Community reintegration after traumatic brain injury

Abstract

Background: Traumatic brain injury (TBI) affects cognitive, behavioural and physical function to varying degrees. Although the burden is spread throughout the world, developing countries such as South Africa (SA) are especially affected. The level of community reintegration post-TBI and the factors that influence it are largely unknown in SA. Aim and objectives: The aim of the study was to describe the level of community reintegration and the associated influencing factors post TBI. The primary objective of the study was to describe the level of community reintegration in patients with TBI six to eighteen months subsequent to discharge from hospital. The secondary objectives include the following:  to describe the level of functioning and disability based on the International Classification of Functioning, Disability and Health (ICF);  to describe the health-related quality of life (HRQoL);  to establish the respective associations between level of functioning and disability and HRQoL and community reintegration; and  to establish the factors that influence community reintegration. Methods: The study used a quantitative, cross-sectional analytical design. The participants were all patients who had sustained a TBI and were discharged home in the past six to eighteen months from Steve Biko Academic Hospital (SBAH) who met the inclusion criteria. Given that the study considered eight factors identified from the literature that have an influence on community reintegration post-TBI in the South African context, it was decided that eighty participants would be required for the study. They were required to complete a demographic questionnaire, the Community Integration Questionnaire (CIQ), the World Health Organisation Disability Assessment Schedule 2.0 (WHODAS 2.0), and the Quality of Life after Brain Injury Overall Score (QOLIBRI-OS). Results: The male to female ratio was found to be nine to one and the median age of the sample was 32 years with an interquartile range of 14 years. A total of 53.8% of the participants presented with mild TBI, with assault (42.5%) being the most common mechanism of injury. The highest level of education was up to Grade 11 (30%) with 65% of the participants being employed pre-morbidly and 37.5% employed subsequent to the injury. Most of the participants (55%) did not receive any rehabilitative treatment. The median total CIQ score was 22 with an interquartile range of 7.5, a minimum score of eight and a maximum score of 29, this result being interpreted as a fairly good level of community reintegration. The median WHODAS 2.0 percentage was 31% with an interquartile range of 18%, this result being interpreted as a high level of functioning with a low level of disability. The median QOLIBRI-OS percentage was 73%, with an interquartile range of 45.5%, this result being interpreted as a fairly high HRQoL. The WHODAS 2.0 percentage proved to be a significant negative predictor of the CIQ score. For every Beta =-0,4 decrease in the WHODAS 2.0 percentage, the CIQ score would increase by one unit. No associations or relationships were found between community reintegration and gender, education levels, pre-morbid occupation, type of lesion, severity of injury or age, thus indicating that these factors do not influence community reintegration in this sample of patients with TBI. Participants with TBI who were in paid employment post-TBI attained significantly higher CIQ scores compared to those participants who, on account of poor health, were unemployed (MD = 7.73, p < 0.001), retired (MD = 8.13, p = 0.02), and, for any other reasons, unemployed (MD = 3.26, p = 0.02). Self-employed individuals attained significantly higher CIQ scores than both unemployed (on account of poor health) (MD = 8.8, p <0.001) and retired individuals (MD = 9.2, p = 0.02). Individuals who were grouped as unemployed on account of poor health attained significantly lower CIQ scores compared to both students (MD = -6.03, p < 0.001) and those who were unemployed for any other reason) (MD = - 4.48, p <0.001). Participants who had suffered a TBI on account of a gunshot wound to the head attained significantly lower CIQ scores compared to those participants who had suffered a TBI on account of a motor vehicle accident (MVA) (MD = -10.19; p = 0.001), a pedestrian vehicle accident (PVA) (MD = -10.97; p = 0.002), a fall (MD = -12.67; p = 0.001) or assault (MD = -12.05; p < 0.001). In this sample of participants with TBI, those who received acute in-patient and outpatient rehabilitative treatment attained significantly lower CIQ scores than individuals who received acute in-patient rehabilitation only (MD = -6.06; < 0.001), out-patient rehabilitation only (MD = -7.2; p = 0.02); and no rehabilitation at all (MD = -8.06; p < 0.001). Conclusion: As indicated by the high CIQ scores, the participants in the study had good community reintegration. They presented with high levels of functioning and low levels of disability, both of which were found to be in tandem with high CIQ scores. In line with the high CIQ scores and low levels of disability, the quality of life experienced by the participants with TBI was generally good.