Sarajuuri Jaana, Vink Martie, Tokola Kari
a Department of Clinical Neuropsychology and Psychology , Validia Rehabilitation , Helsinki , Finland.
b Faculty of Medicine, Department of Psychology and Logopedics , University of Helsinki , Helsinki , Finland.
Brain Inj. 2018;32(13-14):1749-1757. doi: 10.1080/02699052.2018.1539247. Epub 2018 Oct 26.
To explore the relation between objectively measured outcomes of neurorehabilitation and subjective self-appraisal of those outcomes in patients with traumatic brain injury (TBI).
Forty-five adults (34 men; age at injury, mean ± SD, 30.1 ± 10.3 years) with chronic moderate-to-severe TBI (9.7 ± 5.5 years from injury; post-traumatic amnesia, 80% over one week) from two rehabilitation centres, in two countries. The subjects have had to resume working at various levels of competence following post-acute comprehensive neuropsychologically oriented neurorehabilitation, and experienced no functionally incapacitating, medical or psychological problems, for a minimum of six months after discharge. Objective outcome measure was the level of work competence attained post-rehabilitation transposed from the descriptions of the types of work attained by each subject into a number along a 10-point scale. Subjective outcome measure was the personal evaluations by ratings in six consequences of rehabilitation (effort during rehabilitation, meaning in life, productivity, acceptance, social life and intimate relationships) along a 10-point scale.
The attained work competence was statistically significantly related to the subjective self-appraisal of the ability to establish intimate relationships [odds ratio (OR), 1.79; 95% confidence interval (CI), 1.20-2.68; P = .005]. Otherwise, no association between subjective ratings and the levels of work was found. Of the patients, 67% attained competitive, 22% subsidized, and 11% volunteer or sheltered work. The subjective self-rated outcomes of the patients were relatively good [median, lower quartile (Q1) - upper quartile (Q3): 8 to 9, 7 to 8 - 8 to 9 out of 10]. The lowest ratings were observed for the ability to establish intimate relationships (8, 7-8 out of 10).
The results support the need to evaluate rehabilitation outcomes involving both objective measures and subjective appraisals of them. The findings suggest that community functioning and satisfaction with that are distinct aspects of the subjects´ experience that must be considered in the evaluation of rehabilitation. It seems that comprehensive neurorehabilitation improve outcome, and patients with TBI with tailored placements were largely satisfied with the areas of wellness in their life. Additional larger controlled studies are needed to clarify how composition of neurorehabilitation and individualization in outcomes assessment might enhance the outcome of TBI rehabilitation.
探讨创伤性脑损伤（TBI）患者神经康复的客观测量结果与这些结果的主观自我评价之间的关系。
来自两个国家的两个康复中心的45名成年人（34名男性；受伤时年龄，平均±标准差，30.1±10.3岁）患有慢性中度至重度TBI（受伤后9.7±5.5年；创伤后遗忘症，超过一周的占80%）。这些受试者在急性后以神经心理学为导向的综合神经康复后，必须在不同能力水平上恢复工作，并且在出院后至少六个月内没有功能丧失、医疗或心理问题。客观结果测量是康复后达到的工作能力水平，根据每个受试者所从事工作类型的描述转化为一个10分制的数字。主观结果测量是通过对康复的六个方面（康复期间的努力、生活意义、生产力、接受度、社交生活和亲密关系）进行10分制评分的个人评价。
达到的工作能力与建立亲密关系能力的主观自我评价在统计学上显著相关[优势比（OR），1.79；95%置信区间（CI），1.20 - 2.68；P = 0.005]。否则，未发现主观评分与工作水平之间存在关联。在这些患者中，67%达到了有竞争力的工作，22%获得补贴工作，11%从事志愿或庇护性工作。患者的主观自评结果相对较好[中位数，下四分位数（Q1） - 上四分位数（Q3）：8至9分，7至8 - 8至9分（满分10分）]。建立亲密关系能力的评分最低（8分，满分10分，7至8分）。
结果支持需要同时评估康复结果的客观测量和主观评价。研究结果表明，社区功能及其满意度是受试者体验的不同方面，在康复评估中必须予以考虑。似乎综合神经康复改善了结果，并且接受量身定制安置的TBI患者对其生活中的健康领域基本满意。需要更多更大规模的对照研究来阐明神经康复的构成以及结果评估中的个体化如何可能提高TBI康复的效果。
