Bibliographic Information Location Country Setting Sample Characteristics Sample size Gender ratio Age range ABI Type of injury Time since injury Aim/Research Question Method Data collection Data analysis Cloute, K., Mitchell, A., & Yates, P. (2008) England Community n = 6 5 male:1 female 21 – 60 years TBI 4 – 20 years ‘1. What kind of IRs (interpretative repertoires) are used by individuals with a TBI and their significant others? 2. How are they used in conversation to construct aspects of social identity?’ (p654) Semi-structured interview Analysis involved cyclical periods of coding, reflecting and writing. References to time since injury were coded and IRs evident in each time frame were distinguished and compared Douglas, J. M. (2013) Australia Community n = 20 16 male: 4 female 21 – 54 years TBI 5 – 20 years Understand ‘how adults with severe TBI have constructed a sense of self several years after injury’ (p62) In-depth interviews, field notes, a personal demographic questionnaire, client files and two rating scales Grounded theory thematic analysis Table 1: Characteristics of included studies
Table 1: Characteristics of included studies (continued) Bibliographic Information Location Country Setting Sample Characteristics Sample size Gender ratio Age range ABI Type of injury Time since injury Aim/Research Question Method Data collection Data analysis Gracey, F. et al., (2008) England Inpatient rehabilitation n = 32 23 male: 9 female 21 – 59 years Mixed ABI 1 – 10 years ‘The aim of this study is to find out the salient patterns of engaged in by individuals when making sense of changes after brain injury’ (p632) Structured facilitated group discussions of 1 hour (2-5 participants) Personal constructs elicited (‘in vivo’ data reduction) and thematic analysis Hoogerdijk, B., Runge, U., & Haugboelle, J. (2011) Netherlands Community n = 4 3 male: 1 female 33 – 61 years TBI 20 – 27 months ‘How do individuals with traumatic brain injury make sense of their adaptation process and the performance of occupations within this process? This study aimed to understand how individuals valued the performance of everyday life activities within their adaptation process and how those occupational experiences influenced the adaptation process’ (p123) 2 interviews 50mins – 90mins Polkinghorne’s narrative analysis
People were often unable to remember their ABI and the circumstances surrounding it, resulting in confusion about how the changes occurred, often accompanied by a lack of information about their own life history (Nochi, 1997, 1998). Confusion and uncertainty was associated with despair, distress, hopelessness and a loss of confidence (Freeman et al., 2015). People described making efforts to gather information to ‘figure out’ changes and to make their sense of self more stable (Nochi, 1997, 1998). Table 8: Quotes to illustrate ‘confusion and uncertainty’ Quote Reference ‘I think it’s very important to hear the story about what has happened to you, as it is the only way to piece the puzzle together’ (p127) ‘understanding brain injury and coming to terms with the hospital environment’ (p984) ‘It’s like a void, or a black hole. It’s like, my memory is like a chalkboard, where some parts are erased…’ (p539) (Hoogerdijk et al. 2011) (Muenchberger et al., 2008) (Nochi, 1997) Comparison The theme of comparison represents an important mechanism by which individuals make sense of and adjust to their identity following ABI. Comparison was shown to result in both positive and negative outcomes for self-concept. Comparison was reported as less helpful in situations where individuals reported a tendency to compare their current self with their past self or ‘old me’ or a potential future self they had imagined (Freeman et al., 2015; Nochi, 1998). This was usually referring to aspects of their pre-injury identity that they had valued. However, comparison was also seen as helpful where individuals described comparing their
Article THEME Cloute et al., 2008 Douglas, 2013 Freeman et al., 2015 Gelech & 2011 Gracey et al., 2008 et al. 2011 Lennon et al., 2014 et al., 2008 Nochi, 1997 Nochi, 1998 Nochi, 2000 Sabat et al., 2006 CHANGE Continuity versus change Causes of changes Negative changes Positive changes Other people ADJUSTMENT The journey of adjustment and acceptance Confusion and uncertainty Comparison Values, goals and meaningful activity Table 11: Representation of identified themes across studies
