Posts Tagged severe

[ARTICLE] Outcome Measures for Persons With Moderate to Severe Traumatic Brain Injury: Recommendations From the American Physical Therapy Association Academy of Neurologic Physical Therapy TBI EDGE Task Force – Full Text

Background and Purpose: The use of standardized outcome measures (OMs) is essential in assessing the effectiveness of physical therapy (PT) interventions. The purposes of this article are (1) to describe the process used by the TBI EDGE task force to assess the psychometrics and clinical utility of OMs used with individuals with moderate to severe traumatic brain injury (TBI); (2) to describe the consensus recommendations for OM use in clinical practice, research, and professional (entry-level) PT education; and (3) to make recommendations for future work.

Methods: An 8-member task force used a modified Delphi process to develop recommendations on the selection of OMs for individuals with TBI. A 4-point rating scale was used to make recommendations based on practice setting and level of ambulation. Recommendations for appropriateness for research use and inclusion in entry-level education were also provided.

Results: The TBI EDGE task force reviewed 88 OMs across the International Classification of Functioning, Disability, and Health (ICF) domains: 15 measured body functions/structure only, 21 measured activity only, 23 measured participation only, and 29 OMs covered more than 1 ICF domain.

Discussion and Conclusions: Recommendations made by the TBI EDGE task force provide clinicians, researchers, and educators with guidance for the selection of OMs. The use of these recommendations may facilitate identification of appropriate OMs in the population with moderate to severe TBI. TBI EDGE task force recommendations can be used by clinicians, researchers, and educators when selecting OMs for their respective needs. Future efforts to update the recommendations are warranted in order to ensure that recommendations remain current and applicable.

Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A140).

INTRODUCTION

The use of standardized outcome measures (OMs) in physical therapy (PT) practice is growing and becoming the standard of practice. Evidence of intervention effectiveness depends on, among other things, common use of valid and reliable tests and measures, which reflect clinically important outcomes and are responsive to change. An important initial step toward best practice is the identification and selection of the most appropriate OMs for patients whom therapists treat. However, clinicians may be uncertain in how to select the best OM based on an individual’s specific limitations.1,2 Common barriers to using OMs include the time required to learn or use them, perceptions that OMs are too difficult for patients to understand, and the time burden for clinicians to score and analyze test results.3 The ability to track patient progress during recovery from a neurologic condition improves with the use of standardized OMs that are employed across settings. In addition, the use of common OMs may facilitate ongoing clinical research.

To address some of these issues, the Academy of Neurologic Physical Therapy of the American Physical Therapy Association (APTA) began a process to develop recommendations for the identification of core sets of OMs in 2009. A Research Section of APTA task force, the Evaluation Database to Guide Effectiveness (EDGE), was developed to make recommendations for OM utilization in PT practice. Building on recommendations from that group, members of the Academy of Neurologic Physical Therapy initiated what was described as an “EDGE group” focusing on the stroke population. This group established a yearlong process for rating and evaluating OMs, which culminated in the StrokEDGE report.4 The following year, the process was followed by a group focused on OMs for patients with Multiple Sclerosis.5 In the fall of 2011, the Academy of Neurologic Physical Therapy initiated task forces to evaluate OM use in traumatic brain injury (TBI) and spinal cord injury. Task forces looking at vestibular dysfunction and Parkinson disease measures were conducted the following year.

The choice of appropriate OMs for use with TBI can be a challenge. Traumatic brain injury is a chronic health condition that affects physical, cognitive, and behavioral function, often in heterogenous ways. Outcome measures must accommodate a large range of physical and cognitive strengths and limitations. Clinicians must be aware of the complexity of this diagnosis to determine which OMs are most appropriate.6 After TBI, individuals are treated in a wide variety of settings, including intensive care units, acute care, in- and outpatient rehabilitation settings, long-term care facilities, and in the home. The environment, available space and equipment, as well as the individual’s cognitive and physical limitations, all influence which OMs are feasible and appropriate.

The objectives of the TBI EDGE task force were:

  1. to develop recommendations for clinicians, educators, and researchers for the use of standardized OMs to utilize throughout the continuum of care of the TBI population and span the domains of the International Classification of Functioning, Disability, and Health (ICF) and,
  2. following the Academy of Neurologic Physical Therapy Board of Directors approval, to disseminate recommendations through available avenues such as the section Web site, conference presentations, and publications.

The work of each EDGE task force had traditionally been completed in a year period, requiring a scope sufficiently focused to be feasible with a limited volunteer workforce. It is the goal of this article to describe the yearlong processes that were used to create recommendations for OM utilization in the TBI patient population in clinical practice, as well as additional recommendations for inclusion into entry-level PT curricula and for use in research.[…]

 

Continue —> Outcome Measures for Persons With Moderate to Severe Traumat… : Journal of Neurologic Physical Therapy

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[Abstract] Rehabilitation of Cognitive Dysfunction Following Traumatic Brain Injury – Epilepsy Society

This article outlines key principles and considerations in the rehabilitation of cognitive challenges following mild, moderate, and severe traumatic brain injuries, with a focus on the needs of the service member and veteran population. The authors highlight specific evidence-based strategies and interventions and provide functional examples to support implementation. By emphasizing the array of tools and resources that have been designed to address cognitive challenges in the service member and veteran population, they focus on optimizing cognition to support successful community reintegration and the resumption of a full and meaningful life.

