Communication and quality of life outcomes in people with acquired brain injury following project-based treatment
Communication impairments are common following acquired brain injury (ABI) and have a significant impact on a person’s quality of life (QOL) post-injury. While some treatments have improved communication skills, few have measured QOL, and even fewer have shown improved QOL for people with ABI following communication-based treatments. Project-based treatment is an alternative treatment approach that could have an impact on communication skills and QOL for people with ABI who are long-term post-injury. The treatment is embedded in a context of meaningful activities chosen by people with brain injury, whereby, as a group, they work collaboratively to plan and achieve a concrete goal or outcome that contributes others and/or the wider community. Project-based treatment has not been empirically evaluated for people with ABI. More specifically, no research has evaluated whether projects can improve both communication skills and QOL in people with ABI. Therefore, this research aims to evaluate the effectiveness of project-based treatment on the communication skills and QOL for people with ABI.\ud \ud An exploratory study was designed as a prospective quasi-randomised controlled trial with pre, post and follow-up assessments, using mixed methods, and feasibility testing to investigate the effect of project-based treatment. Twenty-one people with ABI were recruited from community settings, allocated to either a TREATMENT (n=11) or WAITLIST group (n=10). Treatment was completed over 6 weeks and comprised an individual session (to set specific communication goals with the person with ABI and their communication partner), followed by nine sessions conducted in groups of 2-3 people. These sessions involved a range of meaningful activities chosen by people with ABI that contributed to a tangible end product designed to help others (e.g. video, pamphlet, radio podcast, piece of art).\ud \ud Mixed methods were used to determine the effect of the treatment on people with ABI. The primary communication outcomes were: (1) Blind ratings of the person with ABI’s conversations on the Interaction and Transaction scales of the Adapted Measure of Participation in Conversation (MPC). The secondary communication outcomes were: (1) Blind ratings of the communication partner’s involvement in conversations on the Acknowledging and Revealing Competence scales of the Adapted Measure of Support in Conversation (MSC); (2) Blind ratings for the Impression scales that described how appropriate, rewarding, effortful, and interesting a conversation was; (3) La Trobe Communication Questionnaire (LCQ) as rated by the person with ABI, and their communication partner; and (4) Goal Attainment Scaling (GAS). The primary QOL outcome was the Satisfaction With Life Scale (SWLS), and the secondary QOL outcome was the Quality of Life in Brain Injury (QOLIBRI) measure. The qualitative data was drawn from semi-structured interviews conducted post-treatment.\ud \ud The first set of analyses for the primary and secondary outcome measures, compared the TREATMENT group with the WAITLIST group over two time points, between which only the TREATMENT group had received the treatment. This showed that people with ABI in the TREATMENT group had improved Interaction scores on the MPC, their communication partners had improved Revealing Competence scores on the MSC, and the conversation was perceived as less effortful, compared to the WAITLIST group. No changes were found for the remaining communication outcomes, or the QOL outcomes. The second analyses compared pre-treatment, post-treatment, and follow-up scores across all people with ABI (i.e. scores for both the TREATMENT and WAITLIST group were combined). This showed significant changes for communication partners on the MSC and LCQ, and significant achievement of communication goals on GAS, as rated by both the person with ABI, and their communication partners. Significant improvement on the QOLIBRI was found, with a trend towards significance on the SWLS. No other significant changes were found. Qualitative data was analysed using content analysis where the content and context of the interview transcripts were analysed and themes identified. People with ABI described overwhelmingly positive experiences of the treatment, the group, the project, and working on goals. They also described a range of positive benefits including improved awareness and skill, and positive feelings.\ud \ud Project-based treatment made modest improvements to both communication skills, and QOL. Moreover, people with ABI perceived positive experiences, and benefited from inclusion in the treatment. While this study was an exploratory trial, with feasibility testing, the results highlight that this treatment could be a potential alternative to other treatments available to people with ABI.