INPA multi-site study of neurobehavioural disability

Slides:

Advertisements

Similar presentations

1 National Outcomes and Casemix Collection Training Workshop Strengths and Difficulties Questionnaire.

Advertisements

Traumatic Brain Injury Presented by: David L Strauss, Ph.D. ReMed.

Improving Psychological Care After Stroke

Functional Cognitive Rehabilitation Hollee Stamper, MSW, LSW, CBIS Jeff Noonan, M.Ed.,CBIS.

Acquired Brain Injury Rehabilitation Services: The Southern Picture Dr. Nicola Ryall Consultant in Rehabilitation Medicine 28 September 2006 NATIONAL REHABILITATION.

Cutting the Mustard: Securing Meaningful Employment for People with an Acquired Brain Injury Nick Rushworth Executive Officer Brain Injury Australia.

Mayo Brain Injury Outpatient Program: Methods and Outcomes James F. Malec, PhD Professor, Professor, Mayo Clinic and Medical School Rochester, MN USA.

Randomized Controlled Trial of Integrated(Managed)Care Pathway for Stroke Rehabilitation 何雲仙倪承華 91 年 8 月 30 日.

Dr. Marie Goss. NORTH SOUTH BRAIN INJURY CONFERENCE SEPT 2006

“This multimedia product and its contents are protected under copyright law. The following are prohibited by law: any public performance or display, including.

Clinical Neuropsychology

Emotional Well Being on an Acute Stroke Unit Implementation of a Mood Screening Pathway Walsall Healthcare NHS Trust Dr Amanda Campbell - Clinical Psychologist.

FIM+FAM – OUTCOME MEASURES Presented by Caroline Ray On behalf of Queen Elizabeth’s Foundation Brain Injury Centre, Banstead, Surrey.

A Clinical Framework for Assessing Function

Implications of Pediatric Brain-Related Disorders for the Clinical Psychologist APA Convention Washington, DC August 6, 2011 Department of Pediatrics Case.

The Clinical and Cost Benefits of Investing in Neurobehavioural Rehabilitation Michael Oddy Director of Clinical Services Sara d S Ramos Research Fellow.

Returning to Work after Brain Injury James F. Malec, PhD Professor, Professor, Mayo Clinic and Medical School Rochester, MN.

1 National Outcomes and Casemix Collection Training Workshop Older Persons Inpatient.

Carver County and Scott County February Children’s Mental Health Case Management seeks to improve the quality of life for children with severe emotional.

Perceived Recovery as a Predictor of Physical Activity after Mild Stroke Jessica Koster, BA, MSOTS 1, & Timothy J. Wolf, OTD, MSCI, OTR/L 1,2 Washington.

Functional assessment and training Ahmad Osailan.

ADOLESCENTS IN CRISIS: WHEN TO ADMIT FOR SELF-HARM OR AGGRESSIVE BEHAVIOR Kristin Calvert.

1 National Outcomes and Casemix Collection Training Workshop Adult Ambulatory.

The Watson Institute Research has demonstrated that psychosocial factors influence the behavioral development and rehabilitation course of children with.

The Role of Psychology in Psychosocial Rehabilitation Srividya Iyer, M.A. University of Nebraska - Lincoln.

METHOD METHOD Long-Term Neuropsychological Functioning Following Mild Traumatic Brain Injury Nathalie C. Bérard and Dennis P. Alfano CONCLUSIONS The group.

1 National Outcomes and Casemix Collection Training Workshop Adult Inpatient.

Amy Houtrow, MD, PhD, MPH No relevant disclosures

INTRODUCTION Emotional distress and sense of burden are experienced by many caregivers of persons with traumatic brain injury (TBI). 1-8 Predicting which.

NeuroRounds Introduction Initial Case Reports.  Continue to develop Rational Clinical Decision Making Skills  Master professional communication and.

Leading Psychosocial Treatment Programmes For Challenging Behaviour in People with Acquired Brain Injury Dr Caroline Knight, Lead Consultant Neuropsychologist.

© The Association for Dementia Studies Dementia, and why it matters. Bernie Coope, Associate Medical Director, WHACT Honorary Senior Lecture, University.

