Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-24T01:14:11.221Z Has data issue: false hasContentIssue false
  • English
  • Français

A Survey of Multidisciplinary Clinicians Working in Rehabilitation for People with Traumatic Brain Injury

Published online by Cambridge University Press:  26 January 2016

Elizabeth Pagan ,
Tamara Ownsworth ,
Skye McDonald ,
Jennifer Fleming ,
Cynthia Honan  and
Leanne Togher
Elizabeth Pagan
Affiliation:
School of Applied Psychology and Menzies Health Institute Queensland, Griffith University, Australia National Health and Medical Research Council Centre of Research Excellence in Brain Recovery, University of New South Wales, Sydney, Australia
Tamara Ownsworth*
Affiliation:
School of Applied Psychology and Menzies Health Institute Queensland, Griffith University, Australia National Health and Medical Research Council Centre of Research Excellence in Brain Recovery, University of New South Wales, Sydney, Australia
Skye McDonald
Affiliation:
National Health and Medical Research Council Centre of Research Excellence in Brain Recovery, University of New South Wales, Sydney, Australia School of Psychology, University of New South Wales, Sydney, Australia
Jennifer Fleming
Affiliation:
National Health and Medical Research Council Centre of Research Excellence in Brain Recovery, University of New South Wales, Sydney, Australia School of Health and Rehabilitation Sciences, The University of Queensland and Occupational Therapy Department, Princess Alexandra Hospital, Brisbane, Australia
Cynthia Honan
Affiliation:
National Health and Medical Research Council Centre of Research Excellence in Brain Recovery, University of New South Wales, Sydney, Australia School of Psychology, University of Tasmania, Launceston, Australia
Leanne Togher
Affiliation:
National Health and Medical Research Council Centre of Research Excellence in Brain Recovery, University of New South Wales, Sydney, Australia Discipline of Speech Pathology, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
*
Address for correspondence: A/Prof Tamara Ownsworth, School of Applied Psychology, Griffith University, Mt Gravatt 4122, Australia. Ph: +61 73735 3307, Fax: +61 73735 3388. E-mail: [email protected].
Get access

Abstract

Little is known about clinicians’ experiences in rehabilitation for people with traumatic brain injury (TBI). This survey study aimed to investigate clinicians’ scope of practice, perceived barriers to practice, factors influencing confidence levels and professional development preferences. Participants included 305 clinicians (88% female, 97% aged 20–60 years) from psychology (28%), occupational therapy (27%), speech pathology (15%), physiotherapy (11%), social work (6%), rehabilitation medicine (3%) and nursing (3%) disciplines. Survey results indicated that goal setting, client or family education, and assessment for rehabilitation, were the most common activities across all disciplines (>90%). Client-related barriers, family-related barriers and client–therapist relationship barriers were more frequently selected than workplace context and professional skill barriers (p < .05). Clinicians working with clients with mild TBI reported significantly fewer barriers (p < .05); yet, they were less confident in overcoming barriers than clinicians working with clients with more severe TBI (p < .001). Clinicians with fewer years of experience (<2 years) reported significantly lower confidence in overcoming barriers than clinicians with 2–10 years and >10 years of experience (p < .01). The most commonly selected professional development areas included new interventions and therapies, translating rehabilitation research into everyday practice and client specific topics. These findings provide a unique multidisciplinary perspective on clinicians working in TBI rehabilitation in Australia. Understanding of the perceived barriers to practice and professional development needs may guide training and support initiatives for clinicians which, in turn, may enhance the quality of brain injury rehabilitation.

