Characteristics, Outcomes, Sex and Gender Considerations of Community-Based Physical Activity Interventions after Moderate-to-Severe Traumatic Brain Injury: Scoping Review.

OBJECTIVE: This scoping review mapped the current evidence about community-based physical activity (PA) interventions for individuals with moderate-to-severe traumatic brain injury (TBI) and identified the reported health-related outcomes, measurement tools used, and considerations given to sex and gender. METHODS: Searches were conducted in six academic databases for peer-reviewed articles (MEDLINE, EMBASE, Cochrane CENTRAL, CINAHL, SPORTDiscus, and PEDro). PRISMA Scoping Review guidelines were followed. Two reviewers independently screened articles for inclusion and extracted data for the analysis with a modified Consensus on Exercise Reporting Template (CERT). Health-related outcomes were classified with domains of the International Classification of Function, Disability and Health (ICF). RESULTS: 19 studies were identified. Seven PA intervention types were included. CERT scores varied (M = 12.74, SD = 3.51 items), with limited details for replication. ICF outcomes focused on improving body functions (74%), activities and participation (14%), environmental factors (1%), and other: not covered (11%). Only four studies (21%) stratified their results by sex or gender. CONCLUSIONS: Identified PA interventions from this review revealed common characteristics that led to improved outcomes. Proposed recommendations aim to improve future research and community practice. There is a pressing need for more sex and gender considerations in PA research after moderate-to-severe TBI.

The association between traumatic brain injury and suicide: are kids at risk?

Traumatic brain injury (TBI) in late adolescence and adulthood is associated with a higher risk of suicide; however, it is unknown whether this association is also present in people who sustained a TBI during childhood. The purpose of the present study was to determine whether experiencing a TBI during childhood is a risk factor for suicide later in life and to examine whether the risk of suicide differs by sex or injury severity. A cohort of 135,703 children aged 0-17 years was identified from the Quebec population-based physician reimbursement database in 1987, and follow-up was conducted until 2008. Of the children in this cohort, 21,047 had sustained a TBI. Using a survival analysis with time-dependent indicators of TBI, we found a higher risk of suicide for people who sustained a TBI during childhood (hazard ratio (HR) = 1.49, 95% confidence interval (CI): 1.04, 2.14), adolescence (HR = 1.57, 95% CI: 1.09, 2.26), and adulthood (HR = 2.53, 95% CI: 1.79, 3.59). When compared with less severe injuries, such as concussions and cranial fractures, more severe injuries, such as intracranial hemorrhages, were associated with a higher risk of suicide (HR = 2.18 vs. 2.77, respectively). Repeated injuries were associated with higher risks of suicide in all age groups.

Recommendations for the use of common outcome measures in pediatric traumatic brain injury research.

This article addresses the need for age-relevant outcome measures for traumatic brain injury (TBI) research and summarizes the recommendations by the inter-agency Pediatric TBI Outcomes Workgroup. The Pediatric Workgroup's recommendations address primary clinical research objectives including characterizing course of recovery from TBI, prediction of later outcome, measurement of treatment effects, and comparison of outcomes across studies. Consistent with other Common Data Elements (CDE) Workgroups, the Pediatric TBI Outcomes Workgroup adopted the standard three-tier system in its selection of measures. In the first tier, core measures included valid, robust, and widely applicable outcome measures with proven utility in pediatric TBI from each identified domain including academics, adaptive and daily living skills, family and environment, global outcome, health-related quality of life, infant and toddler measures, language and communication, neuropsychological impairment, physical functioning, psychiatric and psychological functioning, recovery of consciousness, social role participation and social competence, social cognition, and TBI-related symptoms. In the second tier, supplemental measures were recommended for consideration in TBI research focusing on specific topics or populations. In the third tier, emerging measures included important instruments currently under development, in the process of validation, or nearing the point of published findings that have significant potential to be superior to measures in the core and supplemental lists and may eventually replace them as evidence for their utility emerges.

Assessment of organizational readiness for e-health in a rehabilitation centre.

