Winter Laraine, Moriarty Helene, Robinson Keith M, Newhart Brian
a Nursing Service, Department of Veterans Affairs Medical Center , Philadelphia , PA , USA .
b Philadelphia Research and Education Foundation , Department of Veterans Affairs Medical Center , Philadelphia , PA , USA .
Disabil Rehabil. 2016;38(13):1280-90. doi: 10.3109/09638288.2015.1077531. Epub 2015 Aug 28.
Families of patients with traumatic brain injury (TBI) often perceive patients' functional capabilities differently from patients themselves. Research documents inconsistent findings regarding direction of differences. Differences have implications for family support and are germane to clinicians' treatment planning during rehabilitation. We compared two analytic approaches to patient-family differences in ratings of 30 functional tasks: (a) comparing patients' and families' mean scores in domains derived from factor analysis versus (b) examining differences on a task-by-task basis.
In-home interviews were conducted with 83 outpatients with TBI at a Veteran Affairs polytrauma clinic and for each a family member, using the Patient Competency Rating Scale with both.
Principal components analysis identified three functional domains--cognitive, interpersonal/emotional and physical--with significant patient-family differences in the cognitive domain only (family competency ratings were higher). By contrast, task-by-task examination showed significant veteran-family differences in 12 items, mostly in interpersonal/emotional functioning, with mixed directions of differences. The task-by-task approach thus revealed a different picture of patient-family differences than examination by functional domains.
Grouping tasks by domains may obscure important differences in functional ratings. Examination of patient-family differences by task has clinical applications for helping patients and families to manage TBI symptoms and for treatment planning.
Differences in functional capacity ratings by patients with TBI and their family members are not well understood, with past research demonstrating inconsistencies in direction of difference. Differences in ratings may affect family relationships and may inform clinicians' treatment plans. The study showed that different approaches to analyzing the same data yield two distinct pictures of patient-family differences. Examining patient-family differences by specific tasks is clinically meaningful. The Competency Rating Scale could be used as a clinical tool with patients and families. Its use may improve family understanding of the patient's strengths and struggles and also guide treatment planning.
创伤性脑损伤（TBI）患者的家属对患者功能能力的认知往往与患者自身不同。研究文献关于差异方向的研究结果并不一致。这些差异对家庭支持有影响，并且与临床医生在康复期间的治疗计划密切相关。我们比较了两种分析患者与家属在30项功能任务评分上差异的方法：（a）比较患者和家属在由因子分析得出的领域中的平均得分，与（b）逐一检查每项任务的差异。
在一家退伍军人事务多创伤诊所，对83名TBI门诊患者及其每位家庭成员进行了家庭访谈，使用患者能力评定量表对两者进行评估。
主成分分析确定了三个功能领域——认知、人际/情感和身体——仅在认知领域患者与家属存在显著差异（家属能力评分更高）。相比之下，逐一检查显示退伍军人与家属在12个项目上存在显著差异，大多在人际/情感功能方面，差异方向不一。因此，逐一检查方法所揭示的患者与家属差异情况与按功能领域检查不同。
按领域对任务进行分组可能会掩盖功能评分中的重要差异。通过任务检查患者与家属的差异在帮助患者和家属管理TBI症状以及治疗计划方面具有临床应用价值。
TBI患者及其家庭成员在功能能力评分上的差异尚未得到充分理解，过去的研究表明差异方向存在不一致。评分差异可能会影响家庭关系，并可能为临床医生的治疗计划提供参考。该研究表明，对相同数据采用不同的分析方法会得出两种截然不同的患者与家属差异情况。通过特定任务检查患者与家属的差异具有临床意义。能力评定量表可作为针对患者和家属的临床工具使用。其使用可能会增进家庭对患者优势和困难的理解，同时也指导治疗计划。
