Thriving in the wake of a storm: A systematic qualitative review & meta-synthesis on facilitating post-traumatic growth in patients living with Acquired Brain Injury

Figures & data

Table 1. Search strategy: CINAHL (Ebscohost) date run: 27th December 2022.

1.	MH “Brain Injuries+”
2.	MH “Cerebral Hemorrhage+”
3.	MH “Stroke”
4.	MH “Cerebrovascular Disorders”
5.	MH “Intracranial Arterial Diseases+”
6.	MH “Hypoxia, Brain”
7.	MH “Brain Concussion+”
8.	MH “Head Injuries”
9.	MH “Meningitis+”
10.	MH “Encephalitis+”
11.	TI (ABI OR Acquired Brain Injur* OR TBI OR Traumatic Brain Injur*) OR AB (ABI OR Acquired Brain Injur* OR TBI OR Traumatic Brain Injur*)
12.	TI (Stroke OR CVA OR Cerebrovascular Accident* OR Poststroke or Post-stroke) OR AB (Stroke OR CVA OR Cerebrovascular Accident* OR Poststroke or post-stroke)
13.	TI ((Brain or Cerebr*) N2 (Injur* or Hypoxi* or Damage* or Concussion or Trauma* or Tumor* or Tumour*))
14.	AB ((Brain or Cerebr*) N2 (Injur* or Hypoxi* or Damage* or Concussion or Trauma* or Tumor* or Tumour*))
15.	TI (Head Injur* OR Meningitis OR Encephalitis) OR AB (Head Injur* OR Meningitis OR Encephalitis)
16.	OR/1-15
17.	MH “Hardiness”
18.	MH “Adaptation, Psychological”
19.	MH “Posttraumatic Growth, Psychological”
20.	TI (“Posttraumatic Growth” OR “Post-traumatic Growth” OR “Post Traumatic Growth” OR “Stress-related Growth” OR “Stress Related Growth”) OR AB (“Posttraumatic Growth” OR “Post-traumatic Growth” OR “Post Traumatic Growth” OR “Stress-related Growth” OR “Stress Related Growth”)
21.	TI (Resilien* OR Hardiness) OR AB (Resilien* OR Hardiness)
22.	TI ((Positiv* OR Psychol*) N1 (Adapt* OR Adjust* OR Experienc* OR Chang* OR Growth))
23.	AB ((Positiv* OR Psychol*) N1 (Adapt* OR Adjust* OR Experienc* OR Chang* OR Growth))
24.	TI ((Thriv* OR Recover*) N2 (Trauma* OR Adversit*))
25.	AB ((Thriv* OR Recover*) N2 (Trauma* OR Adversit*))
26.	TI (Personhood) OR AB (Personhood)
27.	OR/17-26
28.	MH “Qualitative Studies+"
29.	MH “Action Research”
30.	MH “Content Analysis”
31.	MH “Ethnographic Research”
32.	MH “Focus Groups"
33.	MH “Thematic Analysis”
34.	MH “Multimethod Studies”
35.	TI (Qualitative OR Interview* OR Focus Group* OR Ethnographic OR “Action Research” OR “Content Analysis” or “Thematic Analysis” or “Mixed Methods” OR Multimethod*) OR AB (Qualitative OR Interview* OR Focus Group* OR Ethnographic OR “Action Research” OR “Content Analysis” or “Thematic Analysis” or “Mixed Methods” OR Multimethod*)
36.	OR/28-35
37.	16 AND 27 AND 36

Table 2. Summary information of studies included in the meta-synthesis.

