COVID-19's impact on a community-based physical activity program for adults with moderate-to-severe TBI.

PURPOSE: Physical activity (PA) is proposed for long-term problems after traumatic brain injury (TBI) with mood, quality of life, and participation. However, COVID-19 mitigation strategies resulted in widespread closures of community-based fitness centres, including one housing a peer-assisted PA program (TBI-Health). The purpose of this study was to provide an in-depth exploration of COVID-19's impact on the TBI-Health program for adults with moderate-to-severe TBI and determine how their PA behaviours could be supported in the pandemic. METHODS: Interpretative phenomenological analysis was employed to collect and analyze data from semi-structured Zoom-facilitated interviews with seven female and nine male adults with moderate-to-severe TBI (including program participants and mentors). RESULTS: Three major themes were identified. Need for PA after TBI included specific benefits of PA after TBI and desire for an adapted PA program. Lasting Impacts of the TBI-Health Program identified belonging to the TBI-Health community, benefits, and knowledge transfer from the program. Resilience and Loss through the Pandemic comprised the repercussions of COVID-19, loss of the PA program, adapting PA to the pandemic, and resilience after TBI. CONCLUSION: This study provides insights about impacts of participating in community-based peer-assisted PA programs after moderate-to-severe TBI and ways to support PA in unforeseen circumstances.IMPLICATIONS FOR REHABILITATIONOur community-based peer-assisted physical activity program for adults with moderate-to-severe traumatic brain injury (TBI) promoted a range of daily and social activities.Outdoor group-based physical activity programs provide physical activity and social opportunities for adults with moderate-to-severe TBI when indoor physical activity is restricted.Community-based peer-assisted physical activity programs can assist with posttraumatic growth after moderate-to-severe TBI.

Misperception of sleep duration in mild traumatic brain injury/concussion: a preliminary report.

Background: Polysomnographic (PSG) findings of persons with mild traumatic brain injury (mTBI)/concussion show longer total sleep time than patients themselves report; the reason for this is not entirely clear.Objective: This study aimed to elucidate the socio-demographic, brain-injury-related, and clinical characteristics that underlie accuracy of sleep duration reporting in mTBI/concussion.Methods: Thirty-seven participants diagnosed with mTBI/concussion (57% male, 47.54 ± 11.3 years old) underwent clinical and neuroimaging examinations, full-night PSG, and estimated sleep duration following PSG.Results: Mean self-reported sleep duration was 342 ± 93.6 minutes and PSG-measured sleep duration was 382 ± 76.8 minutes. Measurements were moderately correlated (rho = 0.46, p = .004). Age associated with self- and PSG-measured sleep duration (rho = 0.34 and rho = 0.84, respectively, p < .05). Self-reported sleep duration was uniquely associated with insomnia severity (rho = -0.48, p = .002). In the fully adjusted multivariable regression analysis, several clinical characteristics of patients explained 30% of the discrepancy between self- and PSG-measured sleep duration.Conclusion: The observed results indicate that persons with mTBI do not accurately assess their sleep duration and, therefore, PSG is warranted in clinical situations where sleep duration is of concern.

Critical methodological considerations in recruiting and engaging non-native English speaking workers with a head injury: a Canadian perspective.

OBJECTIVE: Non-native English speaking workers with a mild work-related traumatic brain and/or head injury are a vulnerable and underrepresented population in research studies. The researchers present their experiences with recruiting and performing qualitative interviews with non-native English speaking individuals with a work-related mild traumatic brain injury, and provide recommendations on how to better include this vulnerable population in future research studies. This paper presents considerations regarding ethics, recruitment challenges, interview preparation and debriefing, sex & gender and language and cultural issues must be made when working with this vulnerable population. RESULTS: The researchers discuss critical issues and provide recommendations in recruiting and engaging with non-native English language workers including ethics, recruitment challenges, interview preparation and debriefing, sex & gender and language, and cultural considerations that must be made when working with this population. The study recommendations advise investigators to spend more time to learn about the non-native English participants in the mild wrTBI context, to be familiar with the vulnerabilities and specific circumstances that these workers experience. By increasing their awareness of the challenging facing this vulnerable population, the intention is to provide better care and treatment options through evidence-based research and practice.

A qualitative exploration of work-related head injury: vulnerability at the intersection of workers' decision making and organizational values.