Reintegration of Children with Aquired Brain Injury into the Educational Process Hermina Damjan Svetlana Logar Tanja Babnik Sabina Andlovic Metka Teržan.

Health Related Quality of Life after serious occupational injuries and long term disability Presenter: Ibishi Nazmie MD,PhD University Clinical Center.

EXTENDED OCCUPATIONAL REHABILITATION Ksenija Šterman, MD, Specialist for Occupational, Traffic and Sports Medicine Ljubljana,

2016 Scorecard Our scorecards give information about our client groups and their rehabilitation outcomes. Inpatient Rehabilitation in Auckland Over-18.

The Therapeutic Benefits of Sensory Rooms on Disability Populations

Principles & Practice of Neurobehavioural Rehabilitation

The stroke and aphasia quality of life scale (SAQOL-39g) in Greek: Psychometric evaluation K. Hilari1, 3, E. Efstratiadou1,3, M. Ignatiou1, V. Christaki1,

Satisfaction outcomes

Inclusive Community Choices

TBI, CBT, DBT? What to do? Psychological and neuropsychiatric care of the patient with TBI. Margo Lauterbach, MD Sarah Loeffler, LCSW-C Andrea Gottlieb,

Life/Future Care Cost Analysis Following A Traumatic Injury

Welcome back from Lunch everyone – I do hope that you all enjoyed.

BrICC Brain Injury & Concussion Center Oral Case Reporting

2016 Scorecard Our scorecards give information about our client groups and their rehabilitation outcomes. Long-Term Residential Rehabilitation in Wellington.

2016 Scorecard Our scorecards give information about our client groups and their rehabilitation outcomes. Long-Term Residential Rehabilitation in Auckland.

A Client with a severe mental illness

Providing innovative services for survivors of brain injury

Balance and Falls for people with Multiple Sclerosis

“Is my treatment the cause of this person’s change?” (Wilson, 1991)

Module 2: Program Development in Community-based Practice

The Relationship Between Mental and Physical Health

THE PREVALENCE OF BEHAVIOURAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA IN RURAL TANZANIA

Investigating the Impact of Traumatic Brain Injury on Caregiver Life Satisfaction: A Key Element of Successful Community Participation *Wheeler, S., **Motsch,

D.Shaun Gray, MD, PhD, Robert S. Burnham, MSc, MD

Chapter 17 Developmental Delay and Intellectual Disability

Adjustment Disorders Maladaptive reactions to psychosocial stressors occurring within the past 3 months Not do to another mental disorder Described as.

TBI in the Veteran Population MVAHS

Post-Acute Rehabilitation Length of Stay and Traumatic Brain Injury Outcome Jessica Ashley, Ph.D. 42nd Traumatic Brain Injury Rehabilitation Conference.

Traumatic Brain Injury

Satisfaction outcomes

Dementia and TBI.

A.S.David, R.McCormack and Lishman Unit MDT

A Shared Developmental Approach: Meeting Well-Being Needs and Addressing Trauma to Promote Healthy Development CLARE ANDERSON, DEPUTY COMMISSIONER ADMINISTRATION.

Progress Assessed With the Mayo-Portland Adaptability Inventory in 604 Participants in 4 Types of Post–Inpatient Rehabilitation Brain Injury Programs

Recreational Therapy at St. Marks Hospital

Longitudinal Description of the Glasgow Outcome Scale-Extended for Individuals in the Traumatic Brain Injury Model Systems National Database: A National.

Interreg-IPA Cross-border Cooperation Programme Romania-Serbia

Presentation transcript:

INPA multi-site study of neurobehavioural disability Which measures should we use? Sara D S Ramos Research Fellow Reducing the Burden of Neurobehavioural Disability after Acquired Brain Injury: Past, Present and Future Swansea 28 November 2016

Neurobehavioural disability What are we measuring? Outcomes Inputs Neurobehavioural disability Which measures should we use?

