THE BIO-PSYCHO-SOCIAL EFFECT OF REHABILITATION OF ADULTS WITH ACQUIRED BRAIN INJURY MEDIATED BY COORDINATED INTERVENTIONS E CP 2 0 1 3 I N STOCKHOLM C H A L O T T E G L I N T B O R G, C G L @ H U M. A A U. D K A N E S Ø N D E R G A A R D T H O M S E N, A N E S T @ H U M. A A U. D K
Background A c q u i r e d b r a i n injury (ABI) prevalence i n DK In 2010: 19.543 A p p r o x. 125.000 live with an A B I Current situation R e h a b i lit a t ion i s a n area of priority to the Danish g o v e r n m e n t No r e s e a r c h in DK on eff e c t s of coordinated r e h a b i litation Ve ry f e w i n t e rnational s t u d i e s ( 9 s t u d i e s) 2
Objective To p r o v i d e a n e v a l u ation o f a c o o r d i n a t e d r e h a b i litation p r o g r a m E v i d e nce-based i n t e rvention c o n t r i b u t e t o t h e p r o v i s ion o f q u a l i t y s e r v i c e t o p e o p l e s u ff e r i ng f r o m A B I and, thus, to improve t h e i r quality of life a s s i st a d m i n istrators i n m a k i n g p rogram -level d e c i s ions e c o n o m i c b e n e f i t s 3
Timeframe Project start Implementation (April) Project end 2012 2013 2014 2015 Program theory (August) Organizational halfway status (April) Pretest Posttest Organizational posttest 4
Timeframe the focus of this presentation Project start Implementation (April) Project end 2012 2013 2014 2015 Program theory (August) Organizational halfway status (April) Pretest Posttest Organizational posttest 5
Services provided for a citizen suffering from ABI Temporary housing Permanent housing Own home Aids Special needs teaching Furnishing Counselling Disabled-friendly car Relief care Social education support Accompaniment Home help Communication training Sickness benefit Rehabilitation 6
The rehabilitationprogram that we study H e i g h t e ning t h e level o f t h e neuro - s c i e n t ific k n o wledge C o o r d i n a t ion i n t e r n a l ly a t t h e m u n i c ipal level ( e s t a b l i sh a c o o r d i n a t ion c e n t e r and new ways o f working t o g e t h e r ) I n t e r d i s c iplinary c o o r d i n ation o f p r o c e s s e s a c r o s s t h e p r i m a r y and s e c o n d a r y s e c t o rs U n i t e d e ff o rts (joint o u t c o m e m e a s u res, t e s t s and rehabilitation p l a n s ) B a s e d o n the bio - p s yc h o - s ocial m o d e l ( Operationalized b y I C F ) 7
Two integrated projects in a mixed method design Interviews (citizens and their relatives) Interviews (employees) Field notes Tests Effect study on adults with ABI Organizational study Documents Observations / participation Surveys 8
Interviews (citizens and their relatives) Field notes Effect study on adults with ABI Tests 9
Test measures Quality of Life (WHOQOL) M a j o r Depression Inventory (MDI) Functional Independence Measure (FIM) I m p a c t on Participation a n d A u t o n o m y Questionnaire (IPA Q) 10
Research design effect study C o n t r o l g r o u p 2011 2013 N=55 (55 adult ABI survivors) Test: FIM Treatment as usual N= 58 (36 adult ABI + 22 relatives) Test: FIM, IPAQ QOL, MDI and Field notes I n t e r v e n t i o n g r o u p 2013 2014 N=140 (70 adult ABI + 70 relatives) Test: FIM, IPAQ, QOL, MDI Interview & Field Notes Eksperimental Intervention N=? Test: FIM, IPAQ, QOL, MDI, Interview & Field Notes 11
Aalborg Jammerbugt (control) Vesthimmerland (control) Brønderslev (control) 2011 Control 2011 BNC, pretest N=55 Intervention: TAU (treatment as usual) 2013 2013, posttest N=58 2013 BNC, pretest N=60 2013 BNC, pretest N=15-20 2013 BNC, pretest N=5-10 2013 BNC, pretest N=10-20 Intervention: CI (coordinated intervention, type 1) Intervention: CI (coordinated intervention, type 2) Intervention: CI (coordinated intervention, type 3) Intervention: CI (coordinated intervention, type 4) 2014 2014, posttest N=? 2014, posttest N=? 2014, posttest N=? 2014, posttest N=? 12
Preliminary results (on an individual level) R e s u l t s from c o n t r o l g r o u p (2011 ) with no c o o r d i n a t e d r e h a b i litation: Pre- and post-functional independence Pre- and post-w o r k situation P o s t Depression l e ve l P o s t QOL l e v e l T h e m e s f r o m f i e l d n o t e s 13
Pre- and post-functional independence 14
Work situation 2011 2013 15
Post Depression level 16
Interviews (employees) Organizational study Documents Observations / participation Surveys 17