BACKGROUND: Work-related head injury is a critical public health issue due to its rising prevalence; the association with profound disruption of workers' lives; and significant economic burdens in terms of medical costs and lost wages. Efforts to understand and prevent these types of injuries have largely been dominated by epidemiological research and safety science, which has focused on identifying risk at the level of the individual worker, population group, or organizational sector. Limited research has focused on the perspectives of the workers, a key stakeholder group for informing understanding of vulnerability to work-related head injury. This study explored workers' perspectives to better understand their decision-making and how and why their injuries occurred. METHODS: We conducted a qualitative study using in-depth semi-structured interviews with thirty-two adult workers who had sustained a work-related head injury. Workers were recruited from an urban clinic in central Ontario, Canada. Labour Process Theory informed the thematic analysis. RESULTS: Three hazardous work conditions were identified: insufficient training; inadequate staffing; and inattention to the physical environment. In addition, professional and organizational norms were implicated in vulnerability to head injury including putting the client before the worker and the pressure to work unsafely. The findings also highlight a complex interrelationship between workers' decision-making and professional and organizational norms that produces vulnerability to head injury, a vulnerability which oftentimes is reproduced by workers' decisions to work despite hazardous conditions. CONCLUSIONS: Our findings suggest that, beyond the need to redress the inattention to hazards in the physical environment, there is a need to address norms that influence worker decision-making to improve the safety of workers. Using Labour Process Theory highlights an important social dynamic within workplace sectors that could inform future development and implementation of multi-level and integrated public health strategies to reduce work-related head injury.

Level of agreement of occupational titles between persons with traumatic brain injury and their informants.

BACKGROUND: Returning to work is one of the most important goals cited by individuals with traumatic brain injury (TBI). However, they may have difficulty evoking past work history. The ability to recall work history is integral to the rehabilitation process of return to work. OBJECTIVE: The aim of this study was to determine 1) the level of agreement on the reporting of occupations and 2) if agreement is affected when specific occupational details are required in recall between adults with traumatic brain injury and their informants. METHODS: This is a retrospective cohort study of 259 individuals, with moderate to severe traumatic brain injury, and their selected informants (e.g. spouse, parent). Interviews were conducted separately for the individual and respective informant to gather information on type of occupation at time of injury and at time of interview. Reported occupations were coded using a standard classification system. Level of agreement was analyzed by interclass correlation coefficients and percent agreement, and the significance of bias was calculated. RESULTS: Participants were a mean age of 44.5 at time of study with 40% employed compared to 77% at time of injury. Agreement between participants and their informants for occupational title was high for both time periods though more so at the time of injury compared to current status. Level of agreement for specificity was moderate to high however, decreased as need for specificity of detail increased. CONCLUSION: While participant-informant responses appear to be reliable for occupational classification, when detailed information is required corroborating information is likely needed.

Factors associated with hospitalisations for ambulatory care-sensitive conditions among persons with an intellectual disability: a publicly insured population perspective.

BACKGROUND: Hospitalisations for ambulatory care-sensitive (ACS) conditions are used as an indicator of access to, and the quality of, primary care. The objective was to identify factors associated with hospitalisations for ACS conditions among adults with an intellectual disability (ID) in the context of a publicly insured healthcare system. METHODS: This study examined adults with an ID living in a Canadian province between 1999 and 2003 identified from administrative databases. Using 5 years of data for the study population, characteristics of persons hospitalised or not hospitalised for ACS conditions were compared. Using a conceptual model, independent variables were selected and an analysis performed to identify which were associated with hospitalisations for ACS conditions. The correlated nature of the observations was accounted for statistically. RESULTS: Living in a rural area [odds ratio (OR) 1.3; 95% confidence intervals (CI) = 1.0, 1.8], living in an area with a high proportion of First Nations people (OR 2.3; 95% CI = 1.3, 4.1), and experiencing higher levels of comorbidity (OR 25.2; 95% CI = 11.9, 53.0) were all associated with a higher likelihood of being hospitalised for an ACS condition. Residing in higher income areas had a protective effect (OR 0.56; 95% CI = 0.37, 0.85). None of the health service resource variables showed statistically significant associations. CONCLUSIONS: Persons with an ID experience inequity in hospitalisations for ACS conditions according to rurality, income and proportion who are First Nations in a geographic area. This suggests that addressing the socio-economic problems of poorer areas and specifically areas densely populated by First Nations people may have an impact on the number of hospitalisations for ACS conditions. Study strengths and limitations and areas for potential future research are discussed.

Post-injury symptoms after work related traumatic brain injury in Canadian population.