Determine treatment need Track progress Ethical practice Determine treatment need Determine overall functioning Benchmarking Research Image credit: https://huntingenglish.wordpress.com/2013/06/25/question-time-and-asking-why/ Inform plan of care Marketing Enhance communication Required by stakeholder Which measures should we use? Hatfield & Ogles (2004) Professional Psychology Research & Practice, 35 (5) Jette (2009). Physical Therapy, 89 (2)

Which ones could be used? 746 pages http://www.tbims.org/combi/ http://www.rehabmeasures.org/ Image credits: http://sydney.edu.au/medicine/people/academics/profiles/robyn.tate.php; http://www.compendium-of-scales.com/

Which ones are being used? Inpatient rehabilitation Cognitive and behavioural units Category Examples Motor function Mobility Upper limb Global disability EADLs General Health Motricity index 10’ walk 9-hole peg test Modified Barthel Index Original Barthel Index FIM FIM+FAM Nottingham EADL General Health Questionnaire Category Examples Global Behavioural Agitation and aggression Psychosocial outcome Vocational independence Glasgow Outcome Scale FIM+FAM Neurobehavioural Rating Scale Neuropsychiatric Inventory Health of the Nation Outcome Scale Overt Aggression Scale MPAI-4 Pender & Fleminger (1999) Neuropsychological Rehabilitation, 9 (3/4) Turner-Stokes (1999) Neuropsychological Rehabilitation, 9 (3/4) Turner-Stokes & Turner-Stokes (1997) Clinical Rehabilitation, 11 Which measures should we use?

• To measure clinical input How? What? • Symptoms • Disability • Intervention target Why? • To measure outcome • To show change • To measure clinical input How? … Which measures should we use?

The INPA multi-site study of neurobehavioural disability Which measures should we use?

Executive dysfunction Cognitive The term that has grown in use to denote this complex, subtle, yet pervasive constellation of cognitive-behaviour changes is ‘neurobehavioural disability’. - Wood (2001), p. 4 Behavioural Emotional Personality changes Poor social judgement Labile mood Poor impulse control Poor insight Executive dysfunction Attention deficits Which measures should we use?

The INPA multi-site study of neurobehavioural disability 14 services 299 admissions 6 measures Which measures should we use?

The INPA multi-site study of neurobehavioural disability Measures HoNOS-ABI Health of the Nation Outcome Scale FIM+FAM Functional Independence + Functional Assessment Measure SASNOS Saint Andrews-Swansea Neurobehavioural Outcomes Scale MPAI-4 Mayo Portland Adaptability Inventory (version 4) SRS Supervision Rating Scale RCS-E Rehabilitation Complexity Scale-Extended Which measures should we use?

The INPA multi-site study of neurobehavioural disability Method Ratings collected at two time points for the all measures… … Except RCS-E (gathered fortnightly) Raw scores converted into t-scores when available Sub-scale scores used for FIM+FAM, MPAI-4, SASNOS and RCS-E Which measures should we use?

The INPA multi-site study of neurobehavioural disability Results The INPA multi-site study of neurobehavioural disability Age and gender The INPA multi-site study of neurobehavioural disability Results M = 43.54, SD = 15.59 Which measures should we use?

Diagnosis N Valid % TBI 115 46.2 CVA 51 20.5 Infarct 13 5.2 Haemorrhagic stroke 14 5.6 Sub-arachnoid haemorrhage 5 1.8 Other stroke 19 7.0 Anoxia 28 11.2 Inflammatory 7.6 Intoxication 8 3.2 Tumour 2 0.7 Other 26 10.4 (Missing) (23) (8.8)

Median = 8 months M = 49.02 SD = 92.69 30% within 3 months The INPA multi-site study of neurobehavioural disability Time Since Injury Median = 8 months M = 49.02 SD = 92.69 30% within 3 months 62% within 12 months 71% within 24 months Which measures should we use?

Measure (Reference) Mean (SD) Median HoNOS (36-48) 16.97 (6.99) 16 The INPA multi-site study of neurobehavioural disability Total Scores on Admission Measure (Reference) Mean (SD) Median HoNOS (36-48) 16.97 (6.99) 16 FIM+FAM (30-150) 122.39 (46.95) 134 SASNOS (30-40) 37.41 (12.96) 38 MPAI-4 (50-60) 51.82 (8.98) 53 SRS (4-13) - 8 RCS-E (≥ 10) 11.93 (3.98) 12

Which measures should we use?

