Structured Abstract
Brain Injury Structured Abstract - BI #8
Exercise may benefit clients with traumatic brain injury
CITATION: Gordon, W. A., Sliwinski, M., Echo, J., McLoughlin, M. M., Sheerer, M. S., & Meili, T. E. (1998). The benefits of exercise in individuals with traumatic brain injury: A retrospective study. Journal of Head Trauma and Rehabilitation, 13(4), 58-67.
LEVEL OF EVIDENCE: IIA1b
This retrospective two-group treatment comparison design study, sample size above 20 per condition (n = 379, Traumatic brain injured n = 240, Control n = 139) with high internal validity and moderate external validity provided a IIA level of evidence.
RESEARCH OBJECTIVE/QUESTION
To determine whether the effects of exercise differed for persons with traumatic brain injury and those without a disability with respect to handicap, disability, health status and mood.
DESIGN
| |
RCT |
|
Single Case |
|
Case Control |
|
X |
Cohort |
|
Before-After |
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Cross-Sectional |
This study is occasionally referred to as a prospective design. A cohort design involves a group of people who have been exposed to a certain situation (not an identical situation necessarily) and the results that follow. This group of people is compared to a control that has not been exposed to the situation. This is different from an RCT study because a group of exposed people is formed primarily, and a group of non-exposed people is found to match the experimental group as best as possible. This study divided the participants into two groups - exercisers and non-exercisers.
SAMPLING PROCEDURE
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Random |
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Consecutive |
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X |
Controlled |
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Convenience |
Individuals for the study are selected according to criteria that have been pre-selected for that certain study. This sampling procedure is not necessarily composed of volunteers but people who fit the criteria. Participants had to meet certain criteria in regards to the participants' history of exercise.
SAMPLE
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N = 240
Male = 66.5%
Female = 66.8% |
M age =
|
EX
37.1 |
No EX
37.8 |
|
Ethnicity %
White |
62.2 |
84.8 |
|
Black |
15.3 |
6.3 |
|
Hispanic |
13.1 |
1.6 |
|
Other |
7.4 |
7.7 |
A retrospective study. 379 Participants, 240 traumatic brain injured, 139 without disability, were recruited. The traumatic brain injured participants were divided into exercisers and non-exercisers. The non-disabled participants were divided into the same categories (66 exercisers and 73 non-exercisers). All were at least 1-year post injury. Medical charts were not reviewed. Information came from interviews.
PARTICIPANT CHARACTERISTICS
Traumatic Brain Injured
MEDICAL DIAGNOSIS/CLINICAL DISORDER
Traumatic Brain Injured
OT TREATMENT DIAGNOSIS
Physical substrates: Sensory motor substrate: Neuromuscular System
OUTCOMES
Disablity Scales
Handicap Scales
|
Measures |
Reliability |
Validity |
|
The Beck Depression Inventory (BDI) |
NR |
NR |
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TIRR Symptom Checklist |
NR |
NR |
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The SF-36 Health Survey |
NR |
NR |
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The Community Integration Questionnaire (CIQ) |
NR |
NR |
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The Craig Handicap Assessment Capacity Technique (CHART) |
NR |
NR |
NR = Not Reported
Outcome - OT terminology
II. Performance Area
Activities of Daily Living
Outcome - ICIDH-2 terminology
Participation: Activity
INTERVENTION
Traumatic brain injured clients in non-institutional community setting (exercisers vs. non-exercisers)
1. Exercisers = 3 times a week for 30 min. ea.
2. Non-exercisers - exercise less than once a week
Description
- Treatment
- Jogging
- Swimming
- Biking
Who delivered
Participants exercised on their own. They reported when the researchers conducted a survey
Setting
Recruited from non-institutional rural, suburban, and urban areas of New York State
Baseline
Quality of Life and Health Interviews in person or by phone
Frequency
Exercisers: 3 Times per week, minimum 30 minutes each session
Non-exercisers: Less than one time per week
Duration
6 Months
Follow-up
None
RESULTS
- Description of samples: those without a disability were more likely to be married (x2 = 32; p < 0.007) and to be better educated (x2 = 42.1; p < 0.001).
- Symptoms on TIRR Symptom check list: Normal group had fewer symptoms than traumatic brain injured group (f = 119.93; p < 0.0001); traumatic brain injured with exercise had fewer symptoms than without exercise (p < 0.0004)
- Mood on BDI: normal group less depressed than traumatic brain injured group (f = 15.00; p < 0.001) traumatic brain injured with exercise less depressed than traumatic brain injured without exercise (f = 6.17, P < 0.01) (x2 = 8.81; p < 0.003)
- Health status: Individuals with traumatic brain injury who exercised were better than those without exercise
- CIQ: Normal group had higher scores on total f = 36.44; p < 0.001. Social Integration f = 14.21; p < 0.002. Home Integration f = 14.21, p < 0.002. Productive Activities f = 51.36; p < 0.001. Traumatic brain injured with exercise had higher scores (f = 0.81; p < 0.63)
- Handicap: Normal group hand higher scores on social (f = 35.13; p < 0.0001), physical (f = 12.46; p < 0.0005), occupational (f = 11.77; p < 0.001), exercise effect on traumatic brain injured group (f = 9.44; p < 0.002)
CONCLUSIONS
Biases
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Attention |
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Masking/blinding |
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Drop outs |
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Contamination |
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Co-intervention |
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It was found that traumatic brain injured exercisers had better health status than non-exercising traumatic brain injured individuals. Traumatic brain injured exercisers were less depressed and reported better health status than non-exercisers.
Terminology used in this document is based on two systems of classification current at the time the evidence-based literature reviews were completed: Uniform Terminology for Occupational Therapy Practice - Third Edition (AOTA, 1994) and International Classification of Functioning, Disability and Health (ICIDH-2) (World Health Organization [WHO], 1999). More recently, the Uniform Terminology document was replaced by Occupational Therapy Practice Framework: Domain and Process (AOTA, 2002), and modifications to ICIDH-2 were finalized in the International Classification of Functioning, Disability and Health (WHO, 2001).
This work is based on the evidence-based literature review completed by Beatriz C. Abreu, PhD, OTR, FAOTA, and colleagues. For more information about the Evidence-Based Literature Review Project, contact the Practice Department at the American Occupational Therapy Association, 301-652-6611, x 2040.
Copyright 2003 American Occupational Therapy Association, Inc. All rights reserved. This material may be reproduced and distributed without prior written consent.
