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Long-term outcome after brain injury with a focus on return to work, life satisfaction and participation
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Rehabilitation after brain injury is often a process which is spread over several years and runs through different phases. After sub acute in-patient rehabilitation a community based post-acute rehabilitation can follow. In this late phase after injury the rehabilitation focuses on reintegration into the community through a return to work and participation in other occupations in society. The overall aim of this dissertation was to study the long-term outcome of brain injury, with a special emphasis on the return to everyday domestic and productive occupations and the connection these have to life satisfaction as a whole. The aim was also to describe and understand the lived experience of the consequences of brain injury in these areas.

This dissertation comprises four studies on different aspects of the long-term outcome of those who have had a brain injury. In a sample of 56 people, the value of occupational therapy assessments as predictors of an eventual return to work was investigated. In a longitudinal follow-up study, the life satisfaction of the participants (n 36) was reported and its correlation to a return to work was evaluated. Interviews were conducted (n 10) to explore the main characteristics of the meaning of work after brain injury in ten respondents. And, finally, in the fourth study, 157 people reported their participation in community activities. The extent of the correspondence between the level of participation and life satisfaction was calculated.

The findings showed that occupational therapy assessments were useful in predicting a return to work in the late phase of the recovery after brain injury. A combination of assessments on the level of body function with assessments on activity level appeared to comprise the best predictive model. In two different studies the reported life satisfaction was found to be significantly lower than the level of life satisfaction in a sample of healthy Swedes for almost all domains. When comparing life satisfaction at two points in time with an interval of three years between them in the longitudinal study, no significant improvement was found. There was no difference reported by the participants for their overall life satisfaction regardless of whether they were back at work or in education, or not. On the other hand, participation in daily occupations in a wider perspective was found to have a positive impact on satisfaction with life as a whole. However, half or more than half of the participants claimed that their participation was restricted except for the items self-care and mobility, where a higher degree of participation was reported. The meaning of work after the brain injury had changed: Work had taken on a new place in life and the importance of work had decreased. In contrast, the social dimension of work had expanded in importance. After the brain injury, the perception of the participants’ own competence and work identity had changed and the respondents described their striving to return to normality.

To conclude, brain injury has a lasting effect on a person’s life, even many years after the injury; consequently there is need for rehabilitation in this late phase. Life satisfaction, which is often used as an overriding goal for rehabilitation, did not improve over time. This finding raises the question of whether life satisfaction is too broad a concept and/or insufficiently sensitive to improvements. There is need for further research in this area to clarify the factors that have an impact on life satisfaction.

Place, publisher, year, edition, pages
Arbetsterapi, Umeå Universitet , 2004. , 70 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 920
Keyword [en]
activities of daily living, brain injury, community integration, lived experience, life satisfaction, longitudinal, occupational therapy, participation, phenomenology, prediction, return to work, rehabilitation
National Category
Medical and Health Sciences
Research subject
Occupational and Environmental Medicine
Identifiers
URN: urn:nbn:se:umu:diva-375ISBN: 91-7305-739-8 (print)OAI: oai:DiVA.org:umu-375DiVA: diva2:143308
Public defence
2004-12-10, Aulan, Vårdvetarhuset, Umeå, 09:00
Opponent
Available from: 2004-11-22 Created: 2004-11-22 Last updated: 2010-06-28Bibliographically approved
List of papers
1. Predicting return to work after brain injury using occupational therapy assessments
Open this publication in new window or tab >>Predicting return to work after brain injury using occupational therapy assessments
2001 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 23, no 11, 474-480 p.Article in journal (Refereed) Published
Abstract [en]