OBJECTIVES: To examine the nature and extent of persistent post-injury symptoms of persons who have experienced a work-related traumatic brain injury (WrTBI) in Ontario, Canada. METHODS: Using a retrospective case series design, post-injury symptoms, occupation, and work factors were examined for WrTBIs among an adult population. Data were abstracted from medical records of individuals who sustained a WrTBI and were discharged from a referral-based outpatient neurology service between the years of 1998 and 2001. RESULTS: Of the 435 individuals who sustained a WrTBI, most were ≥ 45 years of age and male. Approximately 50% had injuries to the head only, while others had multiple injuries. The most common post-injury symptoms were headaches (85.1%), memory changes (74.3%), and mood/personality changes (68.3%). A small subset of individuals reported very long-term post-injury symptoms, and a majority of individuals had not yet returned to work. CONCLUSIONS: This study profiles the demographic and clinical characteristics of an outpatient injured worker population with a history of WrTBI which provides a basis for the planning and implementation of assessment and treatment programs for this clinical population.

Hospitalisation rates for ambulatory care sensitive conditions for persons with and without an intellectual disability--a population perspective.

BACKGROUND: There is evidence that persons with an intellectual disability (ID) face barriers to primary care; however, this has not been extensively studied at the population level. Rates of hospitalisation for ambulatory care sensitive conditions are used as an indicator of access to, and quality of, primary care. The objective of the study was to compare hospitalisation rates for ambulatory care sensitive conditions between persons with and without an ID in a publicly insured population. METHODS: Persons with an ID were identified among the general population of a Canadian province between 1999 and 2003. Using a list of conditions applicable to persons with an ID, rates of hospitalisations for ambulatory care sensitive conditions for persons with and without an ID were calculated and compared. Regression models were used to adjust for age, sex and place of residence. Hospitalisation rates for specific conditions were also compared, controlling for differences in disease prevalence where possible. RESULTS: Persons with an ID were consistently hospitalised for ambulatory care sensitive conditions at a higher rate than persons without an ID. Between 1999 and 2003 the adjusted rate ratio (RR) was 6.1 [95% confidence interval (CI) = 5.6, 6.7]. Rate ratios were highest when comparing persons with, to persons without, an ID between the ages of 30-39 (RR = 13.1; 95% CI = 10.6, 16.2) and among urban area dwellers (RR = 7.0; 95% CI = 6.2, 7.9). Hospitalisation rates for epilepsy and schizophrenic disorders were, respectively, 54 and 15 times higher for persons with compared with persons without an ID. Rate ratios for diabetes and asthma remained significant after controlling for the population prevalence of these diseases. CONCLUSIONS: The large discrepancy in rates of hospitalisation between persons with and without an ID is an indicator of inadequate primary care for this vulnerable population. Decreasing the number of ambulatory care sensitive condition hospitalisations through specialised outpatient programmes for persons with an ID would potentially lead to better health, improved quality of life and cost savings. Future research should include potentially important factors such as disease severity, socio-economic variables and measures of health service organisation in the analysis. International comparisons of ambulatory care sensitive condition hospitalisation rates could point to the benefits and limitations of the health service policy directions adopted by different countries.

Ethnicity and mental health: conceptualization, definition and operationalization of ethnicity from a Canadian context.

The current study provides a critical review of Canadian studies on ethnicity and mental health with respect to the definition, conceptualization and operationalization of ethnicity. It provides a discussion on the methodological issues related to these factors and their implications to guide future research and enable comparability of results across studies. Sociological Abstracts, PsycINFO, MEDLINE and CINAHL were used to identify relevant Canadian articles published between January 1980 and December 2004. The review highlights a number of key issues for future researchers to consider such as the need for: 1) clear rationales as to why ethnicity is important to their outcome of interest; 2) clarity on the definition of ethnicity, which affects its conceptualization and operationalization; 3) a theoretically driven conceptualization of ethnicity, which should be related to the research question of interest; and 4) clear rationales for the decisions made regarding the data source used, the operationalization of ethnicity, and the ethnic categories included in their studies.

Pathways to suicidality across ethnic groups in Canadian adults: the possible role of social stress.