 

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via Rehabilitation of Cognitive Dysfunction Following Traumatic Brain Injury – Physical Medicine and Rehabilitation Clinics

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[Abstract] Cognition, Health-Related Quality of Life, and Depression Ten Years after Moderate to Severe Traumatic Brain Injury: A Prospective Cohort Study

The aim of this study was to evaluate cognitive function 10 years after moderate-severe traumatic brain injury (TBI) and to investigate the associations among cognitive function, depression, and health-related quality of life (HRQoL). In this prospective cohort study, with measurements at 3, 6, 12, 18, 24, 36, and 120 months post-TBI, patients 18–67 years of age (n = 113) with moderate-severe TBI were recruited. Main outcome measures were depression (Center for Epidemiologic Studies-Depression Scale [CES-D]), subjective cognitive functioning (Cognitive Failure Questionnaire [CFQ]), objective cognitive functioning, and HRQoL (Medical Outcomes Study 36-Item Short Form Health Survey [SF-36]). Fifty of the initial 113 patients completed the 10 year follow-up. Twenty percent showed symptoms of depression (CES-D ≥ 16). These patients had more psychiatric symptoms at hospital discharge (p = 0.048) and were more often referred to rehabilitation or nursing homes (p = 0.015) than non-depressed patients. Further, they also had significantly lower scores in six of the eight subdomains of the SF-36. The non-depressed patients had equivalent scores to those of the Dutch norm-population on all subdomains of the SF-36. Cognitive problems at hospital discharge were related with worse cognitive outcome 10 years post-TBI, but not with depression or HRQoL. Ten years after moderate-severe TBI, only weak associations (p < 0.05) between depression scores and two objective cognitive functioning scores were found. However, there were moderate associations (p < 0.01) among depression scores, HRQoL, and subjective cognitive functioning. Therefore, signaling and treatment of depressive symptoms after moderate-severe TBI may be of major importance for optimizing HRQoL in the long term. We did not find strong evidence for associations between depression and objective cognitive functioning in the long term post-TBI. Disease awareness and selective dropping out may play a role in long-term follow-up studies in moderate-severe TBI. More long-term research is needed in this field.

 

via Cognition, Health-Related Quality of Life, and Depression Ten Years after Moderate to Severe Traumatic Brain Injury: A Prospective Cohort Study | Journal of Neurotrauma

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[Abstract] Longitudinal Recovery of Executive Control Functions After Moderate-Severe Traumatic Brain Injury: Examining Trajectories of Variability and Ex-Gaussian Parameters

Background. Executive control deficits are deleterious and enduring consequences of moderate-severe traumatic brain injury (TBI) that disrupt everyday functioning. Clinically, such impairments can manifest as behavioural inconsistency, measurable experimentally by the degree of variability across trials of a reaction time (RT) task (also known as intraindividual variability [IIV]). Growing research on cognition after TBI points to cognitive deterioration in the chronic stages postinjury. Objective. To examine the longitudinal recovery of RT characteristics (IIV and more detailed ex-Gaussian components, as well as the number of impulsively quick responses) following moderate-severe TBI. Methods. Seventy moderate-severe TBI patients were assessed at 2, 5, 12, and 24+ months postinjury on a go/no-go RT task. RT indices (ex-Gaussian parameters mu and sigma [mean and variability of the normal distribution component], and tau [extremely slow responses]; mean, intraindividual coefficient of variation [ICV], and intraindividual standard deviation [ISD]) were analyzed with repeated-measures multivariate analysis of variance. Results. ICV, ISD, and ex-Gaussian tau significantly decreased (ie, improved) over time in the first year of injury, but worsened from 1 to 2+ years, as did the frequency of extremely fast responses. These quadratic patterns were accentuated by age and shown primarily in tau (extremely slow) and extremely fast (impulsive) responses. Conclusions. The pattern of early recovery followed by decline in executive control function is consistent with growing evidence that moderate-severe TBI is a progressive and degenerative disorder. Given the responsiveness to treatment of executive control deficits, elucidating the trajectory and underpinnings of inconsistent behavioral responding may reveal novel prognostic and clinical management opportunities.

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via Longitudinal Recovery of Executive Control Functions After Moderate-Severe Traumatic Brain Injury: Examining Trajectories of Variability and Ex-Gaussian Parameters – Brandon P. Vasquez, Jennifer C. Tomaszczyk, Bhanu Sharma, Brenda Colella, Robin E. A. Green, 2018

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