Outcome Measures Following Traumatic Brain Injury: A Synthesis of Speech-Language Pathologist’s Perspectives

Abstract

AbstractPurpose. Traumatic brain injury (TBI) is a major public health concern and impacts several different cognitive domains, often simultaneously. Outcome measures are used to evaluate progress in the clinic, and treatment efficacy in research. However, there can be mismatches between the cognitive impairments that commonly-used outcome measures assess and how these impairments impact the individual in real life. Historically, TBI research has relied on the opinions of researchers, rather than key stakeholders, to decide what is most important in assessment, treatment, and outcome measurement in TBI. By ignoring the opinions of individuals who hold lived experiences with TBI, there is a risk of treating and measuring domains that have less relevance to the individuals most closely impacted by TBI. This thesis is part of a larger study that aims to solicit the opinions of key stakeholders (individuals with TBI, their families, and speech-language pathologists) to find what matters most during TBI rehabilitation, in order to inform the selection of outcome measures for treatment efficacy research as well as the development of new outcome measures for domains not currently assessed in clinical and research settings. Here, we consider the perspectives of speech-language pathologists. Method. 41 speech-language pathologists (SLPs) across the United States completed an online survey. The two-part survey included: a clinical experience section and an open-ended response section including questions designed to elicit measurable outcome domains in TBI rehabilitation. The clinical experience section was analyzed using descriptive statistics. Open-ended responses were analyzed using qualitative thematic analysis. Data-driven thematic analyses included creating and refining a codebook, coding the data set, and organizing codes into themes for interpretation. Results. Results from the clinical experience section revealed the respondents had experience as SLPs averaging 14 years with CCCs (Certificate of Clinical Competence), and an average of 9.5 years of experience with TBI. Respondents worked in varied practice settings ranging from acute care to outpatient. The inductive qualitative analysis of the open-ended responses resulted in three themes that are of value to speech-language pathologists in TBI rehabilitation: Primary Impairments Following TBI (with 41 [100%] of 41 participants contributing to this theme), Changes to Activities and Participation (41 [100%]), and Process Factors in TBI Rehabilitation (40 [96%]). Conclusion. Many of the frequently cited domains reported by SLPs (e.g. memory, attention, executive function) are captured currently used outcome measures for TBI; however, some of the domains cited by SLPs are rarely or never measured in current outcome measures for TBI rehabilitation (e.g. acceptance, ease-effort, use of compensatory strategies). Future work should synthesize findings from the current study with perspectives of other key stakeholder groups (e.g. individuals with TBI and their families) to inform the development of new outcome measures. Limitations of the current study and opportunities for future research are discussed.