Keywords

multidisciplinaryrehabilitationtraumatic brain injuryclinicians
Type
Articles
Information
Brain Impairment , Volume 16 , Issue 3 , December 2015 , pp. 173 - 195
Copyright
Copyright © Australasian Society for the Study of Brain Impairment 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Access Economics. (2009). The economic cost of spinal cord injury and traumatic brain injury in Australia. Report by Access Economics Pty Limited for the Victorian Neurotrauma Initiative. Retrieved from http://www.tac.vic.gov.au/upload/vni/pdf.Google Scholar
Ammentorp, J., Sabroe, S., Kofoed, P.E., & Mainz, J. (2007). The effect of training in communication skills on medical doctors’ and nurses’ self-efficacy: a randomized controlled trial. Patient Education and Counseling, 66, 270–277.CrossRefGoogle ScholarPubMed
Area of Practice Endorsements Registration Standard. (2010). Psychology board of Australia. Retrieved from: http://www.psychologyboard.gov.au/.Google Scholar
Australasian Faculty of Rehabilitation Medicine. (2011). Standards for the provision of inpatient adult rehabilitation medicine services in public and private hospitals. Retrieved from: http://www.racp.edu.au.Google Scholar
Australian Institute of Health and Welfare (2007). Disability in Australia: Acquired brain injury. AIHW Bulletin 55. Canberra: AIHW.Google Scholar
Barclay, D.A. (2013). Family functioning, psychosocial stress, and goal attainment in brain injury rehabilitation. Journal of Social Work in Disability & Rehabilitation, 12, 159–175.CrossRefGoogle ScholarPubMed
Bishop, M., Degeneffe, C.E., & Mast, M. (2006). Family needs after traumatic brain injury: Implications for rehabilitation counselling. Australian Journal of Rehabilitation Counselling, 12, 73–87.CrossRefGoogle Scholar
Boosman, H., Visser-Meily, J.M.A., Ownsworth, T., Winkens, I., & Van Heugten, C. M. (2014). Validity of the dynamic wisconsin card sorting test for assessing learning potential in brain injury rehabilitation. Journal of the International Neuropsychological Society. 20, 1034–1044.CrossRefGoogle ScholarPubMed
Booth, J., & Hewison, A. (2002). Role overlap between occupational therapy and physiotherapy during in-patient stroke rehabilitation: An exploratory study. Journal of Interprofessional Care, 16, 31–40.CrossRefGoogle ScholarPubMed
Brooks, V., Rhodes, B., & Tefft, N. (2014). When opposites don't attract: One rehabilitation hospital's journey to improve communication and collaboration between nurses and therapists. Creative Nursing, 20, 90–94.CrossRefGoogle ScholarPubMed
Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155–159.CrossRefGoogle ScholarPubMed
Cook, R.S., Gillespie, G.L., Kronk, R., Daugherty, M.C., Moody, S.M., Allen, L. J., & Falcone, R. A. Jr (2013). Effect of an educational intervention on nursing staff knowledge, confidence, and practice in the care of children with mild traumatic brain injury. Journal of Neuroscience Nursing, 45, 108–118.CrossRefGoogle ScholarPubMed
Corrigan, J.D., Selassie, A.W., & Orman, J.A. (2010). The epidemiology of traumatic brain injury. Journal of Head Trauma Rehabilitation, 25, 72–80.CrossRefGoogle ScholarPubMed
Daneshvar, D.H., Riley, D.O., Nowinski, C.J., McKee, A.C., Stern, R.A., & Cantu, R.C. (2011). Long term consequences: Effects on normal development profile after concussion. Physical Medicine and Rehabilitation, 22, 683–700.Google ScholarPubMed
Doig, E., Fleming, J., Kuipers, P., & Cornwell, P. (2009). Qualitative exploration of a client-centered goal-directed approach to community-based occupational therapy for adults with traumatic brain injury. American Journal of Occupational Therapy, 63, 599–568.CrossRefGoogle ScholarPubMed
Evans, J.J. (2012). Goal setting during rehabilitation early and late after acquired brain injury. Current Opinion in Neurology, 25, 651–655.CrossRefGoogle ScholarPubMed