Which measures should we use?

Making sense of a puzzle… 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 1. FIM+FAM Motor - 2. FIM+FAM Cognitive 3. FIM+FAM EADL 4. SASNOS Interpersonal 5. SASNOS Cognition 6. SASNOS Inhibition 7. SASNOS Aggression 8. SASNOS Communication 9. MPAI-4 Ability 10. MPAI-4 Adjustment 11. MPAI-4 Participation 12. HONOS-ABI 13. SRS 14. RCS Care 15. RCS Risk 16. RCS Nursing 17. RCS Medical 18. RCS Therapy Disciplines 19. RCS Therapy Intensity 20. RCS Equipment Making sense of a puzzle…

Some overlap for areas of impairment 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 1. FIM+FAM Motor - 2. FIM+FAM Cognitive 3. FIM+FAM EADL 4. SASNOS Interpersonal 5. SASNOS Cognition 6. SASNOS Inhibition 7. SASNOS Aggression 8. SASNOS Communication 9. MPAI-4 Ability 10. MPAI-4 Adjustment 11. MPAI-4 Participation 12. HONOS-ABI 13. SRS 14. RCS Care 15. RCS Risk 16. RCS Nursing 17. RCS Medical 18. RCS Therapy Disciplines 19. RCS Therapy Intensity 20. RCS Equipment Some overlap for areas of impairment

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 1. FIM+FAM Motor - 2. FIM+FAM Cognitive 3. FIM+FAM EADL 4. SASNOS Interpersonal 5. SASNOS Cognition 6. SASNOS Inhibition 7. SASNOS Aggression 8. SASNOS Communication 9. MPAI-4 Ability 10. MPAI-4 Adjustment 11. MPAI-4 Participation 12. HONOS-ABI 13. SRS 14. RCS Care 15. RCS Risk 16. RCS Nursing 17. RCS Medical 18. RCS Therapy Disciplines 19. RCS Therapy Intensity 20. RCS Equipment Interpersonal relationships and cognition are associated with everyday function. “It is noteworthy that psychosocial disabilities (such as difficulties in socialization and vocational functions) are more common than physical disabilities (such as problems with mobility or activities of daily living).”

Neurobehavioural disability is associated with supervision needs. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 1. FIM+FAM Motor - 2. FIM+FAM Cognitive 3. FIM+FAM EADL 4. SASNOS Interpersonal 5. SASNOS Cognition 6. SASNOS Inhibition 7. SASNOS Aggression 8. SASNOS Communication 9. MPAI-4 Ability 10. MPAI-4 Adjustment 11. MPAI-4 Participation 12. HONOS-ABI 13. SRS 14. RCS Care 15. RCS Risk 16. RCS Nursing 17. RCS Medical 18. RCS Therapy Disciplines 19. RCS Therapy Intensity 20. RCS Equipment Neurobehavioural disability is associated with supervision needs.

Showing change Which measures should we use?

So, which measures should we use? What? FIM+FAM Cognitive FIM+ FAM EADL SASNOS Interpersonal SASNOS Cognition MPAI Adjustment MPAI Participation Which measures should we use?

So, which measures should we use? What? FIM+FAM Cognitive FIM+ FAM EADL SASNOS Interpersonal SASNOS Cognition MPAI Adjustment MPAI Participation Which measures should we use?

Specifically neurobehavioural? What? SASNOS Cognition SASNOS Inhibition MPAI Adjustment RCS Risk Which measures should we use?

So, which measures should we use? Why? Clinical Input Change RCS Therapy* MPAI Adjustment SRS FIM+FAM EADL* RCS Care/Risk SASNOS Cognition SASNOS Interpersonal Which measures should we use?

So, which measures should we use? Why? Clinical Input Change RCS Therapy* MPAI Adjustment SRS FIM+FAM EADL* RCS Care/Risk SASNOS Cognition SASNOS Interpersonal Which measures should we use?

Which measures should we use?

Which measures should we use?

Working group Nick Alderman Kristy Bolter Keith Jenkins Caroline Knight Mark Butler … and others Which measures should we use?

Thank you! sara.dasilvaramos@thedtgroup.org Which measures should we use?