Evaluating an intervention to increase meaningful activity after severe traumatic brain injury: A single-case experimental design with direct inter-subject and systematic replications

ABSTRACT

Severe traumatic brain injury (sTBI) often results in significant morbidity, with fewer than 50% returning to work and only a minority resuming leisure and social activity. Yet few effective interventions are available for non-vocational activity. The aim of the study was to develop a new goal-directed intervention, the Programme for Engagement, Participation and Activities (PEPA), and evaluate its effect. The research design was a multiple-baseline design across behaviours, with direct inter-subject and systematic replications. Seven participants with sTBI, neurobehavioural impairment including apathy, inability to work, and limited leisure/social activities were categorised into two groups. Group 1 (n = 4) had cognitive impairments but were functionally independent. Systematic replication was conducted in a further three participants (group 2) with major neurobehavioural impairments and functional disability. Generalisation measures evaluated other life domains in group 1 participants (e.g., mood, community participation). Results of the weighted average Tau-U across the tiers was significant for six out of seven participants, with large effect sizes (≥.64) for five participants. Generalisation effects extended to other domains of life. The PEPA thus shows promise as an effective intervention to increase non-vocational activity and improve mental health outcomes in people with neurobehavioural disability after sTBI. These results add to the evidence for the effectiveness of goal-directed interventions.

KEYWORDS:

• Traumatic brain injury
• Apathy
• Goal-setting
• Meaningful occupation
• Leisure
• Single-case experimental design
• Systematic replication

Acknowledgements

We acknowledge the contributions of Dr Amanda Lane-Brown and Michelle Genders in the initial stages of the study, Ulrike Rosenkoetter and Janet Doubleday for conducting post-intervention and follow-up assessments, Ulrike Rosenkoetter for evaluating treatment adherence, and the advice of Dr Michael Perdices regarding data evaluation.

Disclosure Statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The study was funded by Lifetime Care and Support Authority, NSW, Australia and the NHMRC Centre for Research Excellence in Psychosocial Recovery after TBI.