Number of article	Author(s) (year), country	Study's aim/objective	Data Collection/method	Sample	Injury / Condition and Severity	CASP Score (Max score of 20)
1.	Allen, Hevey, Carton, O'Keeffe (2022), Ireland	To explore the experience of living with an ABI in individuals who report moderate-to-high or low PTG.	Semi-structured inter – views; reflexive thematic analysis	N = 14. Low PTG group [N = 5 males, 2 females, M age: 44 years), M time since injury 7.62 years]; High PTG group [N = 3 males, 4 females, M age: 47 years, M time since injury 8.15]. Recruited from a group of individuals who took part in a coping and outcome assessment as part of their neurorehabilitation process at the National Rehabilitation Hospital, 7 years before the study.	TBI (N = 7); Ischaemic Stroke (N = 3), Encephalitis (N = 1), Subarachnoid haemorrhage (N = 2), Benign Brain Tumour (N = 1). Unclear if injuries occurred in adulthood	20
2.	Gillespie (2019), United States	The impact of spirituality in patients recovering from ABI	Open-text question administered by telephone or in person, thematic analysis.	N = 16, 10 males [M age 47.8 years (range 31–64), M time since injury 4.9 years] and 6 females [M age 39.83 years (range 25–67), M time since injury 14 years]. Recruited from the patient population at a stand-alone rehabilitation facility.	Severe TBI, unclear if injuries occurred in adulthood	16
3.	Graff et al. (2018), Denmark	To provide an understanding of the lived experience of rehabilitation in adults with TBI from hospital dis – charge up to four years post-injury. To identify barriers encountered by patients and family related to health care and rehabilitation services and to describe how these barriers are overcome.	Semi-structured in-depth interviews with, face to face.	N = 20, 12 males, 8 females, median age 39 (range 25–63). Time since injury: 1–4 years post hospital discharge. Study conducted at the Copenhagen University Hospital.	TBI survivors: Mild TBI N = 8, Moderate TBI N = 7, Severe TBI N = 5.	20
4.	Karagiorgou et al. (2018), United Kingdom	To investigate experiences of Post-traumatic growth (PTG) following ABI in participants who completed a positive psychotherapy pilot trial.	Individual semi-structured interviews, thematic analysis.	N = 7, 4 from the PPT group (3 male 1 female, age range = 46–62 years old; time since injury = 11–20 months) and 3 from the TAU group (2 male, age range = 58–74 years old, time since injury = 9–22 months). Recruited from a variety of NHS clinics.	ABI comorbid with emotional distress at trial entry, all stroke cases, injury occurred in adulthood, type of severity not mentioned, Mild TBI excluded,	17
5.	Kuenemund et al. (2016), Germany	To explore the characteristics of negative and positive changes following a stroke by using standardized questionnaires and a semi-structured interview, (b) to compare identity changes (PTG, event centrality) of stroke survivors to those endorsed by age-, education – and sex – matched HCs. (c) to explore relationships between PTG, event centrality and measures of mental health. (d) To compare positive changes following a stroke derived by qualitative and quantitative methods.	Mixed methods study. Standardized questionnaires and semi structured interviews (on the phone).	N = 42 stroke survivors, 27 males, 15 females (M age 52.83 years; M time since injury 21.60 months). Recruited in acute rehabilitation facilities.	Stroke (Vascular Brain Injury.	17
6.	Lyon et al. (2021), United Kingdom	The development of PTG by collating people’s views and past reflections on how they experienced positive growth following their ABI.	Face-to-face semi-structured interviews, grounded theory	N = 10 (6 men and 4 female), M age 49.9 years (range age 32–77 years), M time since injury was 15.6 years (range 2–58 years). Living in the community, recruited from Headway centres.	ABI: N = 6 TBI (4 male and 2 female), N = 1 haematoma (female), N = 2 haemorrhage (both male) and N = 1 abscess (female); all injuries acquired in adulthood. Type of severity unspecified but considered varied.	20
7.	McGinnis (2011), United States	To explore the lived experience of PTG among individuals with traumatic brain injuries and intact or impaired self-awareness. Additionally, this study inquires about the role of spirituality in the evolution of PTG.	Mixed-methods approach. Semi-structured interview – Grey literature	N = 14 (9 Males, 5 Females), M age 37.9 years; M time since injury 21.2 years. Living in and recruited from a post-acute inpatient rehabilitation facility.	Traumatic Brain Injury	17
8.	Nochi (2000), United States	To analyse narratives that individuals with TBI share when they seem to cope with their changed lives. To learn from people undergoing TBI them – selves so that rehabilitation services for them can be increasingly improved.	Qualitative methodology, in-depth interviewing and participant observation.	N = 10 (males and females, gender distribution unknown), M age 37.9, M time since injury 9.5 years. Living in the community; recruited from a local TBI support group.	Traumatic Brain Injury	17
9.	Preble (2020), United States	To examine how young adults with infective or autoimmune-mediated encephalitis may create meaning and purpose and to examine how they have adapted and coped with their ABI	Interview, background questionnaire and PTG Inventory – Grey Literature	N = 21 (9 Males, 12 females), M age 21.1 years old, M time since diagnosis 11.8 months. Recruited through online platforms.	Infective and immune-mediated encephalitis.
10.	Roundhill et al. (2007), United Kingdom	To gain understanding of how individuals may experience grief and how they view themselves and their lives in light of these losses.	Individual semi-structured interviews, interpretative phenomenological analysis	N = 7 (6 males, 1 female), M age 45.71 years, M time since injury 15 years. Recruited through Headway charity.	Severe TBI, injuries occurred in adulthood	17
11.	Seeto et al. (2017), United Kingdom	To gain insight into the lived experience of young adults with an ABI and to consider the implications for counselling psychologists.	Focus group, semi-structured questions, thematic analysis.	N = 6; age range 18–30 yrs; time since injury: at least 2 years, gender distribution unknown. Recruited in consultation with a London-based charity supporting people affected by brain injury.	ABI, type of injury and severity not mentioned, unclear if injury occurred in adulthood.	15

