| 1. |
- Dillon, Avril, et al.
(author)
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Is there evidence for a relationship between cognitive impairment and fatigue after acquired brain injury : a systematic review and meta-analysis
- 2023
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In: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 45:26, s. 4359-4372
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Journal article (peer-reviewed)abstract
- Purpose: Fatigue is a major symptom of ABI. Greater fatigue is associated with cognitive impairment. Our aim was to systematically review, describe and analyse the literature on the extent of this relationship. Methods: Five databases were searched from inception. Studies were included where: participants had a defined clinical diagnosis of ABI which included TBI, stroke or subarachnoid haemorrhage; a fatigue measure was included; at least one objective cognitive measure was used. Three reviewers individually identified studies and determined quality using the Quality Assessment Tool for Observational Cohort and Cross-sectional Studies. Results: Sixteen of the 412 identified studies, investigating the relationship between cognitive dysfunction and fatigue, comprising a total of 1,745 participants, were included. Quality ranged from fair to good. Meta-analysis found fatigue was significantly associated with an overall pattern of cognitive slowing on tasks of sustained attention. A narrative synthesis found weak associations with fatigue and information processing, attention, memory and executive function. Conclusion: Analysis found sustained attentional performance had stronger associations with fatigue after ABI. Whereas, weak associations were found between fatigue and information processing, attention and to some extent memory and executive function. More focused research on specific cognitive domains is needed to understand the mechanisms of fatigue.
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| 2. |
- 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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| 3. |
- Jacob, Louis, et al.
(author)
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Predictors of Access to Rehabilitation in the Year Following Traumatic Brain Injury : A European Prospective and Multicenter Study
- 2020
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In: Neurorehabilitation and Neural Repair. - : Sage Publications. - 1545-9683 .- 1552-6844. ; 34:9, s. 814-830
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Journal article (peer-reviewed)abstract
- Background: Although rehabilitation is beneficial for individuals with traumatic brain injury (TBI), a significant proportion of them do not receive adequate rehabilitation after acute care.Objective: Therefore, the goal of this prospective and multicenter study was to investigate predictors of access to rehabilitation in the year following injury in patients with TBI.Methods: Data from a large European study (CENTER-TBI), including TBIs of all severities between December 2014 and December 2017 were used (N = 4498 patients). Participants were dichotomized into those who had and those who did not have access to rehabilitation in the year following TBI. Potential predictors included sociodemographic factors, psychoactive substance use, preinjury medical history, injury-related factors, and factors related to medical care, complications, and discharge.Results: In the year following traumatic injury, 31.4% of patients received rehabilitation services. Access to rehabilitation was positively and significantly predicted by female sex (odds ratio [OR] = 1.50), increased number of years of education completed (OR = 1.05), living in Northern (OR = 1.62; reference: Western Europe) or Southern Europe (OR = 1.74), lower prehospital Glasgow Coma Scale score (OR = 1.03), higher Injury Severity Score (OR = 1.01), intracranial (OR = 1.33) and extracranial (OR = 1.99) surgery, and extracranial complication (OR = 1.75). On contrast, significant negative predictors were lack of preinjury employment (OR = 0.80), living in Central and Eastern Europe (OR = 0.42), and admission to hospital ward (OR = 0.47; reference: admission to intensive care unit) or direct discharge from emergency room (OR = 0.24).Conclusions: Based on these findings, there is an urgent need to implement national and international guidelines and strategies for access to rehabilitation after TBI.
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| 4. |
- Parsonage-Harrison, Jackie, et al.
(author)
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A Delphi method investigation to prioritize activity-related determinants thought to affect mental health in adolescent populations
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In: Early Intervention in Psychiatry. - 1751-7885.
