adequately for practice with clients who have pain. Occupational therapists have a central role in enabling such clients to have productive lives despite pain. In this study, an examination was made of the adequacy of preparation for pain practice in graduates from one Australian occupational therapy curriculum. Recent occupational therapy graduates from the University of Queensland, Australia, who responded to a postal survey, obtained an overall 53% correct response rate to a 69-item pain knowledge and attitudes questionnaire. Results indicated the need for further education in this area, especially in the areas of pharmacological management, and pain assessment and measurement. These results were comparable to those obtained from final year occupational therapy students at Dalhousie University in Halifax, Nova Scotia prior to undertaking an elective course about pain. Follow-up interviews with a number of new graduates supported the inclusion of an elective pain course in the undergraduate occupational therapy curriculum at the University of Queensland in Australia.

Rehabilitation outcomes for brain injured patients in Australia: functional status, length of stay and discharge destination

This study describes the rehabilitation length of stay (LOS), discharge destination and discharge functional status of 149 patients admitted with traumatic brain injury (TBI) to an Australian hospital over a 5-year period. Hospital charts of patients admitted between 1993-1998 were reviewed. Average LOS over the 5-year time period was 61.8 days and only decreased nominally over this time. Longer LOS was predicted by lower admission motor FIM scores and presence of comorbidities. Mean admission and discharge motor FIM scores were 58 and 79, which represented a gain of 21 points. Higher discharge motor FIM scores were predicted by higher admission motor FIM scores and younger age. FIM gain was predicted by cognitive status and age. Most patients, 88%, were discharged back to the community, with 30% changing their living setting or situation. Changing living status was predicted by living alone and having poorer functional status on admission.

Recruitment via the Internet and social networking sites: the 1989-1995 cohort of the Australian Longitudinal Study on Women's Health.

Background Faced with the challenge of recruiting young adults for health studies, researchers have increasingly turned to the Internet and social networking sites, such as Facebook, as part of their recruitment strategy. As yet, few large-scale studies are available that report on the characteristics and representativeness of the sample obtained from such recruitment methods. Objective The intent of the study was to describe the sociodemographic and health characteristics of a national sample of young Australian women recruited mainly through the Internet and social networking sites and to discuss the representativeness of their sociodemographic, health, and lifestyle characteristics relative to the population. Methods A cohort of 17,069 women (born between 1989 and 1995) was recruited in 2012-13 for the Australian Longitudinal Study on Women’s Health. Sociodemographic characteristics (percentages, means, and 95% confidence intervals) from the online survey data were compared with women aged 18-23 years from the 2011 Australian Census. Sample data were compared by age and education level with data from the 2011-13 Australian Health Survey (AHS). Results Compared to the Australian Census data, study participants were broadly representative in terms of geographical distribution across Australia, marital status (95.62%, 16,321/17,069) were never married), and age distribution. A higher percentage had attained university (22.52%, 3844/17,069) and trade/certificate/diploma qualifications (25.94%, 4428/17,069) compared with this age group of women in the national population (9.4% and 21.7% respectively). Among study participants, 22.05% (3721/16,877) were not in paid employment with 35.18% (5931/16,857) studying 16 or more hours a week. A higher percentage of study participants rated their health in the online survey as fair or poor (rather than good, very good, or excellent) compared with those participating in face-to-face interviews in the AHS (18.77%, 3203/17,069 vs 10.1%). A higher percentage of study participants were current smokers (21.78%, 3718/17,069 vs 16.4%) and physically active (59.30%, 10,089/17,014 were classified as sufficiently active vs 48.3%) but alcohol consumption was lower (59.58%, 9865/16,558 reported drinking alcohol at least once per month vs 65.9% in the AHS). Using self-reported height and weight to determine body mass index (BMI, kg/m2), 34.80% (5901/16,956) of the cohort were classified as overweight or obese (BMI of 25 or more), compared with 33.6% respectively using measured height and weight in the AHS. Conclusions Findings indicated that using the Internet and social networking sites for an online survey represent a feasible recruitment strategy for a national cohort of young women and result in a broadly representative sample of the Australian population.

Further evidence for the agreement between patients with stroke and their proxies on the Frenchay Activities Index

Objective: To determine item, subscale and total score agreement on the Frenchay Activities Index (FAI) between stroke patients and proxies six months after discharge from rehabilitation. Design: Prospective study design. Setting/subjects: Fifty patient–proxy pairs, interviewed separately, in the patients residence. Main outcome measures: Modified FAI using 13 items. Individual FAI items, subscales and total score agreement as measured by weighted kappa and intraclass correlation coefficients (ICC). Results: Excellent agreement was found for the total FAI (ICC 0.87, 95% confidence interval (CI) 0.78–0.93), and domestic (ICC 0.85, 95% CI 0.73–0.91) and outdoor (ICC 0.87, 95% CI 0.78–0.95) subscales, with moderate agreement found for the work/leisure subscale (ICC 0.63, 95% CI 0.34–0.78). For the individual FAI items, good, moderate, fair and poor agreement was found for five, three, four and one item, respectively. The best agreement was for objective items of preparing meals, washing-up, washing clothes, shopping and driving. The poorest agreement was for participation in hobbies, social outings and heavy housework. Scoring biases associated with patient or proxy demographic characteristics were found. Female proxies, and those who were spouses, scored patients lower on domestic activities; male patients, and those who were younger, scored themselves higher on outdoor activities and higher patient FIM scores were positively correlated with higher FAI scores. Conclusions: While total and subscale agreement on the FAI was high, individual item agreement varied. Proxy scores should be used with caution due to bias.