King Gillian, Nalder Emily, Stacey Lauren, Hartman Laura R
Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.
Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada.
Disabil Rehabil. 2021 Oct;43(21):3102-3116. doi: 10.1080/09638288.2020.1725158. Epub 2020 Feb 20.
To examine how conceptualizations of caregiver adaptation to traumatic brain injury have changed over time. The objectives were to identify research traditions, adaptive outcomes assessed in these traditions, and psychosocial variables associated with adaptive outcomes.
A meta-narrative review was conducted on 29 identified articles published over a 25-year period (1990-2015).
Four traditions were identified with varying storylines. Burden/Strain (1990-1999) focused on adjustment as the absence of a negative state. Appraisal/Coping (2000-2005) recognized that caregiving experiences could be both positive and negative. In Quality of Life (2006-2011), there was increasing recognition that both personal and contextual factors influence adaptation. Resiliency (2012-2015) used the term "resiliency" as an organizing framework for a broad group of variables and assessed resilience, quality of life, community re-integration, and life/marital satisfaction.
These storylines reflect an evolution from problem-based to strengths-based conceptualizations, from interest in crisis to considering adaptation as a process unfolding over time, from quantitative to qualitative methods, and towards more holistic views of adaptive outcomes. Variables significantly associated with outcomes across the traditions included social support, reframing and positive appraisal, and behavior strategies. Implications concern the need for longitudinal studies, measurement of environmental factors, and the development of best practices.IMPLICATIONS FOR REHABILITATIONResearch studies on the adaptation of caregivers for people with TBI have evolved from a focus on burden, to coping and quality of life, and most recently to resiliency.It is important to assist caregivers of people with TBI to obtain social support, find positive ways of viewing their experiences, and take part in respite and enjoyed activities.Service providers can help caregivers by adopting a strengths-based perspective to help them recognize available resources, supports, and opportunities.Since caregiver adaptation changes over time, service providers should pay attention to changes in family circumstances and the mental health of caregivers.
探讨照顾者对创伤性脑损伤适应的概念化如何随时间变化。目标是确定研究传统、这些传统中评估的适应性结果，以及与适应性结果相关的心理社会变量。
对25年期间（1990 - 2015年）发表的29篇已识别文章进行了元叙事综述。
确定了四种具有不同故事情节的传统。负担/压力（1990 - 1999年）将调整重点放在无负面状态上。评估/应对（2000 - 2005年）认识到照顾经历可能既有积极的也有消极的。在生活质量（2006 - 2011年）方面，人们越来越认识到个人和背景因素都会影响适应。复原力（2012 - 2015年）将“复原力”一词用作一组广泛变量的组织框架，并评估了复原力、生活质量、社区重新融入以及生活/婚姻满意度。
这些故事情节反映了从基于问题到基于优势的概念化演变，从对危机的关注到将适应视为一个随时间展开的过程，从定量方法到定性方法，以及对适应性结果更全面的看法。在所有传统中与结果显著相关的变量包括社会支持、重新构建和积极评估以及行为策略。其影响涉及对纵向研究、环境因素测量以及最佳实践发展的需求。对康复的启示关于创伤性脑损伤患者照顾者适应的研究已从关注负担，发展到应对和生活质量，最近又发展到复原力。帮助创伤性脑损伤患者的照顾者获得社会支持、找到看待自身经历的积极方式并参与喘息和愉快活动非常重要。服务提供者可以通过采用基于优势的视角来帮助照顾者，以帮助他们认识到可用的资源、支持和机会。由于照顾者的适应会随时间变化，服务提供者应关注家庭情况的变化以及照顾者的心理健康。
