Understanding of long-term impact of traumatic brain injury (TBI) on survivors'life during recovery: a 24 month follow-up study.

• Main Author: Mohamed Ludin, Salizar
• Format: Monograph
• Language: English
• Published: 2019
• Subjects: RT Nursing; RT71 Study and Teaching
• Online Access: http://irep.iium.edu.my/78082/1/FINAL%20PROJECT%20REPORT%20FRGS%20TBI_3.1.%202020.pdf; http://irep.iium.edu.my/78082/

Introduction: Traumatic brain injury (TBI) is a major medical and socio-economic problem and is the leading cause of death in children and young adult. Most of the patients will be admitted in the intensive care unit (ICU) for critical illness therapy. Critical illness survivors have reported problems during recovery. Despite medical advances the survival rate after severe TBI, but survivors may face a lifetime disability. The impact and outcome for TBI survivors is of interest to patients and their families, also to clinicians needing to provide prognostic information and health care providers who bear the health costs. Studies concluded that subjects with moderate and severe TBI shows physical and functional improvement but remain with the cognitive and psycho-social problem throughout recovery. Despite all the issues, the impact of TBI on long term survivors in Malaysia is unknown. This study aims to explore the TBI survivors' outcome and their family members' needs during recovery and rehabilitation periods. Methodology: A cohort study design (survey & interview) was employed to investigate the outcome of ICU survivors with sTBI and their caregivers experience during recovery and rehabilitation periods. The samples were those sTBI survivors and caregivers discharge from Hospital Tengku Ampuan Afzan (HTAA) Kuantan, Pahang and Hospital Sultanah Nur Zahirah (HSNZ) Kuala Terengganu. Glasgow Outcome Scale Extended (GOSE) and Quality of life after brain injury (QOLIBRI) were used to obtain baseline data (before discharge), followed by at 3, 6 and 12-month discharge. Caregivers' needs and experience were assessed through individual interviews and focus group discussions. Following that, the Homebased care module (HBCM) model was developed based on the qualitative data (Grounded Theory). Statistical and qualitative analyses were done. Findings: 33 sTBI survivors were surveyed using the Glasgow Outcome Scale Extended (GOSE) in this study. The mean age of the participants was 31.79 years (ranging: 16 – 73 years). The Logistic regression model was statistically significant, ² (5, N= 33) = 29.09, p < 0.001. The length of stay (LOS) in ICU (p = 0.049, odds ratio = 6.062) and duration on ventilator (p = 0.048, odds ratio = 0.083) were good predictors of the functional outcomes. The quality of life 33 survivors after sTBI (QOLIBRI) were also measured. The result reported an impaired range on 6 months post-injury, but improvement occurs within 3 to 6 months post-injury. The QOLIBRI result revealed, age and duration on the ventilator showed a moderate negative correlation in all domains. Meanwhile, length of stay in hospital showed a moderate negative correlation to social, daily life and self domains. Finally, the caregivers/family members of sTBI survivors needs and experience were assessed. The themes that emerged from the interviews and focus group were analysed qualitatively ( Grounded theory analysis) and a model of Home-based Care module is developed and interpreted to the meaning and used as guideline to develop a home-base care model for future use for providing care to survivors during rehabilitation period. Conclusion: The analysis of sTBI impact on long term survivors’ recovery and caregivers experience allows for real time tracking and outcome assessment, documentation of changes in functional status and quality of life after TBI. All these data are important as guidance for healthcare workers (nurses (academic & clinical) and doctors) in planning the best care for the patients when they were admitted to the intensive care unit or general wards and return home after the injury. The caregivers/ family members experience needs and challenging that we found in this study allows us to plan for informative and detail health education for the caregivers. Readings and tools such as health information booklet, CD or applications can be plan in the future for the use of caregivers and survivors during their rehabilitation for better quality of life. Further up to date knowledge can be added into nursing education curriculum to increase nurses’ knowledge for better nursing care.