PURPOSE: The aims of this study were to assess organizational readiness for e-health among the staff of an out-patient rehabilitation centre and to identify the personal characteristics of potential users that may have influenced readiness. METHODS: A cross-sectional study was conducted with 137 clinicians, 28 managers, and 47 nonclinical staff in a rehabilitation centre in Montreal, Quebec, Canada. All participants completed a self-administered questionnaire assessing organizational readiness for e-health. The measure contained three subscales: Individual, Organizational and Technological. Data were also collected on the users' profile, use of technologies and typical response to new information. RESULTS: Generally, participants considered themselves ready to adopt e-health in their work (X = 73.8%, SD = 8.5) and they also had a favorable view of the technologies in place (X 73.8%, SD = 7.2). However, they perceived the center as being only moderately ready (X 66.6%, SD = 9.8) for e-health changes. Perceived workload and position/duties in the organization were found to have an impact on readiness for e-health. CONCLUSIONS: These results underscore the importance of addressing organizational readiness for change as a multidimensional concept. Based on these results, implementation strategies tailored to the specific profile of a rehabilitation organization were identified.

Analysis of the strengths, weaknesses, opportunities and threats of the network form of organization of traumatic brain injury service delivery systems.

UNLABELLED: Networks are an increasingly popular way to deal with the lack of integration of traumatic brain injury (TBI) care. Knowledge of the stakes of the network form of organization is critical in deciding whether or not to implement a TBI network to improve the continuity of TBI care. GOALS OF THE STUDY: To report the strengths, weaknesses, opportunities, and threats of a TBI network and to consider these elements in a discussion about whether networks are a suitable solution to fragmented TBI care. METHODS: In-depth interviews with 12 representatives of network organization members. Interviews were qualitatively analyzed using the EGIPSS model of performance. RESULTS: The majority of elements reported were related to the network's adaptation to its environment and more precisely to its capacity to acquire resources. The issue of value maintenance also received considerable attention from participants. DISCUSSION: The network form of organization seems particularly sensitive to environmental issues, such as resource acquisition and legitimacy. The authors suggest that the network form of organization is a suitable way to increase the continuity of TBI care if the following criteria are met: (1) expectations toward network effectiveness to increase continuity of care are moderate and realistic; (2) sufficient resources are devoted to the design, implementation, and maintenance of the network; (3) a network's existence and actions are deemed legitimate by community and organization member partners; and (4) there is a good collaborative climate between the organizations.

Perceptions of traumatic brain injury network participants about network performance.

BACKGROUND: Networks have been implemented within trauma systems to overcome problems of fragmentation and lack of coordination. Such networks regroup many types of organizations that could have different perceptions of network performance. No study has explored the perceptions of traumatic brain injury (TBI) network participants regarding network performance. OBJECTIVE: To document the perceptions of TBI network participants concerning the importance of different dimensions of performance and to explore whether these perceptions vary according to organization types. METHODOLOGY: Participants of network organizations were surveyed using a questionnaire based on a conceptual framework of performance (the EGIPSS framework). RESULTS: Network organizations reported dimensions related to goal attainment to be more important than dimensions related to process. Differences existed between the perceptions of various types of network organizations for some but not all domains and dimensions of performance. CONCLUSION: Network performance appears different from the performance of an individual organization and the consideration of the various organizations' perceptions in clarifying this concept should improve its comprehensiveness and its acceptability by all stakeholders.

Consensus group sessions: a useful method to reconcile stakeholders' perspectives about network performance evaluation.

BACKGROUND: Having a common vision among network stakeholders is an important ingredient to developing a performance evaluation process. Consensus methods may be a viable means to reconcile the perceptions of different stakeholders about the dimensions to include in a performance evaluation framework. OBJECTIVES: To determine whether individual organizations within traumatic brain injury (TBI) networks differ in perceptions about the importance of performance dimensions for the evaluation of TBI networks and to explore the extent to which group consensus sessions could reconcile these perceptions. METHODS: We used TRIAGE, a consensus technique that combines an individual and a group data collection phase to explore the perceptions of network stakeholders and to reach a consensus within structured group discussions. RESULTS: One hundred and thirty-nine professionals from 43 organizations within eight TBI networks participated in the individual data collection; 62 professionals from these same organisations contributed to the group data collection. The extent of consensus based on questionnaire results (e.g. individual data collection) was low, however, 100% agreement was obtained for each network during the consensus group sessions. The median importance scores and mean ranks attributed to the dimensions by individuals compared to groups did not differ greatly. Group discussions were found useful in understanding the reasons motivating the scoring, for resolving differences among participants, and for harmonizing their values. CONCLUSION: Group discussions, as part of a consensus technique, appear to be a useful process to reconcile diverging perceptions of network performance among stakeholders.

