Evaluating an intervention to increase meaningful activity after severe traumatic brain injury: A single-case experimental design with direct inter-subject and systematic replications

• Published in: Neuropsychological rehabilitation Vol. 30; no. 4; pp. 641 - 672
• Main Authors: Tate, Robyn L, Wakim, Donna, Sigmundsdottir, Linda, Longley, Wendy
• Format: Journal Article
• Language: English
• Published: England Routledge 20.04.2020; Taylor & Francis Ltd
• Subjects: Activities of Daily Living; Adult; Apathy; Apathy - physiology; Brain injured people; Brain Injuries, Traumatic - complications; Brain Injuries, Traumatic - rehabilitation; Cognitive ability; Cognitive Dysfunction - etiology; Cognitive Dysfunction - rehabilitation; Cognitive impairment; Community involvement; Disability; Emotional behavior; Female; Generalization, Psychological - physiology; Goal-setting; Goals; Health status; Humans; Intervention; Learning disabled people; Leisure; Leisure Activities; Male; Meaningful occupation; Mental health; Middle Aged; Mood; Morbidity; Neurobehavioral functioning; Occupational Therapy - methods; Outcome Assessment, Health Care; Program Development; Research Design; Return to work; Single-case experimental design; Single-Case Studies as Topic; Social activities; Systematic replication; Tau protein; Traumatic brain injury; Apathy; Meaningful occupation; Goal-setting; Traumatic brain injury; Leisure; Single-case experimental design; Systematic replication
• ISSN: 0960-2011; 1464-0694; 1464-0694
• DOI: 10.1080/09602011.2018.1488746

Severe traumatic brain injury (sTBI) often results in significant morbidity, with fewer than 50% returning to work and only a minority resuming leisure and social activity. Yet few effective interventions are available for non-vocational activity. The aim of the study was to develop a new goal-directed intervention, the Programme for Engagement, Participation and Activities (PEPA), and evaluate its effect. The research design was a multiple-baseline design across behaviours, with direct inter-subject and systematic replications. Seven participants with sTBI, neurobehavioural impairment including apathy, inability to work, and limited leisure/social activities were categorised into two groups. Group 1 (n = 4) had cognitive impairments but were functionally independent. Systematic replication was conducted in a further three participants (group 2) with major neurobehavioural impairments and functional disability. Generalisation measures evaluated other life domains in group 1 participants (e.g., mood, community participation). Results of the weighted average Tau-U across the tiers was significant for six out of seven participants, with large effect sizes (≥.64) for five participants. Generalisation effects extended to other domains of life. The PEPA thus shows promise as an effective intervention to increase non-vocational activity and improve mental health outcomes in people with neurobehavioural disability after sTBI. These results add to the evidence for the effectiveness of goal-directed interventions.