Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Doctor of Philosophy

Program

Health and Rehabilitation Sciences

Supervisor

Dickey, James P.

2nd Supervisor

Graham, Laura J.

Co-Supervisor

Abstract

Mild traumatic brain injuries (mTBI’s) are the most frequently experienced form of traumatic brain injury. Certain demographic characteristics, including older age, female sex, and pre-existing mental health conditions, increase the risk of experiencing persisting symptoms beyond the acute injury phase. Care for individuals with an mTBI is limited by geography, non-standardized trajectories of care, and gaps in healthcare provider knowledge. An interdisciplinary outpatient intervention has been created to address these issues, but has not been evaluated. Accordingly, the overall purpose of this thesis was to investigate treatment outcomes of individuals with persisting symptoms following an mTBI after completing a combined outpatient physiotherapy and occupational therapy rehabilitation intervention. This question was investigated through three studies evaluating changes in subjective outcomes and how they are influenced by different demographics. The results demonstrated individuals improved in performance and satisfaction of self-identified goals after completing this intervention in-person, and most frequently chose productivity-based goals (Study 1). Additionally, age, baseline symptom and anxiety scores, sex, days since injury, education, and mechanism of injury did not influence change in satisfaction with self-identified goals (Study 2). Lastly, there may be no differences in subjective outcomes after completing a virtual version of this intervention, especially for females (Study 3). In conclusion, this study demonstrates the in-person version of this intervention improves performance and satisfaction of participant-identified goals for adults with persisting symptoms following an mTBI that require physiotherapy and occupational therapy services. Additionally, there may be no difference in subjective changes following participation between in-person or virtual mTBI rehabilitation, particularly in female participants. However, future work is necessary to expand on this work and evaluate whether these preliminary results are supported with a fully powered study.

Summary for Lay Audience

Mild traumatic brain injuries (mTBI’s), or concussions, are the most common form of traumatic brain injury. People that are older, have pre-existing anxiety or depression, and females are more likely to continue experiencing symptoms a year after their injury. However, care for individuals with an mTBI is limited by geography, limited healthcare provider knowledge, and non-standardized care. This is problematic as individuals respond best to prompt care that targets their individual needs. Accordingly, the overall purpose of this thesis was to investigate treatment outcomes of individuals with persisting symptoms following an mTBI after completing a combined outpatient physiotherapy and occupational therapy rehabilitation intervention. This question was investigated through three studies. The results showed participants improved in performance and satisfaction of self-identified goals after completing this intervention in-person, and most frequently chose productivity-based goals, like returning to work, grocery shopping, and cleaning (Study 1). Additionally, age, initial mTBI symptom and anxiety scores, sex, days since injury, education, and mechanism of injury did not influence change in satisfaction with self-identified goals (Study 2). Lastly, there may be no differences in participant-rated anxiety, mTBI symptoms, vision, or performance or satisfaction of goals between the virtual and in-person versions of this intervention, especially for females (Study 3). In conclusion, this study demonstrates the in-person version of this intervention improves performance and satisfaction ratings of goals chosen by adults with persisting symptoms following an mTBI that require physiotherapy and occupational therapy services. Additionally, there may no difference in participant-reported symptoms, anxiety, vision difficulties, or performance or satisfaction with participant-identified goals after completing the in-person or virtual mTBI rehabilitation intervention, particularly in female participants. However, more research is necessary to further understand how participants respond to this intervention, which should include more participants and investigating other outcomes, to support our initial results.

Creative Commons License

Creative Commons Attribution-Noncommercial 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License

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