Bateman bathsrr jan2013slides
Download as PPT, PDF3 likes1,151 views
This document outlines an investigation into discrepancies between self-reports and carer ratings on the European Brain Injury Questionnaire (EBIQ) among a clinical sample of brain injury patients. The study analyzes data from 39 patient-carer dyads, highlighting that while overall scores did not differ significantly, notable discrepancies existed in various domains of reported quality of life. The findings confirm the utility of EBIQ in rehabilitation prioritization while emphasizing the need for careful interpretation of questionnaire results.
Bateman bathsrr jan2013slides
- 1. An investigation into discrepancies between self- and carer rating responses to the European Brain Injury Questionnaire (EBIQ) in a Community Head Injury Service Andrew Bateman PhD MCSP Psaila,K.,Bundock,K., Moss,S.,Palmer,H.,Hutchinson,P., Allanson,J. Evelyn Community Head Injury Service SRR meeting, London, July 2006 INS meeting, Zurich, July 2006 INS satellite meeting, Leichtenstein, August 2006 10th Anniversary Conference, November 2006 UK Rasch User Group, Feb 2007 SRR meeting, Preston, July 2008 SRR Meeting, Bath, Jan 2012
- 2. How to start? •Evelyn Trust 5 year grant •Evelyn Neurorehabilitation Project •Mapping current pathways •Referrals triaged via NT Clinic Aims To: •Provide timely, specialised, assessment •Offer individualised holistic rehabilitation and advice •Create county liaison / advice network •Establish body of research to inform future Neurorehab. Who? Clinical Lead; Evelyn Consultant • Principal Clinical Psychologist • Psychology Assistant • OT – Advanced Practitioner • SALT – Advanced Specialist • Psychology Trainees and OT/ SALT students Service Manager + Admin from Cambridgeshire Community Services` Why? • Evidence; Cochrane Review; • Guidelines; NICE+NSF LTC • EoE Service Mapping • Gap in Cambridgeshire INTERDISCIPLINARY WORKING INDIVIDUAL Assessment +Therapy Psychol/ OT Med / SLT OTHER SERVICES Comm Team Headway OZC GROUPS Brain Injury Info. Fatigue Mood Management Communication Cognitive Family workshops INITIAL Holistic ASSESSMENT/Advice Formulation / Goal planning Rehab plan at weekly team meeting REVIEW Complex Case Discussion Case Conferences Family sessions
- 3. EBIQ • EBIQ contains 63 items proposed to constitute an overall measure of quality of life after brain injury. • The questions are rated with 3 response categories indicating frequency of symptoms ("not at all", "a little", "a lot"). • Scoring range 63-189 (if you use total scores) • Self and carer rating versions • Validated subscales of the tool are related to domains such as “cognitive”, “depression”, “social communication” and “physical(fatigue)” experiences. Original questionnaire available from http://teasdale.psy.ku.dk/ (for free)
- 4. Specific Research questions for this paper? Compared to their relative/carer… •How do people after brain injury report on their symptoms/quality of life •Can we measure differences? •Are the differences similar throughout domains e.g., as detected by subscales of the EBIQ
- 5. Method •Data from 39 dyads of patient self ratings and carer ratings were entered into the analysis •Patients were a clinical sample of people triaged for assessment for rehab at neurotrauma clinic, •…where both sets of data available •The sample (64% male) •with traumatic brain injury (2-62 months prior to assessment) •consecutive referrals to Evelyn Community Head Injury Service. •Rasch validated subscales were used to create subscale scores. •Data entered into MS Excel, using simple functions such as “countif=“ to help create descriptive stats.
- 6. Results 1.On overall (unvalidated total score) analysis there was no difference between carer and patient total scores (e.g wilcoxon p=0.67). 1.Partitioning discrepancies into quartiles suggests thresholds fall at (Q1)=-11.5 suggesting unawareness, and (Q3) = +12 suggesting more endorsement of symptoms than their carer. Hence 25% of our sample had -12 EBIQ point difference from their partner and 25% reported more symptoms.
- 7. Counting up where and how Much discrepancy "-ve values = anosagnosia-like ; +ve values = carer missing
- 9. This isn't new. It is well established that patients and carers report differently. What new information? • Gradient of discrepancies -ve +ve Comm 16 13 Depress 16 16 Cognitive 12 12 Impulsivity 12 12 Fatigue 11 11 SocComm 11 13 Somatic 11 11
- 10. Conclusion 1 • Confirm that this is a useful tool for prioritising rehab • Not all domains of patient and proxy reported outcomes yield similar patterns. • Interpretation of questionnaires merit careful analysis beyond total scores
- 11. CONCLUSIONS 2 Multiple influences on the patient and their interactions with questionnaires Indicator of reliability of responses to other clinical commissioner requested tools such as GOSE Our further planned research How linked to GOSE, DEX, eq5d, MPAI4 etc Does impulsivity impact on other scores
Editor's Notes
- #2: Introduction: It has been debated whether people with brain injury are able to accurately self-report quality of life symptoms. Dyads of patient and independent-rater responses to the checklist potentially reveal agreement or differences in either direction, suggesting either the patient’s anosagnosia or conversely the carer’s reduced awareness of their partner’s symptoms. Method: Administered at baseline assessment on admission to a specialist community head injury service, EBIQ data from 39patient-carer dyads were collated. Self- and Carer-rating discrepancies in endorsing symptoms were examined from the total and subscale score responses. Results: Partitioning discrepancies into quartiles suggests thresholds fall at (Q1)=-11.5 suggesting unawareness , and (Q3) = +12 suggesting more endorsement of symptoms than their carer. Hence 25% of our sample had >-12 EBIQ point difference from their partner and 25% reported more symptoms. There were fewer patients who appeared anosagnosic to cognitive problems than depression & communication problems. Discussion: Thresholds for discrepany have not been previously reported. This dataset demonstrated a continuum of agreement-disagreement between dyads. Possible reasons being anosagnosia, response bias, or that the carer is not aware of their partner’s experiences. Conclusion: Not all domains of patient and proxy reported outcomes yield similar patterns.
- #4: The EBIQ is a 63 item, 3-point Likert (not at all,a little,a lot) symptom checklist that yields a total score between 63-189. There are proxy and a self-rating versions. Validated subscales of the tool are related to domains such as “cognitive”, “depression”, “social communication” and “physical(fatigue)” experiences.
- #6: clinical sample of people triaged for assessment for rehab at a neurotrauma clinic. % discarded Notes: An interesting research question but the rationale for partitioning discrepancies into quartiles and the need for identifying thresholds could have been made more clear. Notes: The method of analysis in this abstract would benefit from further expansion. Notes:
- #7: Possible reasons carer or patient worry, anxiety, viglilence , over reporting, lack of insight, anosognosia, wish to normalise, particularly with a view to returning to work
- #8: This slide is to simply illustrate a step in the scoring procedure
- #9: This slide shows the count of people at each domain plotted against the difference between self rating and proxy rating for each subscale
- #11: How linked to GOSE, DEX, eq5d, MPAI4 etc Specific information Multiple influences on the patient Indicator of reliability of responses to clinicallycommissioner requested tools such as GOSE Does impulsivity impact on other scores