Does Integrating Cognitive and Psychological Interventions Enhance Wellbeing After Acquired Brain Injury? Study Protocol for a Phase II Randomized Controlled Trial of the VaLiANT (Valued Living After Neurological Trauma) Group Program

Background and ObjectivesCognitive and emotional changes affect the majority of individuals with acquired brain injury (ABI) and are associated with poorer outcomes. The evidence for “siloed” rehabilitation approaches targeting cognition and mood separately remains mixed. Valued living (i.e., acting consistently with personal values) is associated with better psychological functioning and participation in work and other productive activities. Rehabilitation interventions that concurrently address cognitive and emotional barriers to valued living may therefore result in improved outcomes. VaLiANT (Valued Living After Neurological Trauma) is an 8-week group intervention developed by our team, which uniquely combines cognitive rehabilitation and psychological therapy to improve wellbeing and meaningful participation (i.e., valued living) following ABI.MethodThis protocol describes the design and implementation of a Phase II parallel-group randomized controlled trial with blinded outcome assessors, to evaluate the potential efficacy of VaLiANT and the feasibility of a Phase III trial. Participants are adults with a history of ABI at least 3 months prior to study entry, who experience cognitive and/or emotional difficulties and associated reduced participation in valued activities. Random allocation to the treatment condition (8-week VaLiANT group program) or a usual care waitlist control condition occurs at a 2:1 treatment: control ratio. The primary outcome is wellbeing, measured by the Warwick-Edinburgh Mental Wellbeing Scale. Secondary outcomes include measures of valued living, mood, cognitive complaints, quality of life, community participation, post-traumatic growth, and self-efficacy. All measures are collected across three time points by blinded assessors (baseline, 8-week follow-up, 16-week follow-up). Trial feasibility will be evaluated against recruitment rates, drop-out rates, intervention acceptability, and treatment fidelity (manual adherence and therapist competence).DiscussionThis trial will extend current knowledge on how to improve long-term outcomes following ABI by evaluating an innovative integrated, multi-domain approach to rehabilitation concurrently addressing cognitive and emotional barriers to participation in meaningful life roles

A Single-Case Experimental Evaluation of a New Group-Based Intervention to Enhance Adjustment to Life with Acquired Brain Injury: VaLiANT (Valued Living After Neurological Trauma)

Adjustment to life with acquired brain injury (ABI) requires self-identity and behaviour to be updated, incorporating injury-related changes. Identifying and enabling new values-consistent behaviours could facilitate this process. We evaluated the feasibility, acceptability, and preliminary efficacy of VaLiANT, a new group intervention that aims to enhance “valued living” following ABI. We used a non-concurrent multiple baseline single-case experimental design (SCED) with an 8-week follow-up phase and randomization to multiple baseline lengths (5–7 weeks). Eight participants (50% women, aged 26–65; 4 Stroke, 3 Traumatic Brain Injury, 1 Epilepsy) attended eight group sessions with assessments before, during, and after the group. Target behaviour was valued living, assessed weekly by the Valued Living Questionnaire. Secondary outcomes included measures of wellbeing, mood, psychological acceptance, self-efficacy regarding ABI consequences, cognitive complaints, and intervention acceptability. Target behaviour was analysed through visual and statistical analysis while secondary outcome data were analysed via reliable change indices and descriptive statistics. Target behaviour data displayed no convincing patterns of improvement. Reliable improvements were found for most participants on secondary outcomes, particularly subjective wellbeing and anxiety. Intervention delivery was feasible with high acceptability ratings. Further investigation of VaLiANT is warranted, based on the feasibility and acceptability of intervention delivery and signals of efficacy identified across adjustment-related secondary outcomes

Development of the Valued Living Questionnaire – Comprehension Support version (VLQ-CS) and validation in adults with acquired brain injury

Valued living (acting in accordance with personal values) is associated with better outcomes after acquired brain injury (ABI), but its measurement using the Valued Living Questionnaire (VLQ) may not be valid due to comprehension errors relating to structure and content. We aimed to modify the VLQ to improve its accessibility and evaluate construct validity and reliability in an ABI cohort. Adaptations made in the VLQ – Comprehension Support version (VLQ-CS) used established communication support methods and addressed common comprehension errors. 103 community-dwelling participants (34% female; mean age 52.17, range 19–79) with ABI (66% stroke, 16% TBI, 18% other) completed the VLQ-CS, and measures of convergent (valued living, mood, wellbeing, psychological inflexibility) and divergent validity (subjective memory). Test-retest reliability was evaluated with repeated administrations 6–8 weeks apart for a subset of participants (n = 44), using Intraclass Correlation Coefficients (ICCs). Convergent validity was supported; VLQ-CS scores were positively correlated with measures of valued living (r=.60–.65) and wellbeing (r=.64–.67), and negatively correlated with depression (r=-0.56–.58), anxiety (r=-0.35–.38) and psychological inflexibility (r=-0.37–.41). Divergent validity was marginal (r=-0.29). Test-retest reliability was good for the VLQ-CS Composite score (ICC=.80). The VLQ-CS shows promise as a valid, reliable measure of valued living post-ABI. Future research should extend to neurotypical and other clinical populations. Valued living or values-based action is associated with better functional and psychosocial outcomes after acquired brain injury (ABI) and is therefore an important target for intervention.Measurement of valued living needs to be clear, easily understood, and relevant for people with cognitive and communication impairments associated with ABI and other conditions.The Valued Living Questionnaire – Comprehension Support version (VLQ-CS) was developed to optimise accessibility and reduce comprehension errors.The VLQ-CS is valid, reliable and fit-for-purpose as a measure of valued living for people with ABI. Valued living or values-based action is associated with better functional and psychosocial outcomes after acquired brain injury (ABI) and is therefore an important target for intervention. Measurement of valued living needs to be clear, easily understood, and relevant for people with cognitive and communication impairments associated with ABI and other conditions. The Valued Living Questionnaire – Comprehension Support version (VLQ-CS) was developed to optimise accessibility and reduce comprehension errors. The VLQ-CS is valid, reliable and fit-for-purpose as a measure of valued living for people with ABI.</p