Foster, A.M., Armstrong, J., Buckley, A., Sherry, J., Young, T., Foliaki, S., & McPherson, K.M. (2012). Encouraging family engagement in the rehabilitation process: a rehabilitation provider's development of support strategies for family members of people with traumatic brain injury. Disability & Rehabilitation, 34, 1855–1862.CrossRefGoogle ScholarPubMed
Government of South Australia. (2012). Acquired brain injury model of rehabilitation for South Australia. Statewide Rehabilitation Clinical Network. Government of South Australia, Department of Health, Adelaide.Google Scholar
Graham, F., Robertson, L., & Anderson, J. (2013). New Zealand occupational therapists' views on evidence-based practice: A replicated survey of attitudes, confidence and behaviours. Australian Occupational Therapy Journal, 60, 120–128.CrossRefGoogle ScholarPubMed
Hicks, E.J., Larkins, B.M., & Purdy, S.C. (2011). Fatigue management by speech-language pathologists for adults with traumatic brain injury. International Journal of Speech-Language Pathology, 13, 145–155.CrossRefGoogle ScholarPubMed
Holland, K., Middleton, L., & Uys, L. (2012). Professional confidence: A concept analysis. Scandinavian Journal of Occupational Therapy, 19, 214–224.CrossRefGoogle ScholarPubMed
Hux, K., Walker, M., & Sanger, D.D. (1996). Traumatic brain injury knowledge and self-perceptions of school speech-language pathologists. Language, Speech, and Hearing Services in Schools, 27, 171–184.CrossRefGoogle Scholar
Jackson, H., & Manchester, D. (2001). Towards the development of brain injury specialists. NeuroRehabilitation, 16, 27–40.CrossRefGoogle ScholarPubMed
Judd, D., & Wilson, S.L. (2005). Psychotherapy with brain injury survivors: an investigation of the challenges encountered by clinicians and their modifications to therapeutic practice. Brain Injury, 19, 437–449.CrossRefGoogle ScholarPubMed
Körner, M. (2010). Interprofessional teamwork in medical rehabilitation: a comparison of multidisciplinary and interdisciplinary team approach. Clinical Rehabilitation, 24, 745–55.CrossRefGoogle ScholarPubMed
Mazmanian, P.E., Kreutzer, J.S., Devany, C.W., & Martin, K. (1993). A survey of accredited and other rehabilitation facilities: Education, training and cognitive rehabilitation in brain-injury programmes. Brain Injury, 7, 319–331.CrossRefGoogle ScholarPubMed
McDonald, S., Anderson, V., Ponsford, J., Tate, R., Togher, L., Morgan, A., & Murdoch, B. (2012). Moving ahead: a new centre of research excellence in brain recovery, focusing on psychosocial reintegration following traumatic brain injury. Brain Impairment, 13 (02), 256–270.CrossRefGoogle Scholar
McLaughlin, A.M., & Carey, J.L. (1993). The adversarial alliance: Developing therapeutic relationships between families and the team in brain injury rehabilitation. Brain Injury, 7, 45–51.CrossRefGoogle Scholar
Mitsch, V. (2011). To the back of Bourke, delivering brain injury rehabilitation to remote areas in New South wales. Proceedings of the 11th National Rural Health Conference, March 13–16th, Perth, Australia.Google Scholar
NSW Government. (2011). Care and support pathways for people with an acquired brain injury. Retrieved from: http://www.adhc.nsw.gov.au/__data/assets/file/0007/237751/ADHC-ABIPathways-R10.pdf.Google Scholar
Pedrazza, M., Trifiletti, E., Berlanda, S., & Bernardo, G.A.D. (2013). Self-efficacy in social work: Development and initial validation of the self-efficacy scale for social workers. Social Sciences, 2, 191–207.CrossRefGoogle Scholar
Ponsford, J., Willmott, C., Rothwell, A., Cameron, P., Kelly, A., Nelms, R., & Ng, K. (2000). Factors influencing outcome following mild traumatic brain injury in adults. Journal of the International Neuropsychological Society, 6, 568–579.CrossRefGoogle ScholarPubMed