BACKGROUND: Ethnicity is an important determinant of mental health outcomes including suicidality (i.e. suicidal ideation and suicide attempt). Understanding ethnic differences in the pathways to suicidality is important for suicide prevention efforts in ethnically diverse populations. These pathways can be conceptualized within a social stress framework. METHOD: The study examines ethnic differences in the pathways to suicidality in Canada within a social stress framework. Using data from the Canadian Community Health Survey Cycle 1.1 (CCHS 1.1) and path analysis, we examined the hypotheses that variations in (1) socio-economic status (SES), (2) sense of community belonging (SCB), (3) SES and SCB combined, and (4) SES, SCB and clinical factors combined can explain ethnic differences in suicidality. RESULTS: Francophone whites and Aboriginals were more likely to report suicidality compared to Anglophone whites whereas visible minorities and Foreign-born whites were least likely. Disadvantages in income, income and education, income and its combined effect with depression and alcohol dependence/abuse led to high rates even among the low-risk visible minority group. Indirect pathways for Asians differed from that of Blacks and South Asians, specifically through SCB. With the exception of SCB, Aboriginals were most disadvantaged, which exacerbated their risk for suicidality. However, their strong SCB buffered the risk for suicidality across pathways. Disadvantages in education, income and SCB were associated with the high risk for suicidality in Francophone whites. CONCLUSIONS: Francophone whites and Aboriginals had higher odds of suicidality compared to Anglophone whites; however, some pathways differed, indicating the need for targeted program planning and prevention efforts.

Brain injury in a forensic psychiatry population.

OBJECTIVES: The prevalence and profile of adults with a history of traumatic brain injury (TBI) has not been studied in large North American forensic mental health populations. This study investigated how adults with a documented history of TBI differed with the non-TBI forensic population with respect to demographics, psychiatric diagnoses and history of offences. METHOD: A retrospective chart review of all consecutive admissions to a forensic psychiatry programme in Toronto, Canada was conducted. Information on history of TBI, psychiatric diagnoses, living environments and types of criminal offences were obtained from medical records. RESULTS: History of TBI was ascertained in 23% of 394 eligible patient records. Compared to those without a documented history of TBI, persons with this history were less likely to be diagnosed with schizophrenia but more likely to have alcohol/substance abuse disorder. There were also differences observed with respect to offence profiles. CONCLUSIONS: This study provides evidence to support routine screening for a history of TBI in forensic psychiatry.

Prediction of long-term occupational performance outcomes for adults after moderate to severe traumatic brain injury.

PURPOSE: To examine predictors of long-term occupational performance outcomes for adults after moderate to severe traumatic brain injury (TBI). METHOD: This study involved analysis of data from a retrospective cohort of adults (N = 306) with moderate to severe TBI discharged from a Pennsylvania rehabilitation treatment facility. Extensive pre-injury sociodemographic, injury-severity, post-injury personal (cognitive, physical, affective), post-injury environmental (social, institutional, physical), and post-injury occupational performance (participation in self-care, productivity, leisure activities) data were gathered from hospital records and using in-person interviews. Interviews occurred at a mean time of 14 (range, 7-24) years post-injury. Hierarchical multiple regression analysis was used to investigate determinants of long-term occupational performance outcomes. RESULTS: Pre-injury behavioural problems, male gender, post-injury cognitive and physical deficits, and lack of access to transportation were significant independent predictors of worse occupational performance outcomes. CONCLUSIONS: The study supports the use of a comprehensive model for long-term outcomes after TBI where pre-injury characteristics and post-injury cognitive and physical characteristics account for the greatest proportion of explained variance.

Long term symptoms and limitations of activity of people with traumatic brain injury: a ten-year follow-up.

This study examined the effect of Traumatic Brain Injury 10 years post-injury. Frequencies of head injury symptoms and activity limitation by level of severity were measured in a consecutive series of 61 adults who were admitted to a tertiary-care center for traumatic brain injury. Irritability and Anxiety were the most frequently reported symptoms from the Head Injury Symptom Checklist. Bothered by noise and Bothered by light were the least frequently reported. Trouble hearing what is said in a group conversation and Trouble hearing what is said in a one-to-one conversation were the most commonly reported limitations of activity from the Health and Activity Limitations Survey. Overall, this study illustrates that symptoms remain many years following brain injury, irrespective of the injury's severity.

Aging with traumatic brain injury: long-term health conditions.

Although traumatic brain injury (TBI) is a leading cause of death and disability in young adults, older adults over the age of 75 are also at high risk for TBI. As even mild injury can lead to disabling consequences, the long-term consequences of TBI need to be better understood, especially as the survival rate has increased dramatically in the last few decades. This research examined the prevalence of long-term health conditions after TBI. Using a retrospective cohort design, we examined consecutive records of adults with moderate to severe TBI discharged from a large rehabilitation hospital in Pennsylvania from 1974 to 1989. Baseline clinical information was abstracted from medical records. We interviewed consenting participants up to 24 years after injury. Our findings show a higher than expected prevalence of self-reported arthritis in the middle-aged population. There was also a high prevalence of problems with sleep and nerves many years post-injury. Some of the health conditions documented in this study could potentially be addressed early in rehabilitation; this study supports the screening of more physical health conditions in persons aging with TBI.

