Building resilience among families supporting relatives with ABI in rural NSW: testing the feasibility of telephone delivery of Strength2Strength program.

BACKGROUND: Strength2Strength (S2S) is a group psychoeducational program aiming to build resilience among families supporting relatives after traumatic injury. OBJECTIVE: To test the feasibility, acceptability and outcomes of teleconference delivery of a 5 hour S2S program in rural New South Wales. METHODS: A mixed methods design investigated the (i) convenience of telephone-based delivery; and (ii) acceptability of the program material (purpose-designed survey and the Narrative Evaluation of Intervention Interview). Program efficacy was measured with the Resilience Scale (RS) and Connor-Davidson Resilience Scale (CD-RISC); the Positive and Negative Affect Scale (PANAS); Depression, Anxiety and Stress Scale - 21 (DASS-21); Carer Assessment of Managing Index (CAMI); and Caregiver Burden Scale (CBS). Participant outcome data were collected at baseline, post program and 3 months follow-up. RESULTS: 11 participants supporting adult relatives with severe brain injury completed the program. All participants and facilitators commented positively about the cost, ease of use and quality of the teleconference facility. Statistically significant gains were found between pre-program and follow-up scores on the RS, CD-RISC, PANAS-Positive, and CAMI, with statistically significant reductions found on the DASS-21 Depression Scale and CBS scores. CONCLUSION: The study provides preliminary evidence for the efficacy of telephone-based delivery of S2S to family participants.

A vocational intervention that enhances return to work after severe acquired brain injury: A pragmatic trial.

BACKGROUND: Following a severe acquired brain injury, individuals often have low return to work rates. The Vocational Intervention Program (VIP), a partnership of Brain Injury Rehabilitation Program community rehabilitation centres with external vocational rehabilitation providers in New South Wales, Australia, was developed to facilitate a return to competitive employment for working-age people. OBJECTIVES: To evaluate the efficacy of the VIP partnership model, this intervention was compared to outcomes from a health-based brain injury vocational rehabilitation centre (H-VR) or community brain injury rehabilitation centres ("treatment as usual"; TAU). METHODS: A 3-arm non-randomized controlled trial was conducted among the 12 adult rehabilitation centres of the NSW Brain Injury Rehabilitation Program. The VIP arm was delivered by 6 community rehabilitation centres in partnership with 3 external private Vocational Rehabilitation providers. The H-VR arm was delivered by 1 health-based vocational rehabilitation centre and the 5 remaining centres delivered TAU. Competitive employment status ("Yes"/"No") and clinician ratings of disability and participation were collected pre- and post-intervention, and at 3-month follow-up. Multilevel models were conducted to investigate change over time by treatment arm. RESULTS: In total, 148 individuals with severe brain injury were included in the trial: n = 75 (VIP), n = 33 (H-VR) and n = 40 (TAU). Sixty-five people (of 108, 60%) completed the VR intervention. A significant arm-by-time interaction was found, with higher return to work rates from pre- to post-intervention in VIP and H-VR arms compared to TAU (P = 0.0002). Significant arm-by-time interactions also indicated improved work-related participation and independent living skills from pre- to post-intervention in VIP and H-VR compared to the TAU arm (P < 0.05). These improvements were maintained at 3-month follow-up. CONCLUSIONS: The VIP improved return to competitive employment at comparable rates to the specialist H-VR. Larger-scale adoption of the VIP model could provide significant improvements in vocational rehabilition sevices to support people in their return to work following severe brain injury. ANZCTR TRIAL REGISTRY NUMBER: ACTRN12622000769785.

Validation of the work-ability support scale in individuals seeking to return to work after severe acquired brain injury.