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Journal article (peer-reviewed)abstract
- Introduction: Emergent mental illness during adolescence affects daily functioning, causing disruption to daily activities, routines, and patterns. Multiple inter-related personal, social and environmental determinants influence the onset, nature and subsequent course of those difficulties. Research suggests a bi-directional relationship exists between mental health and activity choices. Activity-focused interventions such as occupational therapy may improve adolescent mental health related outcomes. In this study, we identify and select which activity-related determinants should be prioritized in the development of an occupation therapy-based intervention for adolescents with emerging mental health difficulties using expert consensus. Method: A modified two-round Delphi survey method was conducted with occupational therapists and researchers to ascertain a consensus opinion on the prioritization of specific activity-related determinants that influence 16- to 17-year-olds'. Results: Eighty-nine determinants were identified and prioritized. Fourteen of these were personal activity-related determinants including ‘types of activity’ in which young people engage, the ‘balance of activities’ in which they engage, their ‘over and under consumptions of activities’, and their ‘underdeveloped occupation-based coping skills’. The expert panel prioritized ‘personal self-confidence’, ‘values’, and ‘perception of confidence’ in relation to the activities adolescents do. Conclusions: This study generated a detailed picture of the activity-related determinants that are important in adolescence, and aligns with the adolescent model of occupational choice. Our findings have potential to inform activity-related intervention development and policy. Further research is needed, particularly to understand young people's perspectives on these determinants and to investigate the determinants that would benefit from further empirical research.
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| 5. |
- Parsonage-Harrison, Jackie, et al.
(author)
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A scoping review of interventions using occupation to improve mental health or mental wellbeing in adolescent populations
- 2023
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In: British Journal of Occupational Therapy. - : SAGE Publications. - 0308-0226 .- 1477-6006. ; 86:3, s. 236-250
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Research review (peer-reviewed)abstract
- Introduction: Occupation-based interventions could help to address a growing mental health crisis among young people and adolescents. To develop new interventions and avoid research waste, a review of the academic literature is needed that systematically identifies and describes interventions designed to improve the mental health and wellbeing of 11–25 year-olds. Aim: The scoping review aims to systematically review the academic, literature to identify and describe key characteristics of intervention studies using occupation to improve adolescents’ and young people’s mental health and wellbeing, exploring the range of interventions, reviewing reporting quality and illuminating gaps for further research. Method: An iteratively developed scoping review protocol informs a systematic database search and review of the literature. Core characteristics are extracted and described, using the TIDIER guidelines and the CASP assessment tool. Results: Five occupational therapy-based interventions, and 69 other occupation-based studies representing a wide breadth of approaches, outcomes and settings were identified. Conclusions: Robust development, testing and reporting of occupation-based and occupation-focused intervention studies to promote and support mental health and wellbeing in adolescents and young people are needed. Interventions should be co-designed, developmentally appropriate and scaffold development. However, better agreement is needed about core outcomes measurement in this area.
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| 6. |
- Parsonage, Jackie, et al.
(author)
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An exploration of occupational choices in adolescence : A constructivist grounded theory study
- 2022
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In: Scandinavian Journal of Occupational Therapy. - : Informa UK Limited. - 1103-8128 .- 1651-2014. ; 29:6, s. 464-481
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Journal article (peer-reviewed)abstract
- Background: Adolescence is a critical period within the life course, for developing adult occupational competencies and health behaviours. Few studies have considered how 16–17 year olds choose activities and behaviours from an occupational perspective. Aim and objectives: To explore how adolescents aged 16–17 years old make choices about their daily occupations to inform a theoretical model of occupational choice. Materials and methods: About 27 secondary school students aged 16–17 years attended one of six focus groups. Transcripts were analyzed using constructivist grounded theory, informing the iterative development of a theoretical model of occupational choice. Results: Adolescent occupational choice occurred in response to experiencing needs, and was characterized by ‘weighing up’ and ‘juggling’ the following four key domains: ‘Appraising values and priorities’, ‘Interacting with the situational context’, ‘Exploring skills and occupational repertoire’ and ‘Considering time factors’. A developing sense of responsibility and autonomy for occupational choices was described, leading to the development of the future occupational self. Conclusions and significance: A theory illuminating how adolescents make choices was developed. The theory aligns with existing developmental literature and provides unique insights, from an occupational science perspective, on the conscious process by which adolescents make, develop and adapt choices about the occupations they do considering contextual and individual opportunities and constraints.
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