Evidence-based evaluation of programme interventions to achieve positive community integration outcomes for adults with acquired brain injury

Background. The growing population of people with acquired brain injury (ABI) requires a strong focus on clients to be integrated into the community in order to use their productive skills in society, to help them live with greater independence, and to reduce community expenditure. To date, there is limited theoretical and conceptual development of frameworks documenting the factors influencing community integration as it applies to adults with acquired brain injury. Furthermore, although there is considerable attention paid to community integration as a desired outcome, there exists no evidence-based framework explaining characteristic of successful community interventions for people with acquired brain injury. In addition, fidelity of ABI interventions is not considered in the literature against an evidence-based framework.Objectives. This study was completed in three phases aiming (1) to develop a framework for community integration for adults with post acute ABI; (2) to investigate characteristics of successful community integration programmes in order to develop an instrument to evaluate fidelity of community integration program for adults with ABI; and (3) to field test the instrument to (a) identify implementation issues; (b) explore the relationship between the themes and attributes across the three services; and (c) establish some aspects of the psychometric properties of the instrument.Methodology and Results. The first phase of the study aimed to obtain a framework to define community integration for adults with ABI. The Participant Groups included six researchers, seven health professionals, six policy makers, eight people with ABI and ten family members. Following a pilot study which examined understandability of the documentation and terms used in the study, the Policy Delphi survey method (Hasson, Keeney, & McKenna, 2000; Turoff, 2002; 1995) was applied which included three steps. Each step of the study began with a survey or a semi-structured interview. The data were analysed and the results were used in the next step. At the end of the first phase of the study, a framework to identify community integration for adults with ABI was developed. A broad literature review confirmed its themes. The community integration framework (CIF) included seven community integration themes and descriptors. The themes consisted of Relationships, Acceptance, Community access, Occupation, Being at home, Picking up life again, and Heightened risks and vulnerability.In the second phase of the study, a multi attribute utility (MAU) technique was applied (Camasso & Dick, 1993; Huber, 1974; Lewis, Johnson, & Scholl, 2003). The CIF which resulted from the first phase was used in this phase as a basis to identify the characteristics of programmes that contributed to the achievement of community integration for adults with ABI. This part of the study was completed using four stages. In each stage, surveys or semi-structured interviews were used to gather the participants‘ opinions on the characteristics of a successful community integration programme. Analysis of the results of each stage informed the next stage.In the first stage of the second phase the data (descriptors of community integration programmes) were categorised into seven clusters and 26 sub-clusters. In the second stage, the Participant Groups reviewed and examined the importance of the programme characteristics using a Likert Scale. This stage resulted in determining the priority weights of the items. In the third stage, an Expert Panel reviewed the results during a day-long working group. The Expert Panel including 10 people as a sub-group of the participant groups modified the themes, their descriptors and attributes, and then identified indicators for the attributes as the programme characteristics for community integration for people with ABI. The themes, their descriptors and attributes were compared with ABI outcome measures currently available in the literature.During the fourth stage, the themes and attributes were sent to the Participant Groups and the Expert panel to finally confirm and determine the relative importance of each theme and attribute. This was the final stage in the development of the programme assessment of community integration attributes (PACIA) which included seven themes and 21 attributes. The themes consisted of Person centred approaches and planning, Relationships, Working together, Development of skills, Community based practices, Support for service users, and Service setting and atmosphere. Each attribute was further defined with indicators. Sources of evidence were identified to enable attributes to be rated.The third phase of the study included a field study of PACIA, an examination of possible implementation issues with the tool, and an evaluation of some specific psychometric properties of PACIA. The field study aimed to examine the effectiveness of the evaluation process, and investigate the relationship between the themes and attributes across the three services.A trained evaluation team first individually rated each service by PACIA through observation, reading the documents, and interviews with the staff, service users, and families. A conciliation meeting followed to achieve consensus on the service ratings. The three services achieved a range of scores on the PACIA themes and attributes based on their different qualities. This phase also explored the ease of use and issues in the implementation of the instrument based on the raters‘ feedback, and examined inter-rater reliability, face validity, and content validity of PACIA. Within the limitations of the field test method, the study indicated that PACIA is a valid and reliable instrument to evaluate community integration programmes.Conclusion. Integration or re-integration into the community is a vital social objective for people with ABI for whom intensive medical rehabilitation may be followed by an uncertain pathway of longer-term rehabilitation. This study developed an evidencebased community integration framework (CIF) to describe community integration for adults with ABI. The research method surveyed a wide group of key stakeholders whose views formed the basis of the framework. The framework may be useful as a basis for making policy decisions to enhance community inclusion. The CIF provides an agreed description of a theory or model upon which the characteristics of programmes aimed to facilitate community integration were identified and the fidelity of those programmes were assessed. The other result of this study was the development of a fidelity instrument named as Programme Assessment of Community Integration Attributes (PACIA). While there are obviously additional characteristics of PACIA that remain to be researched, this evidence-based instrument appears to be valid and reliable to test the fidelity of community integration programmes. Community integration programmes can be evaluated more comprehensively by PACIA than has been the position in the past. Such an evaluation instrument may help existing programmes re-focus to provide more efficient services for people with ABI

