Community Integration Questionnaire Total Scores Research Articles

Correlation between the Quality of Life after Brain Injury in Japanese version (QOLIBRI-J) and Community Integration Questionnaire (CIQ)

The Quality of Life after Brain Injury (QOLIBRI; 37 items) is a disease specific subjective questionnaire of health-related quality of life (HRQoL) in persons after traumatic brain injury. We developed Japanese version of QOLIBRI; QOLIBRI-J and reported that it's test-retest reliability (ICC; 0.92, Cronbach α = 0.86) and validity (Correlations of SF-36) were excellent. The Questionnaires of QOLIBRI-J are based on subjective satisfaction, although those of another popular QOL instrument, Community Integration Questionnaire; CIQ is based on objective situations. We investigated between the relationship of QOLIBRI-J and CIQ of the persons with higher brain dysfunctions after TBI to show the differences of subjective and objective QOL. Subjects: 73 recruited community-dwelling Japanese with higher brain dysfunction after traumatic brain injury [61 male, 12 female: age 41.6 ± 14.3, Glasgow Outcome Scale-Extended; GOSE (3 to 8: median 5)]. The Correlations between QOLIBRI-J and CIQ were investigated in 73 subjects at the same time. They were also asked to fill the GOSE. The questionnaires were administered in one of three modes: by self-report (mail), self-report (participant presents at the clinic), and face-to-face interview. Distribution of GOS-E score were as follows, 3: lower severe disability (12.3%), 4: upper severe disability (27.4%), 5: lower moderate disability (27.4%), 6: upper moderate disability (16.4%), 7: lower good recovery (11.0%), 8: upper good recovery (5.5%). There was a low correlation between QOLIBRI-J total score and the CIQ total score (ρ=0.326 Spearman correlation coefficient). By the subscale analysis, the strongest correlation was found between QOLIBRI-J (Daily life/autonomy) and CIQ (social life). In contrast there was the weakest correlation between QOLIBRI (emotions) and CIQ (productive life). There was no correlation between the QOLIBRI and GOSE (ρ=0.21). QOLIBRI-J had a mild correlation with CIQ. There were some differences between QOLIBI and CIQ. One of the reasons of this difference was thought to be the subjective emotional factor about taking a productive work.

Community integration questionnaire: Outcomes of people with traumatic brain injury and high support needs compared with multiple matched controls

Objectives: To determine level of community integration in adults with traumatic brain injury and high support needs (TBI-HSN) compared with multiple matched controls.Setting: Community setting, Victoria, Australia.Participants: Adults with TBI-HSN living in the community (n = 61). Australian normative data (n = 1973) was used for matching purposes (1:4).Design: Matched analysis from people with and without TBI. Matching aimed to reduce variability expected from age, gender, metropolitan/rural residence and co-resident status.Main measures: Community Integration Questionnaire (CIQ): total and sub-scales of Home Integration, Social Integration and Productivity.Results: Matched analysis showed large effects favouring the general population, e.g. CIQ total scores were significantly different, F(1, 304) = 5.8, p < 0.0001. Conditional relative risk showed community-dwelling participants with TBI were 540-times more likely to report a poor CIQ total score compared to the general population.Conclusion: Normative CIQ data has enabled meaningful comparisons of the community integration of adults with chronic TBI to the general population in Australia. Evidence makes clear with numeric precision that individuals with TBI and high support needs are much less integrated than their non-TBI counterparts despite living in the community for many years.

Community integration 2 years after moderate and severe traumatic brain injury

Objective: The aim of this study was to examine community integration by the Community Integration Questionnaire (CIQ) 2 years after injury in a divided TBI sample of moderately and severely injured patients. The second aim was to identify social-demographic, injury-related and rehabilitation associated predictors of CIQ.Design: A cohort study.Setting: Outpatient follow-up.Participants: Fifty-seven patients with moderate (n = 21) or severe (n = 36) TBI were examined with the Community Integration Questionnaire (CIQ) at 2 years after injury. Possible predictors were analysed in a regression model using CIQ total score at 2 years as the outcome measure.Main outcome measures: The Community Integration Questionnaire.Results: At 2 years follow-up, there was significant difference between the moderately and severely injured patients in the productivity scores (p < 0.003), while difference in the total CIQ scores approached the significance level (p = 0.074). Significant predictors of a higher CIQ score were living with a spouse, higher Glasgow Coma Scale (GCS) in the acute phase, shorter Post-Traumatic Amnesia (PTA), longer rehabilitation stay (LOS) and use of rehabilitation service. Use of rehabilitation service (B = 7.766) and living with a spouse (B = 4.251) had the largest influence. This means that living with a spouse, better score on the GCS scale, shorter PTA, longer LOS and use of rehabilitation service after discharge equated to better community integration 2 years after TBIConclusions: Two years after TBI the moderately injured patients have a higher productivity level than the severely injured patients. Marital status, injury severity and rehabilitation after injury were associated with community integration 2 years after TBI.

