Factors influencing outcomes and their measurement after brain injury

Acquired brain injury (ABI) is a major cause of morbidity and mortality, especially among younger people and the psychological sequelae can have chronic detrimental effects on patients’ life and wellbeing. It is important to have clinically relevant, validated measures to be able to determine a person’s psychological needs to structure interventions to improve outcomes. Measures designed for an ABI population have been developed but due to their rigid, closed question-based nature lived experience may not be captured. This means that an important source of clinically relevant information may be missed.
The available evidence on the effect of coping, efforts and strategies to reduce stress, on various outcome measures used in the brain injury population was collated and findings were synthesised. Results suggest that not one coping or quality of life measure is used consistently and that the majority of these measures are not specific to this population. In addition, the studies show that excessive use of coping strategies, or the use of emotionally focused strategies, may have a detrimental effect on quality of life.
The research paper addressed whether outcome measures miss clinically relevant information through their rigid structure. A mixed-methods analysis was used to compare information gathered from participants using an outcome measure (EBIQ) and that gained through analysis of semi-structured interviews. Ultimately, both methods have clinical value but the results from the outcome measure can be enriched through the use of qualitative information collected during interview.
These two papers show that, while outcome measures are valuable in assessing a person’s needs and monitoring progress, there is a need for the more consistent use of outcome measures specific to the ABI population, in parallel with interviews to uncover issues which may otherwise be missed. A reflexive commentary on my journey through the research and thesis process is also presented.