PURPOSE: To assess the reliability and validity of the work-ability support scale (WSS) in a severe traumatic/acquired brain injury (TBI/ABI) population seeking to return to work (RTW). MATERIALS AND METHODS: One hundred forty-four clients were enrolled in a vocational rehabilitation (VR) intervention trial through the Brain Injury Rehabilitation Program in New South Wales, Australia. Each client's primary brain injury clinician and VR provider completed the WSS pre- and post-intervention. Validating measures assessing dysexecutive behavior, disability, participation, and work instability were completed. Several aspects of reliability and validity were evaluated. RESULTS: Internal consistency was excellent for Part A (Cronbach's αs > 0.9) but unacceptably low to questionable for Part B (αs < 0.6). Inter-rater reliability between clinicians and VR providers was generally fair to moderate for Part A (κw < 0.6) and worse for Part B (κw < 0.5), with both slightly improving at post-intervention. Strong support was found for predictive and convergent validity, but not divergent validity. Confirmatory factor analysis indicated a poor fit for Part A, whereas most Part B fit indices met criteria. CONCLUSIONS: The WSS can play a useful role in assessing return to work (RTW) potential, planning and evaluation after severe TBI/ABI. Training could improve consistency of administration among staff working across health and VR service sectors.

The work-ability support scale (WSS) has potential as a screening tool in assisting return to work (RTW) assessment, planning, and evaluation, following severe traumatic brain injury and acquired brain injury.Employment success following a RTW intervention was predicted by the initial WSS Part A total score.The low inter-rater reliability between brain injury clinicians in health settings and vocational rehabilitation providers suggests that training will be important to improve consistency in WSS administration across service sectors.

Hours and costs of formal and informal care following Traumatic Brain Injury and Spinal Cord Injury sustained through Motor Vehicle Accidents: A Cross-sectional Study.

OBJECTIVES: To explore the weekly utilization of formal and informal care, and to calculate and compare the costs associated with these types of care after traumatic brain injury or spinal cord injury sustained through a motor vehicle accident in Australia. DESIGN: Cross-sectional, quantitative design. SUBJECTS: A total of 81 people with traumatic brain injury and 30 people with spinal cord injury from 3 rehabilitation units in New South Wales, Australia. METHODS: Data were collected using questionnaires administered through semi-structured interviews, and analysed using a series of Kruskal-Wallis tests. RESULTS: Spinal cord injury (tetraplegia/ paraplegia) was significantly more expensive for both formal and informal care compared with traumatic brain injury. The costs of formal care were significantly greater for those in the traumatic brain injury group who had a more severe injury (post-traumatic amnesia > 90 days) compared with the other traumatic brain injury groups (post-traumatic amnesia 7-28 days, 29-90 days). The costs of informal care were significantly higher for both traumatic brain injury and spinal cord injury compared with the costs of formal care. CONCLUSION: This study highlights the complementary role of formal and informal care in supporting people with traumatic brain injury or spinal cord injury, particularly highlighting the significant role of informal care, which needs to be more explicitly acknowledged in policy and planning processes.

What are the predictors of TOMM failure in clinical TBI populations? A retrospective analysis.

OBJECTIVES: To determine base rates of invalid performance on the Test of Memory Malingering (TOMM) in patients with traumatic brain injury (TBI) undertaking rehabilitation who were referred for clinical assessment, and the factors contributing to TOMM failure. METHODS: Retrospective file review of consecutive TBI referrals for neuropsychological assessment over seven years. TOMM failure was conventionally defined as performance <45/50 on Trial 2 or Retention Trial. Demographic, injury, financial compensation, occupational, and medical variables were collected. RESULTS: Four hundred and ninety one TBI cases (Median age = 40 years [IQR = 26-52], 79% male, 82% severe TBI) were identified. Overall, 48 cases (9.78%) failed the TOMM. Logistic regression analyses revealed that use of an interpreter during the assessment (adjusted odds ratio [aOR] = 8.25, 95%CI = 3.96-17.18), outpatient setting (aOR = 4.80, 95%CI = 1.87-12.31) and post-injury psychological distress (aOR = 2.77, 95%CI = 1.35-5.70) were significant multivariate predictors of TOMM failure. The TOMM failure rate for interpreter cases was 49% (21/43) in the outpatient setting vs. 7% (2/30) in the inpatient setting. By comparison, 9% (21/230) of non-interpreter outpatient cases failed the TOMM vs. 2% (4/188) of inpatient cases. CONCLUSIONS: TOMM failure very rarely occurs in clinical assessment of TBI patients in the inpatient rehabilitation setting. It is more common in the outpatient setting, particularly in non-English-speaking people requiring an interpreter. The findings reinforce the importance of routinely administering stand-alone performance validity tests in assessments of clinical TBI populations, particularly in outpatient settings, to ensure that neuropsychological test results can be interpreted with a high degree of confidence.

