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- Howe, Emilie Isager, et al.
(author)
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Rehabilitation and outcomes after complicated vs uncomplicated mild TBI : results from the CENTER-TBI study
- 2022
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In: BMC Health Services Research. - : BioMed Central (BMC). - 1472-6963. ; 22:1
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Journal article (peer-reviewed)abstract
- BACKGROUND: Despite existing guidelines for managing mild traumatic brain injury (mTBI), evidence-based treatments are still scarce and large-scale studies on the provision and impact of specific rehabilitation services are needed. This study aimed to describe the provision of rehabilitation to patients after complicated and uncomplicated mTBI and investigate factors associated with functional outcome, symptom burden, and TBI-specific health-related quality of life (HRQOL) up to six months after injury.METHODS: Patients (n = 1379) with mTBI from the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study who reported whether they received rehabilitation services during the first six months post-injury and who participated in outcome assessments were included. Functional outcome was measured with the Glasgow Outcome Scale - Extended (GOSE), symptom burden with the Rivermead Post Concussion Symptoms Questionnaire (RPQ), and HRQOL with the Quality of Life after Brain Injury - Overall Scale (QOLIBRI-OS). We examined whether transition of care (TOC) pathways, receiving rehabilitation services, sociodemographic (incl. geographic), premorbid, and injury-related factors were associated with outcomes using regression models. For easy comparison, we estimated ordinal regression models for all outcomes where the scores were classified based on quantiles.RESULTS: Overall, 43% of patients with complicated and 20% with uncomplicated mTBI reported receiving rehabilitation services, primarily in physical and cognitive domains. Patients with complicated mTBI had lower functional level, higher symptom burden, and lower HRQOL compared to uncomplicated mTBI. Rehabilitation services at three or six months and a higher number of TOC were associated with unfavorable outcomes in all models, in addition to pre-morbid psychiatric problems. Being male and having more than 13 years of education was associated with more favorable outcomes. Sustaining major trauma was associated with unfavorable GOSE outcome, whereas living in Southern and Eastern European regions was associated with lower HRQOL.CONCLUSIONS: Patients with complicated mTBI reported more unfavorable outcomes and received rehabilitation services more frequently. Receiving rehabilitation services and higher number of care transitions were indicators of injury severity and associated with unfavorable outcomes. The findings should be interpreted carefully and validated in future studies as we applied a novel analytic approach.
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| 2. |
- Arango-Lasprilla, Juan Carlos, et al.
(author)
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Early Predictors of Employment Status One Year Post Injury in Individuals with Traumatic Brain Injury in Europe
- 2020
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In: Journal of Clinical Medicine. - : MDPI. - 2077-0383. ; 9:6
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Journal article (peer-reviewed)abstract
- Sustaining a traumatic brain injury (TBI) often affects the individual’s ability to work, reducing employment rates post-injury across all severities of TBI. The objective of this multi-country study was to assess the most relevant early predictors of employment status in individuals after TBI at one-year post-injury in European countries. Using a prospective longitudinal non-randomized observational cohort (The Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) project), data was collected between December 2014–2019 from 63 trauma centers in 18 European countries. The 1015 individuals who took part in this study were potential labor market participants, admitted to a hospital and enrolled within 24 h of injury with a clinical TBI diagnosis and indication for a computed tomography (CT) scan, and followed up at one year. Results from a binomial logistic regression showed that older age, status of part-time employment or unemployment at time of injury, premorbid psychiatric problems, and higher injury severity (as measured with higher Injury severity score (ISS), lower Glasgow Coma Scale (GCS), and longer length of stay (LOS) in hospital) were associated with higher unemployment probability at one-year after injury. The study strengthens evidence for age, employment at time of injury, premorbid psychiatric problems, ISS, GCS, and LOS as important predictors for employment status one-year post-TBI across Europe.
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| 3. |
- Egeland, Jens, et al.
(author)
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Following international trends while subject to past traditions : neuropsychological test use in the Nordic countries
- 2016
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In: Clinical Neuropsychologist (Neuropsychology, Development and Cognition. - : Informa UK Limited. - 1385-4046 .- 1744-4144. ; 30, s. 1479-1500
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Journal article (peer-reviewed)abstract
- Objective: Historically, the neuropsychological test traditions of the four Nordic countries have spanned from the flexible and qualitative tradition of Luria-Christensen to the quantitative large battery approach of Halstead and Klove-Matthews. This study reports current test use and discusses whether these traditions still influence attitudes toward test use and choice of tests. Method: The study is based on survey data from 702 Nordic neuropsychologists. Results: The average participant used 9 tests in a standard assessment, and 25 tests overall in their practice. Test use was moderated by nationality, competence level, practice profile, and by attitude toward test selection. Participants who chose their tests flexibly used fewer tests than those adhering to the flexible battery approach, but had fewer tests from which to choose. Testing patients with psychiatric disorders was associated with using more tests. IQ, memory, attention, and executive function were the domains with the largest utilization rate, while tests of motor, visual/spatial, and language were used by few. There is a lack of academic achievement tests. Screening tests played a minor role in specialized assessments, and symptom validity tests were seldom applied on a standard basis. Most tests were of Anglo-American origin. Conclusions: New test methods are implemented rapidly in the Nordic countries, but test selection is also characterized by the dominating position of established and much researched tests. The Halstead-Reitan and Luria traditions are currently weak, but national differences in size of test batteries seem to be influenced by these longstanding traditions.
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| 4. |
- Egeland, Jens, et al.
(author)
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Questionnaire Use Among Nordic Neuropsychologists : Shift From Assessing Personality to Checking Ecological Validity of Neuropsychological Assessments?
- 2017
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In: Professional psychology, research and practice. - : American Psychological Association (APA). - 0735-7028 .- 1939-1323. ; 48:4, s. 227-235
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Journal article (peer-reviewed)abstract
- The core method of neuropsychologists has been to collect structured samples of behavior through standardized tests. Information that cannot be elicited through tests may be gathered by questionnaires asking questions about behavior. Tests may deconstruct cognitive function precisely, but lack the ecological validity of questionnaires. Thus, many neuropsychologists have advocated more use of questionnaires, but it is not known whether professional practice has changed. Until recently, personality instruments were the only widespread questionnaires in frequent use among neuropsychologists. We studied the inventory use of 702 Nordic neuropsychologists. The most used questionnaires are listed, and differences between countries are analyzed. In addition, the questionnaires are grouped with regard to whether they map cognition, behavior not observable during consultations, emotional symptoms, personality, or are diagnostic tools. The study showed an average use of 8.4 questionnaires (SD 6.4), with a range from 4.5 in Finland to 11 in Norway. Emotional symptoms were most frequently assessed, closely followed by questionnaires of cognition. There was a very low usage rate of personality measures, even though the Minnesota Multiphasic Personality Inventory (MMPI-2; Hathaway & McKinley, 1951) and other measures have been available in the Nordic countries for years. Questionnaire use correlated highly with test use. Frequency of assessment of neuropsychiatric disorders mediated high questionnaire use, whereas assessing patients with neurological conditions predicted below average use of questionnaires. The study indicates a shift from assessing personality to using questionnaires to check the validity of test results. The shift is probably mediated by the expansion of clinical neuropsychology into the field of psychiatry.
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