[Development of the French Canadian version of the Montgomery Borgatta caregiver burden scale]. / Développement d'une version canadienne-française du Montgomery Borgatta Caregiver Burden Scale.

Assessing the burden linked to caring for the frail elderly is becoming an important issue in rehabilitation. The purpose of this study was to translate/validate the Montgomery Borgatta Caregiver Burden Scale into French for use in Canada. This easy-to-use questionnaire evaluates aspects of burden such as objective, subjective stress and subjective demand burden. The instrument underwent: 1) parallel translation/back-translation; 2) expert's committee review leading to an experimental version; 3) pre-test to ensure wording clarity; and 4) study of psychometric properties with bilingual subjects (n = 27) and French-speaking subjects (n = 18). Results suggest that convergence between the original and the French versions is satisfactory for two of the three sub-scales of the MBCBS (ICC 0.83 & 0.96). The test-retest stability coefficients are also very good (ICC of 0.92 & 0.91), as is internal consistency (0.90, 0.66). The objective burden sub-scale correlates moderately with a measure of functional autonomy (SMAF). Results for the subjective burden scale linked to demand are, however, inadequate. All in all, two of the three sub-scales of the French-Canadian version of the Montgomery Borgatta Caregiver Burden Scale demonstrate adequate psychometric properties, thereby favouring its use in geriatric rehabilitation.

Identifying the specific needs of adolescents after a mild traumatic brain injury: a service provider perspective.

PRIMARY OBJECTIVE: To identify the specific service needs of adolescents with mild traumatic brain injury (MTBI) and those of their parents through the perspective of expert service providers as well as to compare it to the perspective of adolescents and their parents obtained in a prior study. STUDY DESIGN: Qualitative design including a focus group held with experts in the field of adolescent TBI and a validation survey of other professionals. METHODS AND PROCEDURES: Eight experts from a variety of disciplines participated in a focus group where important needs of adolescents were discussed. Results were then validated through a questionnaire to 33 professionals. MAIN OUTCOMES AND RESULTS: Experts questioned through both methods are generally in agreement and acknowledge that adolescents are unique, but they often find them challenging. Like adolescents themselves, experts identify the need for information as the most important but are wary of offering too much detail and fear that this could encourage malingering of symptoms and problems. Service providers also recognize the importance of supporting adolescents and parents when returning to activities (school and physical activities). CONCLUSIONS: The notion that teens represent a specific group of consumers of healthcare services is supported by findings in this study. These results provide important information to those involved in the structuring of service provision to adolescents following MTBI.

Previous head injury is a risk factor for subsequent head injury in children: a longitudinal cohort study.

OBJECTIVE: The objective of this study was to determine whether children who sought care for a head injury were at greater risk of having a subsequent head injury within the following 6 and 12 months compared with children who sought care for an injury other than to the head. DESIGN/SETTING: This was a longitudinal cohort study conducted in the emergency departments of 2 Montreal (Quebec, Canada) pediatric hospitals. PARTICIPANTS: The parents of 11,867 injured children aged 1 to 18 years were interviewed by telephone at 6 (n = 10,315) and 12 (n = 9486) months after their child's injury to ascertain outcome (ie, subsequent head injury) and to provide information on potential risk factors (age, gender, chronic medical condition, activity level, and socioeconomic status). MAIN OUTCOME MEASURE: The outcome of interest was a head injury requiring medical attention within the following year ascertained by parental recall or physician claims data. RESULTS: A total of 245 and 386 previously head-injured children sustained a subsequent head injury within 6 and 12 months, respectively. Children who sought care for an initial head injury (n = 3599) were at higher risk of having a subsequent head injury within 6 months than children who sought care for an injury not to the head (n = 6716). The adjusted odds ratio suggested weak confounding by age, gender, and history of previous head injury. Results were consistent on the basis of physician claims data and 12-month follow-up interview data. CONCLUSIONS: These results provide evidence that having a head injury increases a child's risk of having a subsequent head injury. Although age, gender, and history of previous head injury confound the relationship, the effect remains substantial.