Digital divide among individuals with acquired brain injury: a scoping review protocol.

OBJECTIVE: This scoping review will identify literature pertaining to individuals with an acquired brain injury and digital divide; specifically, examining personal access and use of internet-enabled information and communication technologies. The review will identify the information and communication technologies used by individuals with an acquired brain injury as well as the determinants of technology use. The review will also identify and create a taxonomy of information and communication technologies utilized in relation to cognitive and psychosocial outcomes for individuals with an acquired brain injury in community and outpatient settings. INTRODUCTION: Internet-enabled technologies are increasingly central to all aspects of living, including health care and community participation; however, gaps in the access to and use of information and communication technologies among individuals with an acquired brain injury may limit the utility of a digitalized society. INCLUSION CRITERIA: Studies that focus on access to or use of internet-enabled information and communication technologies among individuals with an acquired brain injury (including stroke, infection, tumor, disease, hypoxia, or traumatic brain injury) will be considered in this review. METHODS: Primary peer-reviewed studies published in English from 2001 onward will be considered for inclusion. Six electronic databases will be searched: Embase, MEDLINE, Web of Science Core Collection, Google Scholar, CINAHL, and APA PsycINFO. Gray literature searches for government and nongovernment organization reports and data, and dissertation theses will be conducted via advanced Google searches. Two reviewers will independently screen titles, abstracts, and full texts of articles based on the "population, concept, context" inclusion criteria. Relevant data will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR).

Reasons for living, positive psychological constructs and their relationship with suicide ideation in people with moderate to severe traumatic brain injury: A cross-sectional study.

Positive psychological constructs such as reasons for living, self-esteem and resilience have previously been shown to act as protective psychological barriers against negative psychological outcomes, including suicide ideation in both clinical populations and the general population. This study aims to explore the positive psychological constructs of reasons for living, self-esteem, resilience and their relationship with suicide ideation and predictors of suicide ideation (depression, hopelessness) for N = 50 people who have a severe TBI and are currently receiving community rehabilitation at Liverpool Brain Injury Rehabilitation Unit (LBIRU), NSW. Results indicated good reliability for the use of the RFLI with people who have TBI, with the most frequently endorsed subscale (range 0-5) being "survival and coping beliefs" (4.7 ± 1.0) and the least frequently being "fear of suicide" (2.2 ± 1.1). The shortened version of the RFLI (BRFLI) also displayed good reliability. Positive psychological constructs (reasons for living, resilience, self-esteem) were all significantly inversely associated with suicide and suicide predictors (depression, hopelessness). This study suggests that positive psychological constructs can act as a buffer against suicide ideation after moderate to severe TBI.

Can behaviour support interventions successfully treat inappropriate sexual behaviour after acquired brain injury in community settings? A case series (N = 24).

Inappropriate sexual behaviours (ISX) are challenging clinical sequelae of acquired brain injury (ABI). Limited evidence exists about treatment approaches, with few case studies published to date. This study reports an exploratory clinical trial of community-based behaviour support interventions as a treatment approach to ISX after ABI. From routine referrals to a state-wide service specializing in challenging behaviours after ABI, a cohort (n = 24) displaying ISXs were selected. The interventions addressed multiple behavioural domains, and used a variety of approaches including environmental change, psychoeducation, and specific behavioural techniques. These approaches targetted change in the person with ABI, support personnel, or other environmental domains. Behaviour data were collected using the Overt Behaviour Scale (OBS) at baseline, closure and follow-up. Visual inspection and multilevel models were used to analyse the data. For the sample as a whole, there was a significant decline in ISXs from baseline to closure that was maintained at follow-up. Results at an individual level are also presented. Specificity of the intervention was demonstrated by comparison with concurrent challenging behaviours (aggression, perseveration, absconding) which showed no significant change over the same three time points. The results demonstrate the potential efficacy of community-based behaviour support interventions in treating ISXs after ABI.

