Liverpool Brain Injury Rehabilitation Unit, Liverpool Hospital (Drs Sabaz and Simpson), Rehabilitation Studies Unit, Sydney School of Medicine, University of Sydney (Dr Simpson), Westmead Brain Injury Rehabilitation Unit, Westmead Hospital (Dr Walker), Australian Catholic University (Dr Rogers) School of Psychiatry and Black Dog Institute, Faculty of Medicine, University of New South Wales (Ms Gillis), and Agency of Clinical Innovation (Ms Strettles), Sydney Australia.
J Head Trauma Rehabil. 2014 Mar-Apr;29(2):E19-30. doi: 10.1097/HTR.0b013e31828dc590.
Investigate the prevalence, comorbidities, and correlates of challenging behaviors among clients of the New South Wales Brain Injury Rehabilitation Program.
All community-based rehabilitation services of the statewide program.
Five hundred seven active clients with severe traumatic brain injury.
Prospective multicenter study.
Eighty-eight clinicians from the 11 services rated clients on the Overt Behaviour Scale, Disability Rating Scale, Sydney Psychosocial Reintegration Scale-2, Care and Needs Scale, and Health of the Nation Outcome Scale-Acquired Brain Injury.
Overall prevalence rate of challenging behaviors was 54%. Inappropriate social behavior (33.3%), aggression (31.9%), and adynamia (23.1%) were the 3 most common individual behaviors, with 35.5% of the sample displaying more than 1 challenging behavior. Significant associations were found between increasing levels of challenging behavior and longer duration of posttraumatic amnesia, increasing functional disability, greater restrictions in participation, increased support needs, and greater degrees of psychiatric disturbance, respectively (P < 0.004). Multivariate binomial logistic regression found that premorbid alcohol abuse, postinjury restrictions in participation, and higher levels of postinjury psychiatric disturbance were independent predictors of challenging behavior.
Challenging behaviors are widespread among community-dwelling adults with severe traumatic brain injury. Services need to deliver integrated anger management, social skills, and motivational treatments.
调查新南威尔士州脑损伤康复计划客户中挑战性行为的患病率、共病和相关性。
全州范围内的所有社区康复服务。
507 名活跃的严重创伤性脑损伤患者。
前瞻性多中心研究。
11 个服务中心的 88 名临床医生使用行为量表、残疾评定量表、悉尼心理社会康复整合量表-2、护理和需求量表以及国民健康量表-后天性脑损伤对患者进行评分。
挑战性行为的总体患病率为 54%。不适当的社会行为（33.3%）、攻击性（31.9%）和无力（23.1%）是最常见的 3 种个体行为，35.5%的样本表现出超过 1 种挑战性行为。研究发现，挑战性行为的水平与创伤后遗忘时间延长、功能残疾程度增加、参与受限程度增加、支持需求增加和精神障碍程度增加之间存在显著相关性（P<0.004）。多元二项逻辑回归发现，病前酒精滥用、受伤后参与受限以及受伤后精神障碍程度较高是挑战性行为的独立预测因素。
社区居住的严重创伤性脑损伤成年人中普遍存在挑战性行为。服务机构需要提供综合的愤怒管理、社交技能和动机治疗。
