17 Value-Consistent Rehabilitation is Related to Long-Term Quality of Life and Psychological Adjustment After Traumatic Brain Injury

Abstract

Objective:

Modern perspectives of rehabilitation after traumatic brain injury (TBI) emphasize the importance of individualized holistic approaches (i.e., physical and psychological adjustment) and collaboration toward goals (e.g., among the survivor, rehabilitation professionals, family/friends, etc.). Recent research has sought to employ a holistic, value-based approach (via the Valued Living Questionnaire) to measuring goals and whether those with TBI are acting in accordance with them, and quality of life outcomes. However, no research has examined whether rehabilitation practices are consistent with survivor values using this framework. The aim of the current study was to investigate the impact of value-consistent rehabilitation practices on quality of life and psychological adjustment outcomes in those with TBI.

Participants and Methods:

The current study included a sample of 73 adults with a history of TBI (M years since injury = 7.6, SD = 9.7) between the ages of 18 and 72 (Mage = 44.0 years, SD = 13.1; 73% female, 90.4% white) who had participated in outpatient rehabilitation. Individuals were recruited from brain injury support groups on Facebook and completed a series of surveys measuring TBI severity [Ohio State University Traumatic Brain Injury Identification Method-Short Form (OSU-TBI-ID)], value-consistent rehabilitation practices [modified Valued Living Questionnaire (VLQ)], life satisfaction [Life Satisfaction Questionnaire-9 (LiSat-9)], and psychological flexibility [Acceptance & Action Questionnaire - Acquired Brain Injury (AAQ-ABI)]. Discrepancy scores were calculated to compare perceived importance of and how helpful rehabilitation was for each VLQ domain. Bivariate Pearson correlations were conducted to investigate the relationships between value-consistent rehabilitation, life satisfaction, and psychological flexibility.

Results:

The VLQ domains with the greatest discrepancies were spirituality (-2.26), marriage/intimate relations (-2.06), and family relations (-2.02) such that rehabilitation helped less in these domains despite their importance. Greater levels of value-consistent rehabilitation were related to higher levels of life satisfaction overall (r = 0.40, p < 0.001) and lower levels of reactive avoidance of emotions related to one’s brain injury (r = -0.26, p = 0.03). In terms of specific domains of life satisfaction, greater value-consistent rehabilitation was related to higher levels of vocational (r= 0.44, p < .001), physical self-care (r = 0.28, p = 0.018), and friendship satisfaction (r= 0.41, p < .001).

Conclusions:

Our findings suggest rehabilitation practices may not be acting proportionately with TBI survivor values. Moreover, our results suggest value-consistent rehabilitation is important for long term quality of life and psychological adjustment outcomes. Future work should seek to identify factors that optimize opportunity for individualized treatment.