Long-term outcomes after moderate to severe traumatic brain injury.

OBJECTIVE: This research examined the long-term outcomes of rehabilitation patients with moderate to severe traumatic brain injury (TBI). DESIGN: Retrospective cohort study. SETTING AND SUBJECTS: We examined consecutive records of persons with moderate to severe traumatic brain injury who were discharged from a large rehabilitation hospital in Pennsylvania from 1973 to 1989. We interviewed consenting participants (n = 306) up to 24 years post-injury. MAIN OUTCOME MEASURES: Self-rated health, activity limitations, employment, living arrangements, marital status, Community Integration Questionnaire, and use of rehabilitation services. RESULTS: Participants were most limited in activities such as managing money and shopping. Twenty-nine per cent of our participants were working full time. There were significant relationships between activity limitations and residual cognitive impairment at follow-up. Self-rated health was correlated with most instrumental activities of daily living. CONCLUSION: Our findings document health and function in a large post acute TBI population and implications for rehabilitation are discussed.

Mental health and vitality among Canadian women with physical disabilities.

This study investigated scores for mental health and vitality in a large community-based sample of women with physical disabilities. The scores from two subscales of the SF-36 were collected from 1,096 women with physical disabilities through a mailed survey regarding health and well-being. These scores were compared to normative data using t tests. The mean scores of the vitality subscale were significantly lower than that of the normed sample when analyzed by age groups. The mental health scores were significantly lower as well, except for one age group (65-74 yr.). These results suggest that health care workers should address aspects of mental health and energy when caring for women with physical disabilities, as these areas are often overlooked in this population. Health promotion programs aimed at these topics should be designed specifically for this population as well.

What support do caregivers of elderly want? Results from the Canadian Study of Health and Aging.

The aim of this paper is to document interest in support strategies among caregivers of elderly persons. We used data from the Canadian Study of Health and Aging caregiver questionnaire which included 43 informal caregivers of elderly persons living with dementia and 145 informal caregivers of elderly persons not living with dementia. While the study assessed interest in attending support groups (10.4%), receiving telephone support from either a professional (44.9%) or a fellow caregiver (41.0%), receiving a newsletter (40.5%), receiving volunteer support (24.2%), and interest in support via computer (14.8%), there were no significant differences between the two groups with regard to interest in any of the support services. Implications for program delivery are discussed. Planners may want to consider adding telephone support and newsletters to other supports already available for caregivers.

Factors associated with perceived quality of life many years after traumatic brain injury.

OBJECTIVES: To explore factors associated with perceived quality of life (QOL) 8 to 24 years after traumatic brain injury (TBI). DESIGN: Retrospective cohort study. PARTICIPANTS: Two hundred seventy-five individuals who sustained moderate to severe TBI who were discharged from a rehabilitation hospital participated in this study. We interviewed consenting participants up to 24 years after injury. OUTCOME MEASURES: Self-rated Quality of Life Scale. RESULTS: Multivariate linear regression analyses revealed that perceived mental health, self-rated health, gender (women rating QOL higher), participation in work and leisure, and the availability of emotional support were significantly associated with QOL (P <.05). CONCLUSION: The importance of designing ongoing support programs to further reintegrate TBI survivors several years after injury is discussed.

Assessing support needs of caregivers of persons with dementia: who wants what?

This paper documents the use and interest in support strategies such as telephone support, newsletters, and computer services, among caregivers of all ages. Data obtained from telephone interviews with community living caregivers of persons with dementia (n = 148) showed substantial interest in the use of these types of services. Using a theoretical framework, this paper identifies caregiver and care-receiver characteristics associated with those interested in the utilization of these support strategies. The implications of these findings for program planning and future research are discussed.

Clients' perspectives on problems many years after traumatic brain injury.

This study investigated the types of self-reported main problems that persons report many years following a traumatic brain injury. This preliminary study is part of a large ongoing study of disability and handicap in adults following traumatic brain injury. As part of an extensive interview, subjects were asked an open-ended question regarding their current main problems which they thought resulted from their traumatic brain injury. Responses were obtained from 166 adult subjects (119 men and 47 women) whose time postinjury ranged from 9 to 24 years. Categories for responses were subsequently developed. The most commonly reported categories of problems were those relating to movement (39%), cognition (36%), and sensory impairment (31%). Findings suggest that subjects' long-term concerns were related to specific impairments more than to psychosocial, emotional, or behavioral issues. Methodological issues concerning this research are discussed in relation to findings.