Community Integration for After Acquired Brain Injury: A Literature Review

Objectives: This paper reviews the current literature on acquired brain injury (ABI) with a focus on ABI burden, importance of community integration, and community integration definitions suggested by the literature. Method: Literature review Results: Acquired brain injury (ABI) is referred to a diverse range of disabilities resulted of injury in different parts of the brain. People with ABI are in face with different aspects of individual, family and social concerns or burdens which directly affect their lives. Although community integration as an ultimate aim of rehabilitation is optimal approach to overcome their consequences, a comprehensive concept of it is always challenging. There are several different definitions for community integration including various aspects of life with ABI. Conclusion: Living with brain injury constitutes an expanded experience of community isolation and consequences which reduces participation and social integration. Community integration is aimed to condense concerns of people with ABI with returning them to community

Community Integration for After Acquired Brain Injury: A Literature Review

This paper reviews the current literature on acquired brain injury (ABI) with a focus on ABI burden, importance of community integration, and community integration definitions suggested by the literature. Acquired brain injury (ABI) is referred to a diverse range of disabilities resulted of injury in different parts of the brain. People with ABI are in face with different aspects of individual, family and social concerns or burdens which directly affect their lives. Although community integration as an ultimate aim of rehabilitation is optimal approach to overcome their consequences, a comprehensive concept of it is always challenging. There are several different definitions for community integration including various aspects of life with ABI. Living with brain injury constitutes an expanded experience of community isolation and consequences which reduces participation and social integration. Community integration is aimed to condense concerns of people with ABI with returning them to community

Effects of Transfer Training on Musculoskeletal Pain in the Caregiver of a Stroke Patient: a Case Report

The purpose of this case report was to evaluate the effectiveness of training of transfer techniques to a caregiver of a person who had suffered a stroke in decreasing musculoskeletal pain, depression and anxiety. This study adopted a single subject research design to evaluate the effectiveness of transfer-techniques training on musculoskeletal pain, depression, and anxiety in a 25-year-old female caregiver of a person with a stroke. The study was completed in four phases, including a baseline evaluation (1st and 3rd week), training (3rd, 5th and 7th week), post-training (9th week), and follow-up evaluation (11th week). During the 1st week, demographic and descriptive information (such as age, time since diagnosis, cognition and independence of daily living) were collected from the stroke patient. Also, pain severity, anxiety and depression levels of the caregiver were evaluated. In weeks 3, 5 and 7, transfer training was undertaken. The patient was involved in the training with the caregiver under the supervision of an occupational therapist in their own home. The effectiveness of the training with regard to musculoskeletal pain and depression and anxiety levels of the caregiver was evaluated in the 5th, 9th and 11th weeks. The data were analyzed using a visual analysis of trends and levels. The results showed a decrease in pain severity, anxiety and depression during training and post-training. The changes continued during the follow-up stage. This study suggests promising results for the effectiveness of the transfer-techniques training and justifies further clinical trials. A larger trial is required to confirm the effectiveness of transfer training in improving pain management in caregivers of stroke survivors

The Health-Oriented Lifestyle in Islamic Culture

Introduction: Islam has always stressed the importance of health and wellness. For centuries, Muslims have recognized the value of a good, clean, and healthy life. The purpose of this study is to explain the health-oriented lifestyle in the Islamic culture based on opinions, experiences, and perceptions of clergies, teachers, and students. Method: A qualitative research method was conducted in this study by grounded theory approach. Data were gathered through semi-structured interviews with participants. Moreover, the existing resources, such as case studies, life stories, letters, diaries, and press interviews have been used. Results: This study's central variable was deviation from moderation of thought, belief and behavior. Seven main categories were gained by analysis of data. They were: "policy in the health system", "Islamic education"," Islamic movement in people's family centered lives", "work, effort, and money", "ethics and law abiding citizen", "mobility and leisure", "relationships, interaction, and participation". Conclusion: Lifestyle modification, in the process of acquiring healthy communities and social capital, based on religious teachings could be the perfect solution for the problems of a healthy life in the present day. In structural approach, the government should pay attention to such issues like authority of the family, and supporting parents, and spouses, facilitate family functions by systematic problem solving, and empower and strengthen institutions such as the education system and media. It is suggested that educational institutions direct their teachings toward empowering children of this society in order for them to better play their roles in family and social life, and encourage them to use Islamic teachings Keywords: Health-oriented lifestyle, Islamic culture, Qualitative researc