The Community Approach to Participation: Outcomes Following Acquired Brain Injury Intervention

AbstractObjective: To investigate the participation outcomes of individuals with severe acquired brain injury (ABI) who were provided with up to 12 months of intervention based on the Community Approach to Participation (CAP). Method: A case series study design was undertaken with a total of 85 participants from two private practices specialising in community-based, CAP rehabilitation for people with severe ABI. Inclusion criteria were the person had sustained an acquired brain injury, was aged over 18 years and had received up to 12 consecutive months of CAP input from one of the two practices within a three-year period between January 2004 and January 2007. Twenty-six of the 85 participants were an average of 343 days post injury (Early group) and 59 of the participants were an average of 10.2 years post injury (Late group). They were living in a range of community environments and residential facilities. Initial participants were identified for the study in January 2005. Data were gathered using the Functional Independence Measure (FIM™), Community Integration Questionnaire (CIQ), and Role Checklist (RC Part 1) at two time points: prior to intervention (baseline), and after a 12-month period or at discharge (TI). Within the intervention period, all participants received a customised community occupational therapy (OT) rehabilitation program based on the key principles of the CAP. Intervention focused on participation goals of the individual, and development of the associated skills that underpinned valued role performance. Results: Participants each received an average of 51.01 hours of CAP OT during the 12-month period of intervention. Considerable improvement was seen in functional independence, community integration, and role participation after intervention in both the Early and Late groups. A statistically significant increase in FIM™ and CIQ total scores was found for all participants from Baseline to T1. The number of roles in which participants engaged increased on average by almost one role per participant following intervention, from a mean of 3.06 to 3.99. Increased participation in volunteer, home maintainer, participant in organisations and hobbyist roles were most common. Conclusion: Increased functional independence, community integration, and participation in both the Early and Late groups over a 12 month period demonstrates the potential for improved participation outcomes for people with complex needs following ABI, even many years post injury.

Relationship of race/ethnicity and income to community integration following traumatic brain injury: Investigation in a non-rehabilitation trauma sample

The purpose of the current study was to determine the contribution of race/ethnicity and income to community integration at approximately 6 months following traumatic brain injury (TBI). Participants were 151 persons with mild to severe TBI (38% Black; 38% Hispanic; 24% White) recruited from consecutive admissions to the Neurosurgery service of a county Level I trauma center. A large number of participants had low income and low education. Community integration was assessed using the Community Integration Questionnaire (CIQ), Craig Handicap Assessment and Reporting Technique - Short Form (CHART-SF), and Community Integration Measure (CIM). Results of analysis of covariance (ANCOVA) indicated that, after accounting for injury severity, age, education, and income, race/ethnicity contributed significantly to the variance in CIQ Total score, Home Integration Scale, and Productive Activity Scale scores. Blacks had lower CIQ Total scores compared to Whites. Black and Hispanic participants had lower scores than Whites on the Home Integration Scale, and Blacks had lower scores than Whites and Hispanics on the CIQ Productive Activity Scale. Low income ( < or = $20,000) was related to lower scores on the CIQ and CHART-SF Social Integration Scales, and scores on the CIM Total, Belonging, and Independent Participation scales. These results indicate that racial/ethnic differences in community integration exist, even after accounting for income. However, income was more predictive than race/ethnicity for certain aspects of community integration, indicating that it should be accounted for in all studies investigating racial/ethnic differences in outcomes.

The Frontal Systems Behaviour Scale (FrSBe) as a predictor of community integration following a traumatic brain injury

Primary objective: This study examined the relationships between the Frontal Systems Behaviour Scale (FrSBe), neuropsychological tests and community integration outcomes among individuals with a history of TBI.Methods: Seventy-six individuals with a history of TBI were consecutively recruited from patients seen in a Neuropsychology clinic in an academic healthcare setting. Participants completed neuropsychological tests, the FrSBe and the Community Integration Questionnaire (CIQ) as part of a standard clinical neuropsychological evaluation.Results: The FrSBe was a significant predictor of community integration (CIQ) outcomes. Specifically, poorer executive functioning (FrSBe Executive Functioning) predicted lower CIQ Total Scores, while increased apathy (FrSBe Apathy) was associated with reduced CIQ Productivity. Regarding neuropsychological tests, only Delayed Memory remained as a predictor: higher scores were associated with enhanced CIQ Total Scores and CIQ Social Integration. Finally, female gender was associated with superior CIQ Total Scores, CIQ Home Integration and CIQ Productivity.Conclusions: While neuropsychological tests of executive functioning failed to add predictive power to models of community integration following TBI with this sample, the FrSBe, a measure of behavioural manifestations of frontal lobe dysfunction, did predict these important functional outcomes. This suggests that use of the FrSBe may enhance the ecological validity of information gathered during a clinical neuropsychological assessment.

