Lühdorf, Pernille

Paulsen, Julie Engell

Ryttersgaard, Trine Okkerstrøm

English

HospitalThe patientMunicipalityGeneral practioner01234567890 5 10 15 20 25 30 35 40COPM satisfactionMDIMDI and COPM satisfaction (T1)01234567890 5 10 15 20 25 30 35 40COPM performanceMDIMDI and COPM performance (T1)02468100 10 20 30 40 50COPM satisfactionMDICOPM satisfaction and MDIFirst visit (T1) One year control (T2)Contact: BackgroundThe aim of rehabilitation is to increase individual functioning and life satisfaction. Unfortunately people with acquired brain injury have a high prevalence of psychiatric symptoms including depres-sive symptoms (Scholten et al., In press; Bulloch, 2015).  One study has found a connection between depression and quality of life (QoL) among young people post-TBI (Batista et al. 2014). Addition-ally Eriksson et al. (2009) found a connection between capability to participate in everyday occupations and life satisfaction among patients with ABI.The aim of this study is to explore if there exists a connection be-tween depressive symptoms and satisfaction with everyday occu-pations, and if a change in one domain affects the other.MethodThe Ministry of Health and Elderly in Denmark has made an ini-tiative towards young people with ABI, which has resulted in five regional outpatient clinics.N Gender Age years (SD) Years23Female: 8 (34,8 %) 22,65 (3,84) Min: 0,23Male: 15 (65,2 %) Max: 24,76ResultsA significant increase was found on scores on COPMperformance and COPMSatisfaction from first contact in the clinic (T1) to control one year follow-up (T2). Decrease in depressive symptoms is not found to be significant (Table 2). Table 1 - Descriptive dataThere was found a significant negative correlation between COPM satisfaction and MDI score at T1. The two variables were correlated, Pearson r(21) = -0,56, p = 0,006. Linear regression analysis indicated that depressive symptoms and satisfaction with performance is associated, β = -0.09, t(21)=-3.09, p=0,006 (Figure 1).We found no correlation between scores on COPMperformance and MDI at T1 Pearson r(21) = -0,11, p=0,61 (Figure 2). Measure Statistics T1 - Mean (SD) T2 - Mean (SD) Difference - Mean (SD) PCOPM satisfaction paired t-test 3,62 (1,48) 6,62 (2,10) 2,62 (1,90) p<0,0001COPM performance paired t-test 4,51 (1,57) 6,67 (1,66) 2,16 (1,93) p<0,0001MDI paired t-test 18,56 (9,08) 16,91 (11,45) 1,65(9,37) P=0,41*Table 2 – Differences from T1 to T2 (*not significant)Discussion:The patients experience increased performance and satisfaction with occupational performance from first visit (T1) to the follow-up (T2). This could indicate that an interdisciplinary examination and assessment of need for rehabilitation after discharge, have had a positive influence in the patients’experience and satisfaction with own functioning. Since scores on COPM is associated with mea-sures on QoL, the results could also be interpreted as an increase in QoL.  At this stage, we can’t conclude which factors are respon-sible for the changes. But knowing that 83 % of the patients, who went to the outpatient clinic had an unmet need for rehabilitation, the interdisciplinary examination, which often results in prescrip-tion of rehabilitation, may have had an influence (Poster 0411, 11th IBIA World Congress). The negative correlation between satisfaction with everyday occu-pations and depressive symptoms, is in accordance with Batista et al. (2014), who have shown an association between QoL and depressive symptoms. The causality of the relationship is unclear. Whether high level of depressive symptoms predict a low satisfac-tion with occupational performance or low satisfaction with per-formance predict depression remains unclear at this stage.We found an association between depressive symptoms and sat-isfaction with everyday occupations. However, we only found a sig-nificant change in COPMsatisfaction after one year whereas the change in MDI was non-significant. Furthermore the regression analysis showed that only a part of the increase on COPMsatisfaction were asso-ciated with the decrease on MDI. The increase in satisfaction with everyday occupations can therefore not only be explained by a drop in depressive symptoms, but also depend on other factors. This in-dicates that clinicians need to focus on both depressive symptoms and other rehabilitation needs such as increasing functioning in daily living. Scores on COPM and MDI are both measures dependent on the patients’evaluation. We have not been able to account for factors such as lack of insight among the patients, which could have influ-enced the results. Conclusions•  The patients experience an increase on both performance on everyday occupations and satisfaction with performance. This indicates that an interdisciplinary examination and assesment of rehabilitation-needs have had a positive impact on the  patients’ experiences of own functioning one year after first examination.