Figure 1. Flowchart for thematic analysis process from familiarization to identification of analytical themes.

Figure 1 presents a flowchart of the thematic analysis process structured in four sequential stages. Stage 1, “Familiarization with the Data,” leads downward to Stage 2, “Line-by-line coding.” Following this, Stage 3 is labelled “Generation of descriptive subthemes.” To the right, two interconnected circles provide additional context: “Reviewing and developing themes” and a question “How are our descriptive themes related to the Research Question?” These circles offer a reflective pause in the process. The final stage is “Development of analytical themes,” which is informed by the insights gained from the reflective queries.

Figure 2. PRISMA flow diagram showing the study selection process for the meta-synthesis.

A flowchart showing the study selection process for a systematic review. Starting with 1946 records from CINAHL, PsycINFO, and Medline, 525 duplicates are removed. Of the 1421 records screened, 1248 are excluded, leaving 173 for full-text assessment. All 173 are assessed for eligibility, with 162 excluded for various reasons. Ultimately, 11 studies are included in the review. Each step in the process is connected by arrows to show progression.

Figure 3. Pathway from acquired brain injury to post-traumatic growth and associated facilitators and barriers along that pathway.

The diagram illustrates the pathway to post-traumatic growth (PTG) following an acquired brain injury, emphasizing three analytical themes. “Journey to Self”, “Strength in Connection” and “Overcoming Obstacles,” distinguished by blue colour. Arrows indicate the flow from the injury towards PTG, with “Overcoming Obstacles” as a critical, distinct theme in the journey.

Table 3. Sub-themes identified in each study sorted by analytical theme.

Themes	Sub-themes	Study 1	Study 2	Study 3	Study 4	Study 5	Study 6	Study 7	Study 8	Study 9	Study 10	Study 11
“Journey to Self-Rediscovery”	Building a Positive Mindset	Y		Y	Y	Y	Y	Y	Y	Y	Y	Y
	Re-evaluating myself vs being the same person	Y		Y	Y	Y	Y	Y	Y	Y	Y	Y
	Learning, Adjusting and Accepting my new life	Y		Y	Y	Y	Y	Y	Y	Y	Y	Y
	New sense of meaning and purpose in life	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y
	New perspectives on Spirituality	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y
“Strength in Connection”	Peer Support	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y
	Family Support	Y		Y			Y	Y	Y	Y	Y	Y
	Professional Support	Y		Y			Y	Y	Y	Y	Y	Y
“Overcoming Obstacles”	Financial Restrictions	Y		Y								Y
	Discontent with rehabilitation process	Y		Y			Y	Y	Y			Y
	Resignation	Y		Y	Y	Y	Y	Y	Y	Y	Y	Y
	Difficulties making social connections	Y		Y	Y		Y	Y	Y	Y	y	Y

Note: Study 1 = Allen et al. (2021); Study 2 = Gillespie (2019); Study 3 = Graff et al. (2018); Study 4 = Karagiorgou et al. (2018); Study 5 = Kuenemund et al. (2016); Study 6 = Lyon et al. (2021); Study 7 = McGinnis (2011); Study 8 = Nochi (2000); Study 9 = Preble (2020); Study 10 = Roundhill et al. (2007); Study 11 = Seeto et al. (2017).

Allen, N., Hevey, D., Carton, S., & O'Keeffe, F. (2022). Life is about “constant evolution”: The experience of living with an acquired brain injury in individuals who report higher or lower posttraumatic growth. Disability and Rehabilitation, 44(14), 3479–3492. https://doi.org/10.1080/09638288.2020.1867654

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