Fatigue in Progressive Neurological Conditions: A literature Review

This paper reviews the current literature examining the pervasive symptom of fatigue experienced in three of the most common degenerative neurological conditions: multiple sclerosis (MS), Parkinson's disease (PD) and post-polio syndrome (PPS). The existing literature can be considered under four headings; definition and prevalence, type, cause, impact of fatigue. Fatigue is a common symptom in degenerative conditions and has physical, cognitive and psychosocial manifestations. Although the causes of fatigue seem to differ between conditions, its pattern, with few exceptions, is very similar regardless of diagnosis. The literature consistently shows that the impact of fatigue on the person's physical and mental performance considerably increasing the risk of unemployment and reduced quality of life. Fatigue is one of the most disabling symptoms in degenerative neurological conditions. With few pharmacological solutions, non-pharmacological solutions for fatigue management should be considered when determining rehabilitation interventions for this group of people

Effects of Transfer Training on Musculoskeletal pain in the Caregiver of a Stroke Patient: A Case Report

The purpose of this case report was to evaluate the effectiveness of training of transfer techniques to a caregiver of a person who had suffered a stroke in decreasing musculoskeletal pain, depression and anxiety. This study adopted a single subject research design to evaluate the effectiveness of transfer-techniques training on musculoskeletal pain, depression, and anxiety in a 25-year-old female caregiver of a person with a stroke. The study was completed in four phases, including a baseline evaluation (1st and 3rd week), training (3rd, 5th and 7th week), post-training (9th week), and follow-up evaluation (11th week). During the 1st week, demographic and descriptive information  (such as age, time since diagnosis, cognition and independence of daily living) were collected from the stroke patient. Also, pain severity, anxiety and depression levels of the caregiver were evaluated. In weeks 3, 5 and 7, transfer training was undertaken. The patient was involved in the training with the caregiver under the supervision of an occupational therapist in their own home. The effectiveness of the training with regard to musculoskeletal pain and depression and anxiety levels of the caregiver was evaluated in the 5th, 9th and 11th weeks. The data were analyzed using a visual analysis of trends and levels. The results showed a decrease in pain severity, anxiety and depression during training and post-training. The changes continued during the follow-up stage. This study suggests promising results for the effectiveness of the transfer-techniques training and justifies further clinical trials. A larger trial is required to confirm the effectiveness of transfer training in improving pain management in caregivers of stroke survivors

Comparison of Social Participation Level Between Older Adults With Assistive Mobility Devices and Those Without the Devices

Objectives: Social participation is an important aspect of health in ageing. It is also a part of life and a&nbsp;key element in function that improves physical and psychological health in the elderly. Using assistive&nbsp;mobility devices may influence social participation in this population. Current study aimed to compare&nbsp;social participation in older adults who use assistive mobility devices with those who do not use assistive&nbsp;devices in Tehran. Methods & Materials: In this cross-sectional study, older adults with and without assistive mobility devices&nbsp;were comprised in their social participation. Seventy-nine old age adults (39 women and 40 men)&nbsp;who were 60 years or older were recruited using convenience sampling method. They completed life&nbsp;habit, mini mental state and demographic questionnaires. For analyzing continuous data with normal&nbsp;distribution, t test and ANOVA were used, while Kruskal-Wallis and Mann-Whitney tests were used for&nbsp;categorical variables or those with non-normal distribution. Results: The finding indicates that older adults with assistive mobility devices engage less in social participation&nbsp;than those who do not use these devices (P<0.05). Older adults in age group of 60-74 years&nbsp;had higher social participation in comparison with those in 75-89 age group (P<0.05). There was no&nbsp;significant differences between male and females, and single older adults and married ones in their&nbsp;social participation. Conclusion: Type of assistive device affects social participation in older adults. The results suggest that&nbsp;older adults with higher physical ability have higher social participation. Older adults who use assistive&nbsp;devices face with more limitations to participate socially in their community. It is necessary for rehabilitation&nbsp;team to pay attention in improving social participation of older adults