•  The patients generally experience an increased satisfaction with everyday occupations, even though their depressive symptoms do not decrease.•  The results indicates an association between decrease in  depressive symptoms and increase in satisfaction. Even though, there exists an association, the increase in satisfac-tion with everyday occupations after one year cannot entirely be explained by the association. Other factors influence the  satisfaction with everyday occupations as well.Referencer:Battista, AD et al. (2014) Depression and Health Related Quality of Life in Adolescent Survivors of a Trau-matic Brain Injury: A Pilot Study. PLoS ONE 9(7), e101842Bulloch, AGM (2015) Depression – a common disorder across a broad spectrum of neurological conditions: a cross-sectional nationally representative survey. General Hospital Psychiatry, 2015 Nov.-dec; 37(6): p. 507-12.Carswell, A. et al. (2004). The Canadian Occupational Performance Measure: A research and clinical liter-ature review. Revue canadienne D’ergothérapie, 2004; 71(4): p. 210-222.Eriksson, G. et al. (2009). Relationsship between occupational gaps in everyday life, depressive mood and life satisfaction after acquired brain injury. Journal of rehabilitation Medicine J Rehabil Med, 2009; 41: p. 187-194.Scholten, A.C. et al. (2016 – in Press) Prevalence of and risk factors for anxiety and depressive disorders following traumatic brain injury: A systematic review. J Neurotrauma, 2016 Jan 5 [Epub ahead of print]Subjects:Patients (age 15 -30) living in North Region Denmark with a di-agnosis of possible ABI. Patients with congenital brain injury are excluded. Patients are referred either by discharging hospital or general practitioner.In the clinic patients undergo an interdisciplinary examination at first visit (T1) and a control examination one year after (T2).Examination:The patients are examined by doctor, occupational therapist, phys-iotherapist and neuropsychologist using a standard test-battery consisting of NIHSS, FIM, GOS-E, Mini-Best TEST, HIMAT, COPM, Major Depression Inventory (MDI) and neuropsychological testing.This study focus on the results on COPM and MDI. To ensure that the patient’s cognitive difficulties did not affect the understanding of the questions, MDI is conducted in cooperation with the neu-ropsychologist. The COPM both measure the patients’evaluation with performance on everyday occupations (COPMPerformance) and satisfaction with performance (COPMSatisfaction). The COPM is known to be associated with measures on QoL (Carswell et al. 2004). The COPM-interview is conducted by the occupational therapist.Julie Engell Paulsenj.paulsen@rn.dkHow do depressive symptoms and satisfaction with everyday occupations affect each other?By Julie Engell Paulsen, Neuropsychologist, Trine Okkerstrøm Ryttersgaard, Neuropsychologist, and Pernille Lüdorf, doctor. The Outpatient Clinic for young people with acquired brain injury, Department of Neurology, Aalborg University Hospital.PerspectivesIn the future it could be interesting to look into which other factors than depressive symptoms affect evaluation and satisfaction with everyday occupations?Figure 3Figure 2Figure 1Participation at the 11th World Congress on Brain Injury is supported by Den Obelske Familiefond.Because of the small sample size the results must be comprehended with caution and looked upon as tendencies.  An analysis of covariance was conducted to determine the difference between T1 and T2 on COPM satisfaction. The difference on COPM satisfaction was estimated after linear adjustment for scores on MDI. After controlling for MDI score, the COPM satisfaction increased significantly from T1 to T2, with a mean difference of 2.44, 95 % CI(0.46;4.42), p<0.001 (Figure 3).

How do depressive symptoms and satisfaction with everyday occupations affect each other?

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How do depressive symptoms and satisfaction with everyday occupations affect each other?

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