- Email: [email protected]
Exploring use of Technology in Persons with TBI and Their Caregivers: A Qualitative Content Analysis
e68 Research Objectives: Explore the relationship between sleep apnea status and sleep duration at time of PSG and BMI at one year post-injury in a Veteran and Service Member cohort enrolled in VA TBI Model Systems. Design: Prospective observational study of VA TBI Model System participants who received polysomnography during inpatient rehabilitation. Setting: Polytrauma Rehabilitation Center (PRC) at a VA Polytrauma Rehabilitation Center. Participants: NZ37, predominantly male (95%), median age of 31 years and primarily moderate to severe TBI (Median GCS Z 9; PTA Duration of 45 days). Interventions: N/A. Main Outcome Measure(s): BMI at one year post-injury. Results: The median BMI increased from 23.4 during inpatient rehabilitation to 27.5 at one-year post injury. Univariate linear regression revealed baseline BMI ( < .001) and worsening respiratory indices (i.e., overall apnea-hypopnea index [AHI; < .001], number of times of desaturation [Desaturation Index; < .001], degree of desaturation [NADIR; < .001], and percent of sleep time below 90% desaturation ( < .001) on polysomnography) had significant associations with of higher BMI at one-year injury. Sleep quality and architecture were not significant factors. After adjustment for baseline BMI, sleep and respiratory indices no longer had significant associations with one-year BMI. Conclusion/Discussion: This exploratory study found significant univariate associations between sleep apnea severity and weight gain at one-year post injury. AHRQ has identified the long-term health effects of sleep apnea as a high priority future research need. Given the high incidence and negative health consequences of obesity in TBI, early identification and successful treatment of sleep apnea may be a mechanism for improving the chronic health issues in TBI such as obesity. Future research with larger samples is needed to further explore the relationship between sleep and health in TBI. Key Words: Traumatic Brain Injury, Obesity, Sleep Apnea Disclosures: None.
Research Poster 302454 Exploring use of Technology in Persons with TBI and Their Caregivers: A Qualitative Content Analysis Karthik Arulselvam (Shepherd Center), Tolu Oyesanya, Nicole Thompson, Ronald Seel, Christine Gordon, Misha Pavel, Holly Jimison Research Objectives: Persons with traumatic brain injury (TBI) typically have cognitive, physical, and neurobehavioral impairments that increase risks for unintentional injury or harm after discharge. Behavioral informatics can be used to assist persons with TBI and their families to make decisions about their health and wellness. To increase independence and reduce risk of harm or injury, passively collected data can inform decision making related to health and daily activities. The purpose of this study was to explore the experience of persons with TBI and their family caregivers regarding use of technology and investigate their perspectives on using technology to help reach health, wellness, safety, and independence goals. Design: Conventional content analysis. Setting: Shepherd Center, Inc. Participants: Eleven persons with TBI and nine family caregivers. Interventions: None. Main Outcome Measure(s): Semi-structured interviews identified health and wellness problems and goals; experience and concerns with technology, and technology information of value. Results: Regarding current concerns, participants reported persons with TBI had problems or goals with: 1) mobility; 2) physical activity; 3) safety; 4) memory/attention; 5) sleep; 6) stress; 7) socialization; and 8) independence. Persons with TBI reported negative and positive experiences with technology. Negative experiences included being confused or stressed by technology or feeling disconnected socially. Positive experiences included using technology to achieve goals and increase their motivation for physical activity. Technology concerns focused on limited
Research Posters privacy, yet participants felt sharing data with caregivers and providers would be beneficial. Persons with TBI reported physical activity, sleep, and stress information as valuable. Conclusion/Discussion: Participants reported technology could help to support their overall goals. Findings will inform future development of technology to support persons with TBI and inform their decision making about health, wellness, safety, and independence goals. Key Words: Traumatic Brain Injury, Health, Wellness, Technology Disclosures: None. Research Poster 324469 Factors Associated With Provision of RiskModification Advice After Acute Stroke: Findings From a National Audit Steven McPhail (Queensland University of Technology and Metro South Health), Emma Finch, Jenny Fleming Research Objectives: To examine patient and clinical factors associated with the provision of risk-factor modification advice to patients during hospitalisation for acute stroke. Design: The Stroke Foundation (Australia) National Stroke Audit included hospitals that audited consecutive admitted cases using the Australian Stroke Data Tool (AuSDaT). Re-audits of a subset of cases by a second clinician and program data logic checks ensured the reliability and validity of data, with discrepancies clarified with each facility. Setting: Hospital inpatient facilities (nZ112) from all states of Australia. Participants: Adults admitted to hospital with a new episode of stroke (nZ4087) were included in the audit. Patients not discharged directly to the community or for whom secondary prevention risk factor modification was not considered appropriate (e.g., palliative) were excluded from analyses. Interventions: Routine multidisciplinary care. Main Outcome Measure(s): Whether risk-factor modification advice was provided to patients prior to discharge from hospital. Results: Multi-level (patients clustered in hospitals) generalized linear modelling indicated patients were less likely to have received risk factor modification advice if they were older (per decade) Odds Ratio (OR) Z0.85 (95%CI 0.78-0.93), female ORZ0.77 (95%CI 0.61-0.97), presented with cognitive deficit ORZ0.53 (95%CI 0.39-0.71), required a language interpreter ORZ0.47 (95%CI 0.28-0.77), required a carer ORZ0.65 (95%CI 0.47-0.89) or discharged on a weekend day ORZ0.60 (95%CI 0.39-0.91). They were more likely to have received risk-modification advice if treated on a specialized stroke unit ORZ1.98 (1.44-2.74). Approximately 39% (95%CI 31%-48%) of variation was attributable to differences between hospitals (rather than individuals). Conclusion/Discussion: The aforementioned clinical and patient factors associated with provision of risk modification advice may be used to target improvements in clinical care models to help patients (and their families) reduce the risk of further stroke events. Key Words: Stroke, Secondary prevention, Risk, Quality of Health Care, Hospitalization Disclosures: None disclosed. Research Poster 308626 Family Factors, Distress, and Life Satisfaction Among Caregivers of Patients With Parkinson’s Disease in Mexico Alexandra Terrill (University of Utah Department of Occupational & Recreational Therapies), Stephen Trapp, Justin MacKenzie, Susana Gonzalez Arredondo, Yaneth Rodriguez Agudelo, Juan Carlos Arango-Lasprilla Research Objectives: Examine the mediating role of caregiver (CG) distress between family factors and CG life satisfaction among an understudied population of Parkinson’s disease (PD) CG in Mexico. Design: Cross-sectional. Setting: National Institute of Neurology and Neurosurgery of Mexico.
