Validation of the International Classification of Functioning, Disability and Health Core Sets for traumatic brain injury from Australian community patient perspectives.

OBJECTIVE: To examine the validity of the Comprehensive and Brief International Classification of Functioning, Disability and Health (ICF) Core Sets for Traumatic Brain Injury for patients with traumatic brain injury living in the community in Australia. DESIGN: Qualitative methodology using focus groups and individual interviews. PATIENTS: Community-dwelling adult persons with traumatic brain injury. METHODS: Patients sustaining traumatic brain injury with post-traumatic amnesia between September 2009 and August 2013, selected from the Royal Melbourne Hospital Trauma Registry, were invited to participate in the study. Participants were asked structured questions based on the ICF framework. Digital recordings of the discussions were transcribed in full for linking to the ICF categories. RESULTS: Saturation of data was reached after 5 groups involving 21 participants. Participants identified as relevant 77.7% (n = 108/139) and 100% (n = 23/23) of the Comprehensive and Brief ICF Core Sets for traumatic brain injury, respectively. Additional ICF categories identified in 2 or more groups were: b180 "experience of self and time functions"; b250 "taste function"; b265 "touch function"; b530 "weight maintenance function"; b780 "sensation related to muscles and movement"; and d650 "caring for household objects". CONCLUSION: The study found additional ICF categories to consider and supports the use of the ICF Core Sets for traumatic brain injury in Australian adults in the community.

Factors associated with long-term functional and psychological outcomes in persons with moderate to severe traumatic brain injury.

OBJECTIVE: To examine factors impacting long-term functional and psychological outcomes in persons with moderate-severe traumatic brain injury. METHODS: A prospective cross-sectional study (n = 103) assessed the long-term (up to 5 years) impact of traumatic brain injury on participants' current activity and restriction in participation using validated questionnaires. RESULTS: Participants' median age was 49.5 years (interquartile range (IQR) 20.4-23.8), the majority were male (77%), and 49% had some form of previous rehabilitation. The common causes of traumatic brain injury were falls (42%) and motor vehicle accidents (27%). Traumatic brain injury-related symptoms were: pain/headache (47%), dizziness (36%), bladder/bowel impairment (34%), and sensory-perceptual deficits (34%). Participants reported minimal change in their physical function and cognition (Functional Assessment Measure: motor (median 102, IQR 93-111) and cognition (median 89, IQR 78-95)). Participants were well-adjusted to community-living; however, they reported high levels of depression. Factors significantly associated with poorer current level of functioning/well-being included: older age (≥ 60 years), presence of traumatic brain injury-related symptoms, a lack of previous rehabilitation and those classified in "severe disability categories" at admission. Caregivers reported high levels of strain and burden (55%). CONCLUSION: Cognitive and psychosocial problems are more commonly reported than physical disability in the longer-term. A greater focus on participation and ageing with disability in these persons is needed.

Mild traumatic brain injury presenting with delayed intracranial hemorrhage in warfarin therapy: a case report.

INTRODUCTION: Current literature estimates the risk of delayed intracranial hemorrhage as between 0.6 and 6% after mild head injury for patients on warfarin. Due to resource allocation issues, the need to actually diagnose delayed intracranial haemorrhage has been questioned, especially if it does not require surgery. The purpose of our case report is to consider the functional implications during the six months following a mild traumatic brain injury complicated by delayed intracranial hemorrhage in a patient undergoing warfarin therapy. To the best of our knowledge, the rehabilitative and functional considerations of delayed intracranial haemorrhage in head injury have not been previously described in the literature. CASE PRESENTATION: A previously independent 74-year-old Lebanese man living in Australia sustained mild traumatic brain injury following an unwitnessed fall from the height of two meters while on warfarin therapy, with an international normalized ratio of 4.2. He was found to have amnesia of the event and extensive facial bruising. His Glasgow Coma Scale score was 14 to 15 throughout observation. Following a non-diagnostic initial computerised tomography scan, a repeat scan at 24 hours from the injury identified large intracerebral, subdural and subarachnoid hemorrhages. A detailed examination demonstrated visuospatial and cognitive impairments. He required inpatient rehabilitation for three weeks, and outpatient rehabilitation for two months. By six months, he had returned to his pre-injury level of functioning, but was unable to resume driving. CONCLUSIONS: We describe rehabilitation outcomes of delayed intracranial haemorrhage and mild traumatic brain injury, with diminishing disability over six months. In our case report, the complication of the delayed intracranial haemorrhage resulted in significant activity limitations and participation restrictions, which affected the clinical management, including the need for multidisciplinary rehabilitation. The risk of delayed intracranial haemorrhage in mild head injury remains a significant problem requiring further research.

A comparison of participation outcome measures and the International Classification of Functioning, Disability and Health Core Sets for traumatic brain injury.

OBJECTIVE: To compare the contents of participation outcome measures in traumatic brain injury with the International Classification of Functioning, Disability and Health (ICF) Core Sets for traumatic brain injury. METHOD: A systematic search with an independent review process selected relevant articles to identify outcome measures in participation in traumatic brain injury. Instruments used in two or more studies were linked to the ICF categories, which identified categories in participation for comparison with the ICF Core Sets for traumatic brain injury. RESULTS: Selected articles (n = 101) identified participation instruments used in two or more studies (n = 9): Community Integration Questionnaire, Craig Handicap Assessment and Reporting Technique, Mayo-Portland Adaptability Inventory-4 Participation Index, Sydney Psychosocial Reintegration Scale Version-2, Participation Assessment with Recombined Tool-Objective, Community Integration Measure, Participation Objective Participation Subjective, Community Integration Questionnaire-2, and Quality of Community Integration Questionnaire. Each instrument was linked to 4-35 unique second-level ICF categories, of which 39-100% related to participation. Instruments addressed 86-100% and 50-100% of the participation categories in the Comprehensive and Brief ICF Core Sets for traumatic brain injury, respectively. CONCLUSION: Participation measures in traumatic brain injury were compared with the ICF Core Sets for traumatic brain injury. The ICF Core Sets for traumatic brain injury could contribute to the development and selection of participation measures.