Poster 20: Community integration after traumatic brain injury

Objective: To determine the level of community integration after traumatic brain injury (TBI) and its association with clinical inpatient outcome measures. Design: The Community Integration Questionnaire (CIQ) was used to conduct telephone interviews with either the patient or a proxy who lived with the patient. Setting: Community. Participants: 77 patients with TBI who were 5 to 34 months postdischarge from an acute rehabilitation hospital. Interventions: Not applicable. Main Outcome Measure: The CIQ. Results: The CIQ total score had an inverse correlation with age ( r=−.300, P<.008) and length of stay ( r=−.290, P<.011). There were low but statistically significant correlations with discharge cognitive skills on the FIM™ instrument ( r=.451, P<.0001), discharge FIM total score ( r=.366, P<.001), and FIM efficiency ( r=.367, P<.001). There were significant differences between subjects who were not currently working or attending school versus those who were. The latter group scored higher on home integration (5.6±3.0 vs 3.6±2.9), social integration (8.9±2.1 vs 6.6±2.8), productivity (5.4±0.8 vs 1.5±1.1), and CIQ total scores (20.0±3.7 vs 11.8±5.8). Conclusion: Consistent with previous findings, community integration correlated with functional outcome at discharge from rehabilitation. Patients who return to work or school exhibit better social and home integration.

Impact of Minority Status on Functional Outcome and Community Integration Following Traumatic Brain Injury

Objective: To determine whether minority status affected short-term and 1-year functional outcome and community integration for patients with traumatic brain injury (TBI) in the TBI Model Systems National Data Base. Design: Prospective study, consecutive sample. Setting: Four tertiary care rehabilitation centers. Patients: Five hundred and eighty-six patients with TBI admitted to one of four TBI Model Systems programs from February 1989 through June 1995. Inclusion criteria for the study included evidence of a TBI, admission to the system hospital emergency department within 8 hours of injury, 19 years of age or older, and acute care and inpatlent rehabilitation within the system hospitals. Information was collected for demographics such as race, age, gender, education, employment status, marital status, and data related to the injury such as injury severity, etiology of injury, and payer source. Over half of the sample was white (53.4%) with the 46.6% of minorities composed of blacks (37.2%), Hispanics (7.3%), and Asians (2.0%). Main Outcome Measures: Functional outcome was measured with the Functional Independence Measure (FIM), Disability Rating Scale (DRS), and Community Integration Questionnaire (CIQ). The FIM and DRS were measured at inpatient rehabilitation admission, discharge, and 1 year post injury. The CIQ total score and subscale scores for Home Integration, Social Integration, and Productivity were obtained at 1-year post injury. It was hypothesized that minority status would not predict functional outcome after acute rehabilitation but would predict functional outcome and community integration at 1 year post injury. Results: There were no significant differences between whites and minorities for DRS and FIM scores at acute rehabilitation discharge. There were also no significant differences between whites and minorities on FIM scores 1 year post injury, but there were significant differences between whites and minorities on the Social Integration and Productivity subscales and total score of the CIQ. Multiple regression indicated that minority status predicted functional outcome for CIQ total score (r=-.28) and two subscales, Social Integration (=-.28) and Productivity ( r= -.23) even after controlling for etiology, severity of injury, age, gender, and functional status at rehabilitation discharge. Conclusions: Although minority status does not negatively impact recovery of basic mobility and daily living skills, it may impact long-term outcome related to community integration as measured by productivity and social integration. Greater outreach and access to postdischargc services and support may be needed to optimize community integration outcomes. Further studies are needed to determine how best to serve the needs of this segment of the population with TBI

Predicting community integration after traumatic brain injury with neuropsychological measures.

A neuropsychological test battery was administered to 23 subjects with traumatic brain injury during initial inpatient rehabilitation who were participating in the national Traumatic Brain Injury Model Systems study. Trails B and the Rey Auditory Verbal Learning Test total scores obtained during inpatient rehabilitation were significantly correlated with the Community Integration Questionnaire total score that was administered at one year postinjury. These findings suggest that performances on tests of cognitive speed and flexibility, complex attention, and memory during the acute phase of recovery may be useful for the later prediction of "real world" behavior and psychosocial outcome after one year postinjury.