Problems in functioning after a mild traumatic brain injury within the ICF framework: the patient perspective using focus groups

Abstract

Purpose: To describe problems in body functions, activities, and participation and the influence of environmental factors as experienced after mild traumatic brain injury (TBI), using the ICF framework. To compare our findings with the Brief and Comprehensive ICF Core Sets for TBI. Methods: Six focus-group interviews were performed with 17 participants (nine women, eight men, age ranged from 22 to 55 years) within the context of an outpatient rehabilitation programme for patients with mild TBI. The interviews were transcribed verbatim and analysed using the ICF. Results: One-hundred and eight second-level categories derived from the interview text, showing a large diversity of TBI-related problems in functioning. Problems in cognitive and emotional functions, energy and drive, and in carrying out daily routine and work, were frequently reported. All ICF categories reported with high-to-moderate frequencies were present in the Brief ICF Core Set and 84% in the Comprehensive ICF Core Set. The reported environmental factors mainly concerned aspects of health and social security systems, social network and attitudes towards the injured person. Conclusions: This study confirms the diversity of problems and the environmental factors that have an impact on post-injury functioning of patients with mild TBI.

Implications for Rehabilitation

• Disabilities related to cognitive and emotional functions, energy and drive, and carrying out daily routine and work should be addressed in rehabilitation of people with mild traumatic brain injury (TBI).

• Attention should be given to environmental facilitators and barriers for activities and participation.

• Participation in everyday life after a mild TBI, including social- and work-participation, constitutes a challenge where multidisciplinary rehabilitation efforts should be considered.

• The Brief Core Set does not attain all frequently observed categories of functioning among people with mild TBI.

Keywords::

• Functioning
• ICF
• patient perspective
• traumatic brain injury

Acknowledgements

The authors would like to thank the participants in this study. We thank Anne-Lise Eriksen for skillful transcription of the focus-group interviews, and Maria Hadzic for her assistance during the analysis-process. Professor Cecilie Røe and Professor Erik Bautz-Holter made this study possible, by initiating collaboration with the WHO ICF Research Branch, and we thank them for their continuous support and inspiration during this research.

Declaration of Interest: The study is part of a “Return to work” project initiated by the Norwegian Directorate of Health and the Norwegian Ministry of Labour and funded by the Norwegian Ministry of Health and Care Services.