Title: Development and refinement of an online group-based clinical neuropsychology rehabilitation programme to improve psychological wellbeing and quality of life after acquired brain injury.
Funder: Department of Health and Social Care

Abstract: Background Acquired Brain Injuries (ABI) result in over 1000 daily UK hospital admissions, with some people experiencing life-long problems, costing the UK economy &pound;15 billion annually (&raquo;10% of the NHS annual budget). Approximately 20% will experience increased disability (physical, emotional, and cognitive) and reduced psychological wellbeing. Neuropsychological rehabilitation (NPR) is a form of psychological therapy that links our understanding of brain functioning to cognitive, emotional, and behavioural problems. It has a robust evidence-base when delivered face-to-face in individual and group settings, and is offered in routine NHS ABI clinics. However, such face-to-face interventions are resource-intensive and can exclude some patients. As the primary/sole format of NPR delivery, it reduces patient choice. Although evidence is growing to support the effectiveness of online interventions more generally, online group-based NPR for people with ABI is yet to be systematically developed or evaluated. Aims Our aim is to design an online, group-based NPR programme to improve psychological wellbeing and quality of life of ABI survivors, and to test whether it is useful and acceptable to patients and stakeholders, and feasible to deliver within NHS clinics. Methods Our programme of research follows the Medical Research Council guidelines for developing complex interventions (in this case, the online group-based NPR) in three steps: (1) completing a scoping review incorporating realist and implementation frameworks to produce a comprehensive understanding and prototype of the content and delivery of the intervention. (2) stakeholder surveys, interviews and focus groups, and intervention development decision-making groups to critique and refine the NPR prototype (with data analysed using Framework Analysis). (3) evaluating preliminary acceptability and fidelity by testing the online group-based NPR through a mixed-methods ABA multiple single case series (analysed using Framework Analysis and descriptive statistics). Timelines for delivery Progress towards delivery of the final intervention will be an iterative process over 21-months. The scoping review will be completed by month 4, giving us an early intervention blueprint. This will be refined in months 4-12 via data analysed from the stakeholder survey, stakeholder interviews and expert intervention development and treatment groups. We will undertake preliminary testing of the intervention between months 14-17, with analysis of early outcome indicators and participant feedback informing further refinements of the NPR programme. Anticipated impact and dissemination Our outputs will include a: (1) stakeholder and ABI service user co-constructed NPR prototype, ready for future testing in a feasibility trial. (2) preliminary logic model of how the intervention can be delivered and implemented in the NHS. (3) preliminary understanding of the utility and promise of the intervention. (4) plan to enable generalisability of learning for other online group-based therapies for other patient groups. We will disseminate our findings to clinicians, researchers, and patient groups through presenting at regional NHS meetings, national and international conferences such as World Federation of Neurorehabilitation, journals such as Neuropsychological Rehabilitation, and through PPI-edited study newsletters.

Lay abstract: Context: Acquired brain injury (ABI) is a type of brain injury caused by medical conditions (e.g., stroke) or injuries (e.g., traffic accidents). In the UK, 1.4 million people live with the consequences of ABI, which can be life-long, costing the economy &pound;15 billion annually (10% of the NHS annual budget). Approximately 20% of ABI survivors experience emotional and/or thinking skills problems. These problems can impact people's return to hobbies and work, and increases risk of isolation, resulting in psychological distress and reduced quality of life. The problem: Neuropsychological rehabilitation (a type of psychological therapy) is useful in treating such problems, but is typically delivered face-to-face in individual or group sessions. However, due to a lack of NHS resources, not all ABI survivors get the help they need. Furthermore, limited clinic space and COVID-19 restrictions mean group sessions cannot always be provided safely, if at all. Our solution: Online group-based neuropsychological rehabilitation may provide an alternative, that can fit around busy lives (e.g., for ABI survivors who work), group people according to shared experiences (e.g., young survivors), or overcome issues of physical contact (e.g., those with mobility problems). Despite possible advantages, such ABI-specific neuropsychological rehabilitation has not been systematically developed or evaluated. Our aim To develop an online, group-based neuropsychological rehabilitation programme to improve psychological wellbeing for ABI survivors, and to test whether patients find it useful and acceptable, and the NHS can deliver it. Methods To develop the programme (or &ldquo;intervention&rdquo;), we will: 1. Review previous research to understand how neuropsychological therapies are delivered, by whom, in which contexts, and who benefits. This will enable us to produce an initial plan/blueprint for the new intervention. 2. Develop this plan/blueprint further, to produce an intervention manual, by: (i) surveying ABI survivors and stakeholders to explore different views regarding group-based online interventions (ii) seeking feedback from an advisory group of professional and patient experts (iii) conducting interviews with ABI survivors and stakeholders to critique and refine the intervention. 3. To test the intervention, we will deliver it to two groups of approximately 4-6 patients each. We will seek feedback on acceptability and feasibility of delivering the intervention from ABI survivors and therapists, enabling further modifications of our intervention. Patient and Public Involvement (PPI) PPI underpins our project design and delivery. The idea originated from our clinical work and patient feedback, and this project was co-designed by our PPI Lead. We have listened to feedback from our ABI survivors and carers' PPI group, who think it is vital they get neuropsychological therapies targeting psychological wellbeing, and are keen to explore online options. Dissemination Results of each stage will be communicated to participants (via accessible newsletters), published in scientific journals and presented at conferences.

Research activity codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL;5.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: STROKE;INFECTION;CANCER AND NEOPLASMS;INJURIES AND ACCIDENTS