Norms for 15- to 34-year-olds for different versions of the finger-to-nose test.

OBJECTIVES: To develop norms for the time to execute different versions of the finger-to-nose test (FNT) and to determine the effects of different testing procedures on performance in people aged 15 to 34 years. DESIGN: Cross-sectional. SETTING: Research center. PARTICIPANTS: Healthy subjects (149 men, 148 women; age range, 15-34 y) participated, and 36 men and 36 women were included in each of the 4 age categories studied (15-19 y, 20-24 y, 25-29 y, 30-34 y). Participants performed, in random order, 5 forms of the test in 2 positions (sitting, supine) with the right and left upper limbs (ULs). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Time (in seconds) to complete 5 cycles of movement. RESULTS: Test version and side of UL were found to affect performances; right-sided performances were faster than left-sided. Performances did not vary significantly (P>.001) with sex or among age categories; therefore, the results are presented for the group. Mean performances varied from 3.44 to 4.29 seconds. Subsequent analysis of variance (with data for each UL) showed main effects for testing position (sitting > lying) and eye condition (eyes open > eyes closed). Versions were strongly interrelated (.85

The reliability of the time to execute various forms of the finger-to-nose test in healthy subjects.

The objective of this study was to establish reliability estimates of different versions of the Finger-to-Nose test (FNT) using the generalisability theory. Generalizability theory was used to estimate the relative contribution of trials and occasions to the total measurement error and to generate reliability coefficients. Forty-two healthy adults (aged 20-63 yrs old) free of arm pain or other pathology participated. Participants performed 10 versions of the FNT during two evaluation sessions separated by a 24-hour interval. The time (s) to perform five trials of each version was recorded. The mean reliability coefficient for the one-occasion/one-trial testing situation among the test versions was 0.79 (range = 0.77-0.82). For all versions, the principal source of variance of the test performances came from the participants; minimally important sources of measurement error were also associated with occasion and the interaction effects between participants and occasion. Number of trials was not found to be an important source of error. The 10 versions of the FNT under investigation provide reliable measures of upper limb coordination among healthy adults when assessed by the one evaluator generalised across two days. These results are important to the development of norms for this measure.

Evaluating clients' perceptions of the quality of head injury rehabilitation services: development and validation of a questionnaire.

OBJECTIVE: The objective of this research was to develop a tool to assess clients' perception of the quality of head injury rehabilitation services. METHODS AND RESULTS: A questionnaire PQRS-Montreal 1.0 was developed in Montreal, Quebec using a standardized methodology that incorporated a new technique to reach consensus regarding the tool's contents. Five dimensions of care (i.e. ecological approach, client-centred approach, accessibility, quality of the service providers and continuity) and their corresponding standards were identified as pertinent to include in the tool and were subsequently validated by experts. A phase of item generation followed that led to the development of an 87-item prototype of the questionnaire. The questionnaire is to be administered during an interview and employs a 5-point rating scale. DISCUSSION AND CONCLUSION: The implications for the use of PQRS-Montreal 1.0 in the accreditation process of head injury rehabilitation services are discussed, as well as plans for future quantitative research in the development of the tool.

Reliability associated with the abstraction of data from medical records for inclusion in an information system for persons with a traumatic brain injury.

OBJECTIVE: This article presents the intra- and inter-rater reliability associated with the extraction, from medical rehabilitation charts, of data to be included in a head injury information system currently under development. METHODS: A data collection form was developed to facilitate and standardize the data extraction. Two clinicians extracted information pertaining to 231 variables of the system from 15 charts of persons receiving rehabilitation services following a head injury. RESULTS: Average percentage agreement was high and did not vary from one category of variables to the other (84-88%). Substantial intra-rater agreement (kappa = 0.66) and moderate inter-rater agreement (kappa = 0.56) were found to be associated with the extraction of the variables studied. CONCLUSIONS: The results suggest that clinicians using standardized procedures can reliably extract important data pertaining to personal history, impairments, and disabilities relating to sensorimotor function. Some potential sources of error are identified and recommendations are presented.