Research Priorities for Optimizing Long-term Community Integration after Brain Injury.

OBJECTIVE: This paper reports on a funded summit, which convened a multidisciplinary group of experts to provide consensus on the research priorities necessary for improving long-term community integration of individuals with traumatic brain injury (TBI) and their caregivers. METHODS: The 2-day summit was directed using the World Café Methodology, to engage stakeholders and collaboratively arrive at a consensus on the problems to be targeted in research. Participants (n=54), drawn from two Canadian provinces, included an interdisciplinary group of researchers, clinicians, representatives from brain injury associations, individuals with TBI, and caregivers. In small groups, participants discussed challenges to long-term community integration and potential initiatives that would address these barriers. Field notes from the discussions were analyzed using qualitative content analysis. RESULTS: The consensus on prioritized research directions included developing interventions to optimize the functioning and participation of individuals with TBI, reducing caregiver burden, and evaluating how emerging technology can facilitate delivery of care. CONCLUSIONS: The World Café Methodology was an effective method for developing research priorities. The breadth of expertise of participants and the collegial environment allowed for the identification of a broad perspective on important future research directions with potential to enhance the long-term community integration of individuals with brain injury.

The IADL profile: development, content validity, intra- and interrater agreement.

BACKGROUND: Occupational therapists are frequently asked to document the interplay between individuals' neuropsychological deficits and the requirements of their daily lives. PURPOSE: The present study was designed to develop and validate a measure of independence in everyday functioning that considers recent advances in research regarding the ecological assessment of executive functions. METHOD: Experts (n=8) judged the IADL Profile's content validity and the tool was pilot tested with the target population (n=8). To document the tool's reliability, 30 patients aged 16 to 65 with moderate or severe TBI were recruited. A trained examiner administered the IADL Profile, and three trained judges rated video recordings on two occasions. RESULTS: An eight-task (29-item) test was developed. Comparing ratings of four raters, 95 percent of kappa coefficients indicated moderate to almost perfect agreement, and 94% showed almost perfect intrarater agreement. IMPLICATIONS: The IADL Profile provides occupational therapists with a set of measures of IADL independence with strong preliminary evidence of reliability.