www.archives-pmr.org
Research Poster 302454 Exploring use of Technology in Persons with TBI and Their Caregivers: A Qualitative Content Analysis Karthik Arulselvam (Shepherd Center), Tolu Oyesanya, Nicole Thompson, Ronald Seel, Christine Gordon, Misha Pavel, Holly Jimison Research Objectives: Persons with traumatic brain injury (TBI) typically have cognitive, physical, and neurobehavioral impairments that increase risks for unintentional injury or harm after discharge. Behavioral informatics can be used to assist persons with TBI and their families to make decisions about their health and wellness. To increase independence and reduce risk of harm or injury, passively collected data can inform decision making related to health and daily activities. The purpose of this study was to explore the experience of persons with TBI and their family caregivers regarding use of technology and investigate their perspectives on using technology to help reach health, wellness, safety, and independence goals. Design: Conventional content analysis. Setting: Shepherd Center, Inc. Participants: Eleven persons with TBI and nine family caregivers. Interventions: None. Main Outcome Measure(s): Semi-structured interviews identified health and wellness problems and goals; experience and concerns with technology, and technology information of value. Results: Regarding current concerns, participants reported persons with TBI had problems or goals with: 1) mobility; 2) physical activity; 3) safety; 4) memory/attention; 5) sleep; 6) stress; 7) socialization; and 8) independence. Persons with TBI reported negative and positive experiences with technology. Negative experiences included being confused or stressed by technology or feeling disconnected socially. Positive experiences included using technology to achieve goals and increase their motivation for physical activity. Technology concerns focused on limited
Research Posters privacy, yet participants felt sharing data with caregivers and providers would be beneficial. Persons with TBI reported physical activity, sleep, and stress information as valuable. Conclusion/Discussion: Participants reported technology could help to support their overall goals. Findings will inform future development of technology to support persons with TBI and inform their decision making about health, wellness, safety, and independence goals. Key Words: Traumatic Brain Injury, Health, Wellness, Technology Disclosures: None. Research Poster 324469 Factors Associated With Provision of RiskModification Advice After Acute Stroke: Findings From a National Audit Steven McPhail (Queensland University of Technology and Metro South Health), Emma Finch, Jenny Fleming Research Objectives: To examine patient and clinical factors associated with the provision of risk-factor modification advice to patients during hospitalisation for acute stroke. Design: The Stroke Foundation (Australia) National Stroke Audit included hospitals that audited consecutive admitted cases using the Australian Stroke Data Tool (AuSDaT). Re-audits of a subset of cases by a second clinician and program data logic checks ensured the reliability and validity of data, with discrepancies clarified with each facility. Setting: Hospital inpatient facilities (nZ112) from all states of Australia. Participants: Adults admitted to hospital with a new episode of stroke (nZ4087) were included in the audit. Patients not discharged directly to the community or for whom secondary prevention risk factor modification was not considered appropriate (e.g., palliative) were excluded from analyses. Interventions: Routine multidisciplinary care. Main Outcome Measure(s): Whether risk-factor modification advice was provided to patients prior to discharge from hospital. Results: Multi-level (patients clustered in hospitals) generalized linear modelling indicated patients were less likely to have received risk factor modification advice if they were older (per decade) Odds Ratio (OR) Z0.85 (95%CI 0.78-0.93), female ORZ0.77 (95%CI 0.61-0.97), presented with cognitive deficit ORZ0.53 (95%CI 0.39-0.71), required a language interpreter ORZ0.47 (95%CI 0.28-0.77), required a carer ORZ0.65 (95%CI 0.47-0.89) or discharged on a weekend day ORZ0.60 (95%CI 0.39-0.91). They were more likely to have received risk-modification advice if treated on a specialized stroke unit ORZ1.98 (1.44-2.74). Approximately 39% (95%CI 31%-48%) of variation was attributable to differences between hospitals (rather than individuals). Conclusion/Discussion: The aforementioned clinical and patient factors associated with provision of risk modification advice may be used to target improvements in clinical care models to help patients (and their families) reduce the risk of further stroke events. Key Words: Stroke, Secondary prevention, Risk, Quality of Health Care, Hospitalization Disclosures: None disclosed. Research Poster 308626 Family Factors, Distress, and Life Satisfaction Among Caregivers of Patients With Parkinson’s Disease in Mexico Alexandra Terrill (University of Utah Department of Occupational & Recreational Therapies), Stephen Trapp, Justin MacKenzie, Susana Gonzalez Arredondo, Yaneth Rodriguez Agudelo, Juan Carlos Arango-Lasprilla Research Objectives: Examine the mediating role of caregiver (CG) distress between family factors and CG life satisfaction among an understudied population of Parkinson’s disease (PD) CG in Mexico. Design: Cross-sectional. Setting: National Institute of Neurology and Neurosurgery of Mexico.
www.archives-pmr.org