Testing a Model of Resilience in Family Members of Relatives with Traumatic Brain Injury vs Spinal Cord Injury: Multigroup Analysis.

OBJECTIVE: To test a model comprising explanatory (neurologic impairment, coping, personality) and mediating (resilience, self-efficacy, hope, social support) variables on psychological adjustment and burden among family caregivers of individuals with traumatic brain injury (TBI) vs spinal cord injury (SCI). DESIGN: Structural equation modeling with multigroup analysis. SETTING: Six rehabilitation centers across New South Wales and Queensland, Australia. PARTICIPANTS: A total of 181 family members (N=181; 131 TBI, 50 SCI). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Connor-Davidson Resilience Scale, Eysenck Personality Questionnaire, Ways of Coping Questionnaire, General Self-Efficacy Scale, Herth Hope Scale, Medical Outcome Study Social Support Survey; and 4 measures of psychological adjustment including: Caregiver Burden Scale, Medical Outcomes Survey Short Form-36 (SF-36), General Health Questionnaire-28, and Positive and Negative Affect Scale. RESULTS: The model for the aggregated sample demonstrated a very good model fit (χ2=47.42, df=39, ρ=0.167, normed fit index=.962, incremental fit index=.993, Tucker-Lewis index=.985, comparative fit index=.993, root-mean-squared error of approximation=.035). Multi-group analysis found significant commonalities in the pattern of relationships among variables across the 2 groups. In the only differences found, neuroticism was significantly more influential on burden in family members supporting individuals with TBI than family members of individuals with SCI. Furthermore, problem-focused coping was statistically more influential on positive affect in family members of individuals with TBI when compared with family members of individuals with SCI. CONCLUSIONS: The study found significant similarities in the patterns of resilience and psychological adjustment among family caregivers of individuals with TBI and SCI.

Video-consulting to address mental health needs after traumatic brain injury: evaluation of a training workshop to build capacity among psychologists.

BACKGROUND: Traumatic brain injury (TBI) can lead to significant psychological distress, but few psychologists in Australia are trained in working with this complex clinical group. Despite government funding to provide video-consulting (VC) services in Australia, uptake before COVID-19 was limited. OBJECTIVE: This mixed methods study evaluated whether training in eHealth and evidence based TBI psychological therapies increased provider uptake of VC in clinical practice, and delivery of mental health services to individuals with TBI. METHODS: Mental health professionals completed a range of self-report measures before (n = 50), after (n = 48), and four months following (n = 30) a one-day workshop. Participants' TBI knowledge, client-base and levels of access, confidence, motivation and attitudes toward VC were assessed. Knowledge did not increase after training but participants had significant increases in their confidence and motivation to using VC at follow up. Significant reductions in pragmatic barriers to using VC were reported post training and at follow up, all barrier categories indicated significant reductions. There was no significant change in clinical practice of the participants. CONCLUSIONS: Training to increase TBI knowledge requires specific assessment tools and although training appears to reduce barriers to using VC, uptake in clinical practice may require additional supervision and warrants further research.

Protocol for a Phase Two, Parallel Three-Armed Non-inferiority Randomized Controlled Trial of Acceptance and Commitment Therapy (ACT-Adjust) Comparing Face-to-Face and Video Conferencing Delivery to Individuals With Traumatic Brain Injury Experiencing Psychological Distress.

