The family as a resource for improving patient and family functioning after traumatic brain injury: A descriptive nonrandomized feasibility study of a family-centered intervention

Figures & data

Table 1. Overview and description of the sessions in the intervention (Stevens et al., 2016)

No	Topic	Description
1	Introduction	Overview of expectations, structure of the sessions, and purpose of the intervention. Completion of baseline questionnaires.
2	Making meaning of TBI/SCI	Normalize and validate the family members’ experiences with TBI and overcome misconceptions about TBI.
3	Shifting focus	Shifting focus from negative to positive aspects of the situation and recognizing the relationships among thoughts, mood, and behaviour.
4	Managing emotions	Identify “warning-signs” indicating an escalation of emotions and strategies for managing emotions.
5	Communicating effectively	Recognizing warning signs for communication and providing techniques for communicating effectively.
6	Finding solutions	Moving from a problem-oriented perspective to a solution-oriented perspective, formulating goals, and tracking the progression toward achieving those goals.
7	Boundary making	Externalizations of problems, education of healthy vs. unhealthy family dynamics, and the importance of self-care.
8	Farewell	Summary of skills learned and how changes can be lasting and consistent, provision of feedback on the intervention, and completion of post-intervention questionnaires.

Table 2. Study objectives and success criteria

Objectives	Success criteria
The participants’ willingness and ability to attend the sessions	The participants attend all sessions and complete the given between-session tasks.
The appropriateness of the topics covered in the intervention, including the need for cultural adjustments	Participants and health professionals experience the topics and strategies in the intervention as relevant and recognizable.
The leadership structure of the sessions and collaboration form with the municipal health professionals	(a) The municipal health professionals have the opportunity to attend all sessions and have sufficient training in the intervention. (b) The participants are satisfied with the leadership structure and collaboration form through all sessions
The appropriateness of data collection method, including the participants' understanding of and response to the selected outcome measures	The participants answer the self-reported questionnaires within a given timeframe (70 minutes) with less than 10 % missing variables.

Table 3. Outcome measures

Outcome measure	Scale range	Patient	Family member
Primary
SF36 Mental Health Scales	0–100 (worst–best)	X	X
Caregiver burden scale	22–88 (best–worst)		X
Secondary
QOLIBRI	0–100 (worst–best)	X
FACES IV ratio score	0–10 (worst–best)	X	X
Family communication scale	10–50 (worst–best)	X	X
Family satisfaction scale	10–50 (worst–best)	X	X
Additional measures
Generalized Self-Efficacy Scale (GSE)	10–40 (worst–best)	X	X
TBI Self-Efficacy Scale (TBI SE)	0–66 (worst–best)	X
Patient Health Questionnaire-9 (PHQ-9)	0–27 (best–worst)	X	X
Generalized Anxiety Disorder-7 (GAD-7)	0–21 (best–worst)	X	X
Resilience Scale for Adults (RSA)	33–165 (worst–best)	X	X

Table 4. Patient and family characteristics

	Family A	Family B
Patient (age)	Male with TBI (50)	Female with TBI (24)
Injury severity (GCS)	Severe (3)	Mild (15)
Time since injury	5 years	1 year
Main symptoms and concerns	Impaired memory, lack of taking initiative, problems with decision making	Fatigue, sensitivity to light and sound, and headache
Municipal rehabilitation service	None	2 hours per week
Employment status patient	Part time	Sick-leave
Education patient	University	High School
Family members (age)	Wife (50) Child (16)	Partner (46) Mother (56)
Living in the household (yes/no)	Wife (yes) Child (yes)	Partner (yes) Mother (no)
Education family members	Wife (University) Child (Elementary School)	Partner (University) Mother (University)
Employment status family members	Wife (full-time) Child (student)	Partner (full-time) Mother (disability pension)

Family members are described by their relation to the individual with TBI.

Table 5. Median scores and interquartile range (IQR) of the primary and secondary outcome measures at baseline (T1) and post-intervention (T2)

Outcome measure	Median T1	IQR	Median T2	IQR
SF-36 Role Emotional	66.7	33.3 to 100	66.7	0 to 100
SF-36 Social Function	56.3	31.3 to 100	68.8	46.9 to 100
SF-36 Vitality	52.5	35.0 to 60.0	52.5	42.5 to 65.0
SF-36 Mental Health	66.0	44.0 to 84.0	68.0	58.0 to 79.0
Caregiver Burden Scale	45.0	37.5 to 47.3	38.5	31.0 to 46.3
FACES IV Ratio Score	3.0	2.3 to 3.2	3.2	2.3 to 3.9
Family Communication	39.5	37.8 to 43.0	44.9	41,3 to 47.3
Family Satisfaction	40.5	36.3 to 41.3	44.5	40.8 to 47.0
QOLIBRI	35.5		41.9

Interquartile range is reported. The QOLIBRI (Quality of life after brain injury) was only answered by the patients (n = 2) and the IQR could not be estimated.

Stevens, L. F., Lehan, T., Duran, M. A. S., Plaza, S. L. O., & Arango-Lasprilla, J. C. (2016). Pilot study of a newly developed intervention for families facing serious injury. Topics in Spinal Cord Injury Rehabilitation, 22(1), 49–59. doi:10.1310/sci2101-49

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