Program theories S ynonym : m o d e l, c o n c e p t u a l f r a m e work linking t h e i n t e r v e n t ions to t h e p r o j e c t e d outcomes, a r t i c u l a t e d logic o f p r o g r a m s B e n e f i t s C l a r i f y their assumptions a n d implicit t h e o r i e s D e t e c t implausible a s s u m p t ions U s e that theory o r m o d e l t o c h o o s e t h e c r i t e r i a which a r e t o b e m e a s u r e d a n d that will i n d i cate s u c c e s sful i m p l e m e ntation a n d d e s i r a b le o u t c o m e s I d e n t i f y the intermediate results rather than just t h e final o u t c o m e 18
Education Appoint key persons Enhance the level of knowledge Easier to spot need Improve triage and referral to the coordinationcenter 19
Coordinationcentre One way of access for the citizen Internal coordination among professionals Knowledgetransfer (from hospital to municipal level ) Guide, assistance Get to be known in the organization Uniform efforts Easier transfers across sectors Increased satisfaction among citizens Make the citizen able to concentrate on rehabilitation Break down walls Increased satisfacition among citizens Peace of mind for external collaborators Efficient case work Better economy 20
Articulated logic Joint rehabilitation plans and tests Joint objectives Uniform line of direction Joint use of instruments Using the same language / Joint understanding Meet the citiczens with one united package of instruments Better refferals Possiblity of joint accumulation of experiences Easier knowledge transfer Understand one another Easier access for the citizen Continuous sequence of steps Frees resources from repeated tasks Purposive use of resources Identify indicators of rehabilitationpotential A gradual transision across the primary and secondary sectors Easier and better cooperation Easier to involve the citizen Efficient service Rapid decision making 21
Halfway evaluation / preliminary results Joint rehabilitation plans and tests Joint objectives Uniform line of direction Joint use of instruments Using the same language / Joint understanding Meet the citiczens with one united package of instruments Better refferals Possiblity of joint accumulation of experiences Easier knowledge transfer Understand one another Easier access for the citizen Continuous sequence of steps Frees resources from repeated tasks Purposive use of resources Identify indicators of rehabilitationpotential A gradual transision across the primary and secondary sectors Easier and better cooperation Easier to involve the citizen Efficient service? Rapid decision making 22
Conclusion I n t e r d i s c iplinary c o o r d i n ation o f p r o c e s s e s a c r o s s t h e p r i m a r y and s e c o n d a r y s e c t o rs h a s been e s t a b l ished There is agreement o n j o i n t rehabilitation p l a n s A c o o r d i n a t ion c e n t e r has been established A g r e e m e n t o n a c o l l a boration a c c o r d (new ways o f working together) E d u c a t ional a c t i v ities have s t a rted S o far it seems e m p l o yee s a t i s f a c t ion h a s improved We do not know yet whether or not we wi l l b e able t o i d e n t i f y i n d i cators of r e h a b i litation - p o t e ntial T h e eff e c t on citizens s u ff e r i n g f r o m A B I is s t i l l u n k n o wn 23
Questions? Department of Communication and 24
Acknowledgement Thank you to Aalborg Kommune and other stakeholders Supervisor Tia G.B. Hansen D E P A R T M E N T O F C O M M U N I C A T I O N A N D P S Y C H O L O G Y C O G N I T I V E P S Y C H O L O G Y U N I T 25
Disclaimer The u se of FIM instrument to c ollect data for t h is r e s earch study was a u t h o rized and conducted in a ccordance wi t h the terms of a s pecial p u rpose license g ranted to Licensee by Uniform D a t a S ys t em for M e dical R ehabilitation (a d ivision of UB F oundation Activities, Inc., UDSMR ). L icensee has not b een t r ained by U DSMR in the use of FIM i nstrument, and t he p a tient data c ollected during t he course of t h is research has not b een s u b mitted to or p rocessed by U D S M R. No i m plication is i n t ended t h at s u ch data has been or will be s ubjective to U DSMR s s t a ndard data p r o cessing p r ocedures or that it is o t h e r wise c o m p a r a b l e to data processed by UDSMR 26