Background: People with traumatic brain injury (TBI) face a range of mental health challenges during the adjustment process post-injury, but access to treatment can be difficult, particularly for those who live in regional and remote regions. eHealth provides the potential to improve access to evidence-based psychological therapy for people with a severe TBI. The aim of the current study is to assess the efficacy of a psychological intervention delivered via video consulting to reduce psychological distress in people with TBI. Methods: This paper outlines the protocol for a multi-center, three-arm, parallel, non-inferiority randomized controlled trial (RCT) of an evidence-based manualized psychological intervention, ACT-Adjust. ACT-Adjust provides nine sessions for adults with a moderate to severe TBI experiencing clinical levels of psychological distress. Fifty-six participants referred from Brain Injury Rehabilitation Units across New South Wales (NSW) and the NSW icare scheme will be randomly allocated to three conditions; (1) video consulting (VC), (2) face-to-face (FtF) and, (3) a waitlist control (WL). Discussion: This is the first RCT to evaluate the efficacy of a psychological therapy (ACT-Adjust) delivered via video consulting for individuals with a moderate to severe TBI. Trial Registration: www.anzctr.org.au, Australian New Zealand Clinical Trials Registry ANZCTRN2619001602112.

Evaluating client experience of rehabilitation following acquired brain injury: a cross-sectional study.

Objective: To implement a service-wide approach in the collection of data to evaluate client experience of brain injury rehabilitation.Methods: Mixed methods study. Clients with brain injury and family members of the Liverpool Brain Injury Rehabilitation Unit completed a purpose-designed Patient Experiences Survey for Brain Injury Rehabilitation (PES-BIR) which included closed and free-text responses, as well as the Client Services Questionnaire-8 (CSQ-8). The survey was completed by clients across the inpatient, community rehabilitation, vocational rehabilitation and community-based residential services.Results: 118 questionnaires were completed in relation to 102 clients. The majority of respondents were clients (n = 79, 66.9%) with a small proportion of family members represented (n = 39, 33.1%). High levels of satisfaction were reported (CSQ-8 28.4 ± 3.8) and positive patient experience (PES-BIR total, 37.2 ± 5.5) across all services. Themes identified from the free-text responses suggested that client experience was influenced by communication with the client about their progress and within the team, tailoring of rehabilitation, access to specialist services, integration of care across the rehabilitation continuum and the rehabilitation environment.Implications for practice: Routine collection and evaluation of client experience data in brain injury rehabilitation can be used to evaluate service delivery quality and guide further service improvements.

Providing on-line support to families of people with brain injury and challenging behaviour: A feasibility study.

Challenging behaviour following traumatic brain injury (TBI) is a major source of stress for families. Providing support can be limited by availability of clinicians and geographic location. A solution is to provide support on-line. This study aimed to evaluate the feasibility of an on-line treatment programme "Carer's Way Ahead" that provides families and carers with psychoeducation about TBI and challenging behaviours, specific approaches to managing apathy, irritability/aggression, acting without thinking and social difficulties and also self-care for the family member. Each module was supplemented with detailed notes and summaries of the sessions. Six family carers, five caring for a person with TBI and one caring for a person with stroke, worked through the programme, providing feedback on wording, content, structure and useability. They also completed measures of family functioning, social problem solving, carer strain, mood and the nature and severity of challenging behaviours. In general, the families were positive about the programme with most finding it useful, practical and logically structured although not all believed it was helpful. There was little change in self-reported challenging behaviour, mood, carer strain and family function over the few months of the programme. Longer-term effects were not examined but this requires further research.

Living with suicidality following traumatic brain injury: a qualitative study.

PURPOSE: Numbers of traumatic brain injury (TBI) are increasing, and with suicidality post-injury presenting at 3-4 times higher than in the general population, understanding this is crucial in reducing a devastating outcome. Given the lack of literature, this study investigated the experiences of living with suicidality after TBI. METHODS: Interview data from nineteen participants with TBI from a Brain Injury Rehabilitation Unit (BIRU) in New South Wales (NSW), Australia were collected and thematically analyzed. FINDINGS: The participants (predominantly male) sustained extremely severe injuries (median PTA 60 [IQR 81.0] days) and were in the chronic phase post-injury (median 8.0 [IQR 9.0] years). Six main themes were identified; Loss of sense of self, TBI as a hidden disability, Chronic but transient suicidality, Reliance, Protective factors, and Hope. Tentative relationships between themes and subthemes were identified. CONCLUSION: Chronic suicidality after TBI was demonstrated consistently regardless of receiving long-term support. However, their engagement with protective factors such as social support, spirituality and positive personal qualities was identified. Implementing these as coping strategies during long-term rehabilitation may reduce the levels of suicidal distress. Implications, methodological considerations and future research were discussed, with the aim of improving experiences of individuals with TBI to reduce suicidality.