Purpose: The aim of this study was to evaluate the value of occupational therapy assessments used in an outreach rehabilitation programme to predict return to work after brain injury. The assessments represent the ICIDH-2 levels of body function and activity. Method: Fifty-six persons in a late phase after brain injury who had been admitted to the rehabilitation programme during 2 years were followed up according to work status. The follow up was made at a minimum of 2 years after injury. Demographic data and scores from the occupational therapy assessments were compared for the two groups who were back to work or studies (BTW) and not back to work or studies (NBTW). Results: Assessments of memory, visual perception and apraxia separated between the two groups BTW and NBTW. Logistic regression showed that memory score in combination with data on PADL made up the best predictive model. In a subgroup with 21 persons where data on IADL were added to memory and PADL the predictive value was even stronger. Conclusions: In this study we found that occupational therapy assessments were valuable in predicting failure to return to work or studies after brain injury.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-4283 (URN)10.1080/09638280010010688 (DOI)11437199 (PubMedID)
Available from: 2004-11-22 Created: 2004-11-22 Last updated: 2017-12-14Bibliographically approved
2. Life satisfaction related to work re-entry after brain injury: A longitudinal study
Open this publication in new window or tab >>Life satisfaction related to work re-entry after brain injury: A longitudinal study
2003 (English)In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 17, no 11, 991-1002 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE: The aim of this study was to assess the subjective life satisfaction after brain injury and its relation to work re-entry. METHOD: The research design was a longitudinal study. Thirty-six individuals answered a questionnaire at 3 and 6 years after admittance to a rehabilitation programme. The questionnaire addressed work status, job satisfaction, subjective symptoms of illness and life satisfaction. RESULTS: The reported life satisfaction both for life as a whole and for different domains of life was low. No significant difference between follow-ups was found for satisfaction with life as a whole. For the domain IADL activities, the subjects reported a statistically significant lower satisfaction at the second follow-up than at the first. No correlation between work status and subjective satisfaction with life as a whole was found in this population. At the second follow-up, significantly more people were satisfied with IADL in the group that had returned to work. CONCLUSIONS: The results from this study indicate that brain injury has a lasting effect on a person's life also many years after onset. The decreasing satisfaction with the ability to perform IADL-activities in along-term perspective should give implications for clinical practice. More research in this area is needed.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-4284 (URN)10.1080/0269905031000110508 (DOI)14514450 (PubMedID)
Available from: 2004-11-22 Created: 2004-11-22 Last updated: 2017-12-14Bibliographically approved
3. The meaning of work after acquired brain injury
Open this publication in new window or tab >>The meaning of work after acquired brain injury
2006 (English)In: American Journal of Occupational Therapy, ISSN 0272-9490, Vol. 60, no 1, 60-69 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Research in the field of brain injury rehabilitation has tended to regard return to work as a measure of outcome. Researchers have not paid particular attention to the experiences of people living with a brain injury. The aim of the phenomenological study reported here was to identify and describe what characterizes the meaning of work to those with acquired brain injury. METHODS: Ten participants of working age were interviewed about the meaning of work 1-5 years after being inflicted with a brain injury. Data were analyzed and interpreted using the Empirical Phenomenological Psychological method. RESULTS: The findings revealed a meaning structure consisting of four main characteristics. Work was no longer experienced as the primary event in life and the social dimension had become more important. The perceived competence and work identity were threatened after the injury. A common theme across all interviews was the struggle to return to a state of normality, and working was considered to be evidence of success. CONCLUSION: The findings described the altered meaning of work 1-5 years after brain injury. This knowledge should lead to an increased understanding among occupational therapists engaged in work rehabilitation after brain injury and can serve as a basis for individualized intervention strategies.

Keyword
Achievement, Adaptation; Psychological, Adult, Brain Injuries/*psychology/*rehabilitation, Female, Humans, Interpersonal Relations, Male, Middle Aged, Occupational Therapy, Social Environment, Social Identification, Work/*psychology
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-7488 (URN)16541985 (PubMedID)
Available from: 2008-01-10 Created: 2008-01-10 Last updated: 2010-06-28Bibliographically approved
4. Participation in everyday occupations in a late phase of recovery after brain injury.
Open this publication in new window or tab >>Participation in everyday occupations in a late phase of recovery after brain injury.
2007 (English)In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 14, no 2, 116-125 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to describe to what extent individuals of working age, in a late phase after an acquired brain injury, participate in everyday occupations related to home maintenance, work, and leisure. The aim was also to evaluate if participation in different occupations influences their life satisfaction. A sample of 157 people consecutively admitted to a rehabilitation clinic between June 1995 and December 2000 answered a mailed questionnaire. The subjects who were of working age had had a brain injury on average 6 years before this study. The perceived participation was reported using the Reintegration to Normal Living Index (RNL) and life satisfaction according to an expanded version of the LiSat 11. This study showed that in this late phase of recovery after brain injury the subjects still experienced many restrictions in participation in everyday occupations. The area with the lowest reported participation was work activity while most comfort with the situation was reported for self-care. The RNL subscales showed a significant connection with satisfaction with life as a whole. Furthermore an interaction was found between the two subscales "Daily living" and "Perception of self". This study showed restrictions in participation in the community even several years after brain injury, which underlines the need for rehabilitation services long after injury.

Keyword
Activities of Daily Living, Adult, Aged, Brain Injuries/*rehabilitation, Cohort Studies, Data Collection, Female, Follow-Up Studies, Humans, Male, Middle Aged, Occupations, Patient Compliance, Patient Satisfaction, Recovery of Function, Self Concept
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-10213 (URN)10.1080/11038120601095093 (DOI)17538856 (PubMedID)
Available from: 2008-07-03 Created: 2008-07-03 Last updated: 2017-12-14Bibliographically approved

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