bateman bathsrr jan2013slides
DESCRIPTION
Another presentation I have given at the SRR. This is from the 2013 Winter Meeting in Bath. The European Brain Injury Questionnaire is a useful tool for capturing self and proxy ratings of symptom frequency. We have been using at Oliver Zan gwill Centre since the unit opened, and have amassed a substantial database that is yielding valuable insights for prioritising services. For me, the interesting message in this latest research is that there is a range of types of self-proxy discrepancies in the different EBIQ domains. I have been doing work on the EBIQ questionnaire for some years now, do contact me for more information about this symptom checklist.TRANSCRIPT
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 2006INS meeting, Zurich, July 2006INS satellite meeting, Leichtenstein, August 200610th Anniversary Conference, November 2006UK Rasch User Group, Feb 2007SRR meeting, Preston, July 2008SRR Meeting, Bath, Jan 2012
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 studentsService Manager + Admin fromCambridgeshire Community Services`
Why? • Evidence; Cochrane Review;• Guidelines; NICE+NSF LTC• EoE Service Mapping • Gap in Cambridgeshire
INTERDISCIPLINARY WORKING
INDIVIDUAL Assessment
+TherapyPsychol/ OTMed / SLT
OTHER SERVICESComm Team
HeadwayOZC
GROUPSBrain Injury Info.
FatigueMood ManagementCommunication
CognitiveFamily workshops
INITIAL Holistic ASSESSMENT/AdviceFormulation / Goal planning
Rehab plan at weekly team meeting
REVIEWComplex Case Discussion
Case ConferencesFamily sessions
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 fromhttp://teasdale.psy.ku.dk/ (for free)
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
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.
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.
Counting up where and how Much discrepancy
"-ve values = anosagnosia-like ; +ve values = carer missing
Una
war
e-pt
a
gree
una
war
e-pr
oxy
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
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
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 etcDoes impulsivity impact on other scores