A predictive model of resilience among family caregivers supporting relatives with traumatic brain injury (TBI): A structural equation modelling approach.

Constructs from positive psychology were employed to create an explicit model of caregiver resilience. Predictive and mediating relationships among resilience and related variables (personality, coping, self-efficacy, hope, social support) were then tested for their association with burden and psychological adjustment among family members caring for relatives with severe TBI. Family participants (n = 131) from six rehabilitation units from New South Wales and Queensland completed assessments which elicited explanatory (Eysenck Personality Questionnaire, Ways of Coping Questionnaire), mediating (Connor-Davidson Resilience Scale, General Self-Efficacy Scale, Herth Hope Scale, Medical Outcome Study Social Support Survey), and caregiver outcome (Caregiver Burden Scale, Mental Health sub-Scale-SF36, General Health Questionnaire, and Positive and Negative Affect Scale) variables. Structural Equation Modeling (SEM) showed that resilience had a direct effect on positive affect in caregivers. Resilience also played a protective role in relation to two variables associated with caregiver vulnerability: an indirect association with caregiver burden mediated through social support; a direct effect on hope, which, in turn, was associated with positive mental health. Positive mental health then played a buffering role in relation to psychological distress and negative affect. Resilience, in combination with other psychological attributes, was associated with reduced morbidity among family caregivers after severe TBI.

The Building Bridges project: Linking disconnected service networks in acquired brain injury and criminal justice.

People with acquired brain injury (ABI) are overrepresented in prison populations across many countries. An effective service response to reduce this trend requires collaboration between the ABI and criminal justice (CJ) sectors. The Building Bridges project piloted a novel professional development model designed to increase cross-sectoral knowledge and collaboration between the ABI and CJ sectors. A total of 178 service providers from Victoria, Australia, participated in six professional development forums that included content about ABI, policing, disability and legal supports, and correctional/post-release services. Participants came from the disability, criminal justice, and health and community service sectors. Using a pre-test-post-test design with 6-month follow-up, data were obtained via a project-specific questionnaire evaluating knowledge and behaviour change among participants. Statistically significant gains in knowledge were shown at post-test and maintained at follow-up. Work-related behaviours addressing ABI/CJ issues had increased significantly within both sectors at follow-up compared to the 6 months prior to the forum. Carefully constructed professional forums improved cross-silo collaboration in the ABI/CJ sectors. This pilot project illustrates effective use of existing service resources, and highlights training as an important part of a raft of initiatives needed to address the overrepresentation of people with ABI in the CJ system.

Participation in competitive employment after severe traumatic brain injury: New employment versus return to previous (pre-injury) employment.

There is limited literature comparing the clinical and employment characteristics of clients accessing new employment with those resuming previous employment. To address this gap, a multi-centre observational study was conducted of all active clients with severe TBI from the 11 community rehabilitation services (n = 588) of the New South Wales Brain Injury Rehabilitation Program. Demographic, injury, clinical and vocational data were collected by treating clinicians employing a purpose-designed protocol. New employment constituted almost 40% of competitive employment outcomes. Clients accessing new employment were significantly more likely to be younger, single, less educated, with more severe injuries and more likely to be displaying challenging behaviours than those resuming pre-injury work. Kaplan-Meier analyses found time to RTW was significantly longer for new employment. Stability of new employment was significantly poorer with jobs twice as likely to break down compared to previous employment. New employment positions were also more likely to be part-time and unskilled compared to previous employment. The results found that placement into new employment made a substantial contribution to employment outcomes after TBI but requires more intensive and tailored programmes to meet the multiple clinical and workplace challenges.

External causes of death after severe traumatic brain injury in a multicentre inception cohort: clinical description and risk factors.