Table 1: Outcome measures Instrument Acronym (Reference) Construct measured Items and scale Scores and interpretation Psychometrics Head Injury Semantic Differential Scale - III HISDS-III (Tyerman & Humphrey, 1984; Tyerman, personal correspondence) Developed to explore changes in self-concept arising from severe traumatic brain injury Consists of 18 adjective pairs, rated on a 7 point scale from ‘1’ negative pole to ‘7’ positive pole Sum the 18 items to a total score ranging from 18-126, with higher scores indicative of a more positive self-concept A comparable sample of adults who had experienced a TBI scored a mean of 74.99 (SD = 20.59). A Cronbach’s alpha of 0.92 has been reported for the scale (Carroll & Coetzer, 2011) Hospital Anxiety and Depression Scale HADS (HADS-A & HADS-D) (Zigmond & Snaith, 1983) Developed to identify possible and probable caseness of anxiety and depression among patients in nonpsychiatric hospital clinics Each scale consists of seven items rated on a 4 point Likert scale from ‘0’ (e.g. very seldom, not at all) to ‘3’ (e.g. very often, definitely) Sum to a total score ranging from 0-21 for each subscale. Higher scores are indicative of more symptoms of anxiety or depression. A clinical score of 8 was used (Dahm, Wong & Ponsford, 2013). As some studies have found that cut-off scores of the HADS have limited utility in predicting ‘caseness’ of anxiety or depression following ABI (Whelan-Goodinson et al., 2009), the current study used both clinical cut-off scores and descriptive categories when analysing results and calculating whether clinically significant change had occurred. The descriptive categories used were ‘normal’ (0–7), ‘mild’ (8–10), ‘moderate’ (11–15) and ‘severe’ (16–21) (Snaith & Zigmond, 1994) A Cronbach’s alpha of 0.90 has been reported for the anxiety subscale (HADS-A) and 0.86 for the depression subscale (HADS-D) (Dahm et al., 2013)
Table 1: Outcome measures (continued) Instrument Acronym (Reference) Construct measured Items and scale Scores and interpretation Psychometrics Quality of Life After Brain Injury QOLIBRI (von Steinbuchel et al., 2010). Developed to assess health related quality of life after traumatic brain injury Consists of 37 items across six sub-scales, rated on a five point Likert scale from ‘1’ to ‘5’. The first section assesses level of satisfaction across four domains: cognition, self, daily life and autonomy and social relationships. The second section asks respondents how ‘bothered’ they are by items across two domains: emotions and physical problems The total QOLIBRI score ranges from 37-185. QOLIBRI total scores are converted to a percentage and presented on a 0 (worst possible score on the QOLIBRI) to 100 (best possible score on the QOLIBRI) point scale (Truelle et al., 2010) A Cronbach’s alpha of 0.97 has been reported for the scale (von Steinbuchel et al., 2010) Rosenberg Self-Esteem Scale RSES (Rosenberg, 1965) A one-dimensional measure of global self-esteem Consists of ten items rated on a four point Likert scale from ‘0’ (disagree) to ‘3’ (strongly agree), with five items reverse scored Sum to a total score ranging from 0-30, with higher scores indicative of a more positive A Cronbach’s alpha of 0.88 has been reported for the scale (Robins, Hendin & Trzesniewski, 2001)
Table 1: Outcome measures (continued) Instrument Acronym (Reference) Construct measured Items and scale Scores and interpretation Psychometrics Global Self-Efficacy Scale GSES (Schwarzer & Jerusalem, 1995) A measure of an individual’s belief in his or her own ability to respond to novel or difficult situations and to deal with any associated obstacles or setbacks Consists of ten items rated on a four point Likert scale from ‘1’ (not at all true) to ‘4’ (exactly true) Sum to a total score ranging from 10-40, with higher scores indicative of a more positive sense of general self-efficacy. A Cronbach’s alpha of 0.89 has been reported for the scale (Luszczynska, Scholz & Schwarzer, 2005) Occupational Scale – Short Form OCCSEFF-8 (Schyns & Von Collani, 2002) A shortened version of the OCCSEFF which was designed as a measure of self-efficacy related to the occupational domain Consists of eight items rated on a six point Likert scale from ‘1’ (completely true) to ‘6’ (not at all true) Sum to a total score ranging from 8-48, with lower scores indicative of a more positive sense of occupational self-efficacy The short form was found to be highly correlated with the long form (r=0.947), and has a reported Cronbach’s alpha value of 0.88 (Schyns & Von Collani, 2002) Efficacy