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Supported self-management for traumatic brain injury

Traumatic brain injury (TBI) often results in long-term physical, social, and psychological consequences. Among other complications, individuals who have sustained a TBI may experience challenges such as anxiety, depression, difficulty sleeping, poor memory or concentration, and mood or behavioral changes. These persistent symptoms can interfere with daily life, so many clinicians and researchers focus their efforts on developing interventions to support the management of the chronic consequences of TBI.

Supported Self Management (SSM) is an intervention strategy that helps people manage long-term or chronic conditions. Because living with a chronic condition often requires significant behavioral and lifestyle changes, clinicians recognize that many patients benefit from the guidance of a care team. SSM aims to address the challenges associated with lifestyle adjustments. Using a patient-centered care approach, SSM enables the patient to take an active role in their own care with ongoing support from a care team, who help the patient develop care plans, set goals, and conduct regular follow-ups.

Through education initiatives and personal health management strategies, SSM encourages individuals to take control of their own health in a structured, supportive environment. Critically, researchers emphasize that SSM is most effective when patients place trust in their care team and demonstrate sufficient self-motivation to enact behavioral changes. With effort and coordination from the patient and their care team, SSM has been used to successfully manage conditions such as diabetes, stroke, asthma, arthritis, and Parkinson’s Disease. The strategy can also be flexibly modified to support caregivers who manage the chronic condition of a dependent child, spouse, or elder relative.

Given the success of SSM for a number of diverse chronic conditions, researchers believe that the strategy is also a promising tool for managing TBI symptoms. A systematic review of SSM for patients with brain injury aimed to understand whether peer influence changes the effectiveness of SSM. To do so, the researchers compared the effectiveness of clinician support versus one-on-one care team support in managing persistent symptoms among individuals with brain injury. The studies included in the review demonstrated that one-on-one peer support improved quality of life for patients with TBI, but the results were not statistically significant.

Another group of researchers worked to design and implement the SSM intervention for individuals with TBI. They found that successful implementation of SSM for TBI patients is hindered by practitioners’ resistance to adopting the strategy in their own practice. To address these concerns, the researchers designed an implementation strategy and administered

a training program for staff at one large trauma center in the United Kingdom, with the hope that better training would result in consistent implementation. The researchers implemented the SSM strategy for five months and evaluated the impact of the intervention on patients, family, and staff. They found that the training program helped staff adopt the collaborative approach that is critical to SSM implementation, and helped patients and families understand ways that they could move forward in their recovery. Despite the initial obstacles to implementation, the final results of this study support the continued development of SSM for TBI patients.

While the use of SSM for managing TBI symptoms is in its early stages, current research suggests promise for success. In the meantime, further research is required to understand the best way to implement SSM to improve the quality of life of patients with long-term TBI symptoms.

References:

Self-Management Support. Content last reviewed October 2018. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/ncepcr/tools/self-mgmt/self.html

Levy, B. B., Luong, D., Perrier, L., Bayley, M. T., & Munce, S. E. (2019). Peer support interventions for individuals with acquired brain injury, cerebral palsy, and spina bifida: a systematic review. BMC health services research, 19(1), 288.

Mäkelä, P., Jones, F., de Sousa de Abreu, M. I., Hollinshead, L., & Ling, J. (2019). Supporting self‐management after traumatic brain injury: Codesign and evaluation of a new intervention across a trauma pathway. Health Expectations.

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