Objective: To characterize the clinical profile of patients dying from external causes (EC) following severe traumatic brain injury (TBI). Design and Methods: Data from 2545 patients forming the NSW-BIRP inception cohort discharged from post-acute inpatient rehabilitation between 1 July 1990 and 1 October 2007 were retrospectively reviewed. Standardized mortality ratios (SMRs) were calculated for EC sub-categories. Demographic, clinical and rehabilitation service factors were compared between deaths from EC, deaths from other causes (OC), and non-deceased. Clinical profiles of EC sub-categories were analysed descriptively. Results: Overall, patients with TBI were 5.2x more likely to die from EC relative to the general population. Risk of death was elevated in all EC sub-categories examined, with the largest risks relating to other accidental threats to breathing (SMR = 33.0; 95%CI = 13.79-60.45) and falls (SMR = 14.3; 95%CI = 5.01-28.39). The EC group were younger, more likely to have pre-injury psychiatric histories, less severe injuries, greater functional independence, and die earlier than the OC group. There was considerable heterogeneity in the clinical profiles of patients dying from different EC sub-categories. Conclusions: EC constitutes one of the largest causes of mortality following TBI in patients surviving beyond the post-acute phase. Potential implications for risk modification and prevention of premature and avoidable deaths are discussed.

Family and TBI: an investigation using the Family Outcome Measure - FOM-40.

INTRODUCTION: The Family Outcome Measure (FOM-40) captures multidimensional data about well-being and capacity of family member as well as the relative with brain injury. This study aimed to produce a profile (positive and negative) of families supporting relatives with traumatic brain injury (TBI) and high support needs. METHODS: Thirty-eight dyads (family member plus relative with TBI and high daily support needs) participated in this cross-sectional survey-based pilot study. The survey comprised several published scales, as well as a range of demographic and clinical characteristics of the relative. Non-parametric bivariate analyses were conducted. RESULTS: Independence of the FOM-40 domains was confirmed. Place of residence (shared supported accommodation (SSA)/family home) was an important predictor variable. SSA was strongly associated with lower levels of burden in families. Family home was strongly associated with better adjustment of the relative. Family resilience was positively associated with sustainability of support and comorbidity in the relative. DISCUSSION: Family outcomes were associated with a variety of demographic and clinical characteristics of the relative with TBI including residence, behaviour and mental health symptoms. The results provide meaningful evidence for service providers given the increasing investment in independent living in people with disabilities, and the ongoing reliance on families to supplement paid support.

The Overt Behaviour Scale-Self-Report (OBS-SR) for acquired brain injury: exploratory analysis of reliability and validity.

The objectives were to test the properties, via a psychometric study, of the Overt Behaviour Scale-Self-Report (OBS-SR), a version of the OBS-Adult Scale developed to provide a client perspective on challenging behaviours after acquired brain injury. Study sample 1 consisted of 37 patients with primary brain tumour (PBT) and a family-member informant. Sample 2 consisted of 34 clients with other acquired brain injury (mixed brain injury, MBI) and a service-provider informant. Participants completed the OBS-SR (at two time points), and the Awareness Questionnaire (AQ) and Mayo Portland Adaptability Inventory-III (MPAI-III) once; informants completed the OBS-Adult and AQ once only. PBT-informant dyads displayed "good" levels of agreement (ICC2,k = .74; OBS-SR global index). Although MBI-informant dyads displayed no agreement (ICC2,k = .22; OBS-SR global index), the sub-group (17/29) rated by clinicians as having moderate to good levels of awareness displayed "fair" agreement (ICC2,k = .58; OBS-SR global index). Convergent/divergent validity was demonstrated by significant correlations between OBS-SR subscales and MPAI-III subscales with behavioural content (coefficients in the range .36 -.61). Scores had good reliability across one week (ICC2,k = .69). The OBS-SR took approximately 15 minutes to complete. It was concluded that the OBS-SR demonstrated acceptable reliability and validity, providing a useful resource in understanding clients' perspectives about their behaviour.