Acquired brain injury is the leading cause of disability in Australia and affects one in 45 people. Several research projects coordinated and managed by ISCRR have used research to inform the development of a state-wide, evidence-based acquired brain injury rehabilitation program, as well as building a comprehensive picture of how traumatic brain injury affects the lives of patients and their families.
Longitudinal head injury outcome study: Monash-Epworth Rehabilitation Research Centre Research Report
The overarching purpose of the study is to improve functional outcomes and quality of life as well as reduce cost in relation to individuals with traumatic brain injury serviced by the TAC. This includes identifying the needs of TAC clients at various times across their lifespan, which will assist the TAC to most efficiently and effectively plan how to meet the long-term needs of their clients.
Date published: August 2016
Identifying different patterns of outcome and their predictors Research Report
Two initial studies, using a large cohort of traumatic brain injury participants in the USA, identified five groups of individuals who differed on 12 dimensions that assessed cognitive, personal strengths, environmental, and performance validity factors. Another report has subsequently confirmed that the five-group solution can also be applied in the Australian cohort. This report presents findings regarding these five groups and their association with community participation outcomes and TAC service utilisation.
Date published: August 2016
Process-ABI: Evaluation of the processes of developing a statewide specialist severe ABI rehabilitation service Research Report
Rehabilitation which helps an individual to improve their independence may be expected to reduce the long term costs associated with life-long brain injury. The Process-ABI study evaluated the implementation, mechanisms of change and context of implementing the model of brain injury rehabilitation at the Alfred Health Acquired Brain Injury Rehabilitation Service, with the aim of developing a best-practice service. Initial results show that the centre has achieved adherence to 96% of clinical best practice guidelines indicators, up from 35% pre-centre. Staff levels, diagnoses of patients and the high numbers of admissions who experienced high nursing dependence and behaviours of concern influenced the ease with which the model could be implemented in the new Service. Staff and patients are reporting a positive response to the centre and staff have expressed confidence in making evidence-based decisions.
Date published: July 2016
Multi-modal MRI imaging in severe TBI patients to determine structural impact of DECRA craniectomy surgery, and early prognostication: Pilot studies Research Report
This study aimed to improve outcomes in traumatic brain injury patients through two pilot programs involving the implementation of improved MRI brain scanning. The first pilot study analysed brain structure after decompressive craniectomy surgery and found that there is some preliminary evidence to suggest that these procedures could lead to secondary complications. The second pilot study used multimodal MR imaging to enable early prognostic algorithms to assist early decision making after traumatic brain injury. The second study contributes to a broader international collaboration, with the Alfred now adopting international techniques. The small sample sizes in these studies did not lead to conclusive results, however, initial results are promising.
Date published: December 2014
The pathways of young people with acquired brain injury at risk of placement in residential aged care Research Summary
This study aims to document the pathways of young adults with severe acquired brain injury who experience prolonged acute hospital stay over their first 24 months post-injury from the acute setting to their residence post-rehabilitation.
Date published: September 2014
Community living after catastrophic brain injury in Victoria: Preparedness, outcomes and cost Research Report
This study aimed to determine the burden, cost and configuration of attendant care in Victoria for adults whose acquired brain injury occurred prior to 2014. Although all participants were deemed to have had an ABI severe enough to warrant continuous care (inclusive of supervision, passive and/or active care) at the time of discharge from inpatient hospital care, when assessed >1 year post-discharge they received an average of 92.93 hours of care per week (paid and informal combined). The results of this study provoke important questions about the relationship between access to paid assistance and the amount of informal assistance provided, reasons that participants in this study were receiving an average of 92 hours/week of care, and whether the amount of care that people receive is reflective of actual care need. The findings from this study form an important baseline for the evaluative work that will be conducted in the new Alfred Health Severe ABI Rehabilitation Service over the next 3-5 years
Date published: September 2014
Patients with severe, catastrophic acquired brain injury - using data linkages to identify outcomes Research Report
This study described the profile of severe traumatic brain injury (TBI) in Victoria, where patients are managed acutely and sub-acutely in the Victorian State Trauma System, and the long term outcomes of these patients. The specific aim was to establish the incidence, outcomes (hospital length of stay, functional status, living situation and mortality) and inpatient costs of severe TBI managed at The Alfred and Royal Melbourne Hospital (RMH) in Victoria from July 2009 to June 2012. A key focus was to establish the feasibility of linking Victorian State Trauma Registry (VSTR) data with Victorian Admitted Episode Data (VAED) to provide sufficient baseline data for evaluation of the new ABI unit based at Alfred Health which is due to open in 2014. As proof of concept of data linkage, the project was successful and the learnings will guide the next phase of the project, which will compare discharge destination, costs and outcomes of patients through the trauma system before and after the introduction of the new ABI unit.
Date published: August 2014
Understanding experiences of goal setting and planning for patients with severe acquired brain injury and their carers Research Report
This study examined the extent to which healthcare workers involved patients with moderate to severe brain injuries and their family members in goal-setting processes and the strategies they employ to support involvement in both acute and rehabilitation settings. The process of collaborative goal setting involving healthcare workers, individuals who have acquired brain injuries and their family members is complex and requires specialist skills. Patients and family members are frequently reliant on healthcare workers to provide education and determine the steps required for recovery. Opportunities to improve collaborative goal setting are identified and the need for healthcare workers to have well-developed reflective listening skills is advocated. Strategies to support the engagement of people with acquired brain injuries and their family members in goal setting have been outlined, these include building a therapeutic relationship, responding to patient and family members’ needs and actively engaging patients and family members in the goal setting process.
Date published: May 2014
Models of Care for people with severe aquired brain injury: A Systematic-Review Evidence Review
Acquired brain injury (ABI) affects approximately 1 in 45 Australians and is the leading cause of disability in Australia. The organisation of health care for patients with an ABI presents unique challenges and currently there is no standard model of rehabilitation care. Further, because of a lack of robust research evidence, there is no consensus on the best way to organise health care services for people with an ABI. The aim of this systematic review was to identify and assess the best available evidence on the organisation and models of health care services for people with a severe ABI. Although this review identified limited high quality studies, evidence suggests that: best-practice healthcare should be provided by multidisciplinary teams; better outcomes are achieved under an integrated care model in which acute, rehabilitation, and community/ambulatory services are provided under one management team; adherence to acute care guidelines may result in improved patient outcomes and reduced mortality; and use of quality monitoring approaches may lead to improved patient outcomes although no particular quality monitoring approach can be recommended. There is an opportunity to best-practice evidence-based healthcare for people with severe ABI.
Date published: August 2013