Self-rated competency in activities predicts functioning and participation one year after traumatic brain injury

Abstract

Objective: To investigate whether the Patient Competency Rating Scale at three months predicts global functioning and participation one year after traumatic brain injury.

Design: Prospective cohort study with follow-up at 3 and 12 months post injury. The Patient Competency Rating Scale was analysed in a logistic regression model with the outcomes Community Integration Questionnaire, Glasgow Outcome Scale Extended and return to work/study.

Setting: The neurosurgical department of a trauma referral centre in a metropolitan hospital.

Subjects: A cohort of 70 patients with acute traumatic brain injury, ranging from mild to severe injury.

Main measures: The Patient Competency Rating Scale, assessing competency in activities, was applied as a predictor. Outcomes describing community participation at 12 months were the Community Integration Questionnaire and return to work/study. Global functioning was evaluated by the Glasgow Outcome Scale Extended.

Results: Factor analysis of the Patient Competency Rating Scale items yielded three domains: activities demanding cognition, interpersonal/emotional skills, and activities of daily living (ADL) competency. The first two of these domains significantly predicted return to work/study and community integration, whilst global functioning at one year was predicted by interpersonal/emotional competency.

Conclusions: The Patient Competency Rating Scale at three months predicted functioning and participation one year after traumatic brain injury. This indicates that rehabilitation interventions should focus on cognitive and interpersonal competency in order to enhance participation after traumatic brain injury.

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References

Fleming J. , Tooth L. , Hassell M. , Chan W. Prediction of community integration and vocational outcome 2—5 years after traumatic brain injury rehabilitation in Australia. Brain Inj 1999; 13: 417—31.

Vogenthaler DR , Smith KR Jr , Goldfader P. Head injury, a multivariate study: predicting long-term productivity and independent living outcome. Brain Inj 1989; 3: 369—85.

Fleming JM , Maas F. Prognosis of rehabilitation outcome in head injury using the Disability Rating Scale. Arch Phys Med Rehabil 1994; 75: 156—63.

Willer B. , Ottenbacher KJ , Coad ML The Community Integration Questionnaire. A comparative examination. Am J Phys Med Rehabil 1994; 73: 103—11.

Keyser-Marcus LA , Bricout JC , Wehman P. et al. Acute predictors of return to employment after traumatic brain injury: a longitudinal follow-up . Arch Phys Med Rehabil 2002; 83: 635—41.

Dawson DR , Levine B. , Schwartz ML , Stuss DT Acute predictors of real-world outcomes following traumatic brain injury: a prospective study. Brain Inj 2004 ; 18: 221—38.

Khan F. , Baguley IJ , Cameron ID Rehabilitation after traumatic brain injury. Med J Aust 2003; 178: 290—95.

Hall KM , Bushnik T. , Lakisic-Kazazic B. , Wright J. , Cantagallo A. Assessing traumatic brain injury outcome measures for long-term follow-up of community-based individuals. Arch Phys Med Rehabil 2001; 82: 367—74.

Ownsworth T. , McKenna K. Investigation of factors related to employment outcome following traumatic brain injury: a critical review and conceptual model. Disabil Rehabil 2004 ; 26: 765—83.

10.

Asikainen I. , Kaste M. , Sarna S. Predicting late outcome for patients with traumatic brain injury referred to a rehabilitation programme: a study of 508 Finnish patients 5 years or more after injury. Brain Inj 1998; 12: 95—107.

11.

Teasdale G. , Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974 ; 2: 81—84.

12.

Nakase-Richardson R. , Yablon SA , Sherer M. Prospective comparison of acute confusion severity with duration of posttraumatic amnesia in predicting employment outcome after traumatic brain injury. J Neurol Neurosurg Psychiatry 2006; 78: 872—76.

13.

Corrigan JD , Smith-Knapp K. , Granger CV Outcomes in the first 5 years after traumatic brain injury. Arch Phys Med Rehabil 1998; 79: 298—305.

14.

Alexander MP Mild traumatic brain injury: pathophysiology, natural history, and clinical management. Neurology 1995; 45: 1253—60.

15.

Stilwell S. , Stilwell J. , Hawley C. , Davies C. The National Traumatic Brain Injury Study: assessing outcomes across settings. Neuropsychol Rehabil 1999; 9: 277—93.

16.

Prigatano GP , Fordyce DJ , Zeiner HK et al. Neuropsychological rehabilitation after brain injury. Johns Hopkins University Press, 1986.

17.

Leathem JM , Murphy LJ , Flett RA Self- and informant-ratings on the patient competency rating scale in patients with traumatic brain injury. J Clin Exp Neuropsychol 1998; 20: 694—705.

18.

Heilbronner RL , Millsaps C. , Azrin R. , Mittenberg W. Psychometric properties of the Patient Competency Rating Scale. J Clin Exp Neuropsychol 1993 ; 15: 67—68.

19.

Wilson JT , Pettigrew LE , Teasdale GM Structured interviews for the Glasgow Outcome Scale and the extended Glasgow Outcome Scale: guidelines for their use. J Neurotrauma 1998; 15: 573—85.

20.

Narayan RK , Michel ME , Ansell B. et al. Clinical trials in head injury. J Neurotrauma 2002; 19: 503—57.

21.

Pettigrew LE , Wilson JT , Teasdale GM Reliability of ratings on the Glasgow Outcome Scales from in-person and telephone structured interviews . J Head Trauma Rehabil 2003; 18: 252—58.

22.

Kuipers P. , Kendall M. , Fleming J. , Tate R. Comparison of the Sydney Psychosocial Reintegration Scale (SPRS) with the Community Integration Questionnaire (CIQ): psychometric properties. Brain Inj 2004; 18: 161—77.

23.

Doig E. , Fleming J. , Tooth L. Patterns of community integration 2—5 years post-discharge from brain injury rehabilitation. Brain Inj 2001 ; 15: 747—62.

24.

Borgaro SR , Prigatano GP Modification of the Patient Competency Rating Scale for use on an acute neurorehabilitation unit: the PCRS-NR. Brain Inj 2003; 17: 847—53.

25.

Winer BJ Statistical principles in experimental design. McGraw-Hill , 1991.

26.

Linden MA , Crothers IR , O'Neill SB , McCann JP Reduced community integration in persons following traumatic brain injury, as measured on the Community Integration Measure: an exploratory analysis . Disabil Rehabil 2005; 27: 1353—56.

27.

Sherer M. , Novack TA , Sander AM , Struchen MA , Alderson A. , Thompson RN Neuropsychological assessment and employment outcome after traumatic brain injury: a review. Clin Neuropsychol 2002; 16: 157—78.

28.

Zafonte RD , Mann NR , Millis SR , Black KL , Wood DL , Hammond F. Posttraumatic amnesia: its relation to functional outcome. Arch Phys Med Rehabil 1997; 78: 1103—106.

29.

Tagliaferri F. , Compagnone C. , Korsic M. , Servadei F. , Kraus J. A systematic review of brain injury epidemiology in Europe. Acta Neurochir (Wien) 2006; 148: 255—68.

30.

Prigatano GP , Bruna O. , Mataro M. , Munoz JM , Fernandez S. , Junque C. Initial disturbances of consciousness and resultant impaired awareness in Spanish patients with traumatic brain injury . J Head Trauma Rehabil 1998; 13: 29—38.