Ponsford, J.L., Downing, M.G., Olver, J., Ponsford, M., Acher, R., Carty, M., & Spitz, G. (2014). Longitudinal follow-up of patients with traumatic brain injury: Outcome at two, five, and ten years post-injury. Journal of Neurotrauma, 31 (1), 64–77.CrossRefGoogle ScholarPubMed
Ryan, C., Ross, S., Davey, P., Duncan, E.M., Fielding, S., Francis, J.J., & Bond, C. (2013). Junior doctors' perceptions of their self-efficacy in prescribing, their prescribing errors and the possible causes of errors. British Journal of Clinical Pharmacology, 76, 980–987.CrossRefGoogle ScholarPubMed
Sander, A.M., Raymer, A., Wertheimer, J., & Paul, D. (2009). Perceived roles and collaboration between neuropsychologists and speech-language pathologists in rehabilitation. The Clinical Neuropsychologist, 23 (7), 1196–1212.CrossRefGoogle ScholarPubMed
Sherer, M., Evans, C.C., Leverenz, J., Stouter, J., Irby, J.W. Jr, Eun Lee, J., & Yablon, S.A. (2007). Therapeutic alliance in post-acute brain injury rehabilitation: Predictors of strength of alliance and impact of alliance on outcome. Brain Injury, 21, 663–672.CrossRefGoogle ScholarPubMed
Stringer, A.Y. (2003). Cognitive rehabilitation practice patterns: A survey of american hospital association. Clinical Neuropsychologist, 17, 34–44.CrossRefGoogle ScholarPubMed
Suddick, K.M., & De Souza, L. (2006). Therapists' experiences and perceptions of teamwork in neurological rehabilitation: reasoning behind the team approach, structure and composition of the team and team working processes. Physiotherapy Research International, 11, 72–83.CrossRefGoogle Scholar
Tate, R.L. (2008). Rehabilitation after traumatic brain injury: An Australian context. Higher Brain Function Research (Formerly Aphasia Research), 28, 129–142.CrossRefGoogle Scholar
Triola, M.M., Huwendiek, S., Levinson, A.J., & Cook, D.A. (2012). New directions in e-learning research in health professions education: Report of two symposia. Medical Teacher, 34, e15–e20.CrossRefGoogle ScholarPubMed
Tsaousides, T., & Gordon, W.A. (2009). Cognitive rehabilitation following traumatic brain injury: assessment to treatment. Mount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine, 76, 173–181.CrossRefGoogle ScholarPubMed
Turner, B.J., Ownsworth, T.L., Turpin, M., Fleming, J.M., & Griffin, J. (2008). Self-identified goals and the ability to set realistic goals following acquired brain injury: A classification framework. Australian Occupational Therapy Journal, 55, 96–107.CrossRefGoogle ScholarPubMed
Turner-Stokes, L. (2008). Evidence for the effectiveness of multi-disciplinary rehabilitation following acquired brain injury: A synthesis of two systematic approaches. Journal of Rehabilitation Medicine, 40, 691–701.CrossRefGoogle ScholarPubMed
Wertheimer, J. C., Tresa, M., Roebuck-Spencer, T. M., Constantinidou, F., Turkstra, L., & Pavol, M. (2008). Collaboration between neuropsychologists and speech-language pathologists in rehabilitation settings. Journal of Head Trauma Rehabilitation, 23, 273–285.CrossRefGoogle ScholarPubMed
Wilding, C., Curtin, M., & Whiteford, G. (2012). Enhancing occupational therapists' confidence and professional development through a community of practice scholars. Australian Occupational Therapy Journal, 59, 312–318.CrossRefGoogle ScholarPubMed
Wittig, P.G., Tilton-Weaver, L., Patry, B.N., & Mateer, C. A. (2003). Variables related to job satisfaction among professional care providers working in brain injury rehabilitation. Disability & Rehabilitation, 25, 97–106.CrossRefGoogle ScholarPubMed
Wong, D., McKay, A., & Stolwyk, R. (2014). Delivery of psychological interventions by clinical neuropsychologists: Current practice in Australia and implications for training. Australian Psychologist, 49, 209–222.CrossRefGoogle Scholar