Wrestling with uncertainty after mild traumatic brain injury: a mixed methods study

• Published in: Disability and rehabilitation 2020-07, Vol.42 (14), p.1942-1953
• Main Authors: Snell, Deborah L., Martin, Rachelle, Surgenor, Lois J., Siegert, Richard J., Hay-Smith, E. Jean C., Melzer, Tracy R., Anderson, Tim J., Hooper, Gary J.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Brain Concussion - psychology; Brain Concussion - rehabilitation; Brain Injuries, Traumatic - psychology; Brain Injuries, Traumatic - rehabilitation; Case-Control Studies; educational interventions; Female; Humans; injury recovery expectations; Interviews as Topic; Male; Middle Aged; Mild traumatic brain injury; MTBI; Qualitative Research; Recovery of Function - physiology; Uncertainty
• ISSN: 0963-8288; 1464-5165
• DOI: 10.1080/09638288.2018.1542461

Purpose: Our objective was to explore the intersection between mild traumatic brain injury (MTBI) recovery experiences and injury understandings, using both quantitative and qualitative methods. Materials and Methods: The quantitative component was a descriptive case-control study comparing participants (n = 76) who had recovered or not recovered after an MTBI, across demographic and psychological variables. A subset of participants (n = 10) participated in a semi-structured interview to explore experiences of recovery in more detail. We followed threads across the datasets to integrate findings from component methods. Results: The quantitative analyses revealed differences between the two groups in terms of injury recovery understandings and expectations. The qualitative analyses suggested that achieving consistency across information sources was important. By tracing threads back and forth between the component datasets, we identified a super-ordinate meta-theme that captured participants' experiences of wrestling with uncertainty about their recovery and the impacts in terms of heightened anxiety, confusion, and feelings of invalidation. Conclusion: The effectiveness of psychoeducation and reassurance after MTBI may be optimized when content is tailored to the individual. Clinicians are urged to attend both to the subjective interpretations patients make of information gained from formal and informal, internal and external sources, and where information across these sources conflicts and creates uncertainty. Implications for rehabilitation Effectiveness of psychoeducation and reassurance after injury may be optimized when content is tailored to the individual rather than being generic. Effectiveness of such interventions may also be optimized by understanding the subjective interpretations individuals make of injury knowledge gleaned from formal and informal, internal and external sources. Conflicting information from such multiple sources may create uncertainty with associated increased distress as an individual negotiates their recovery from injury. Attending to this uncertainty may be a helpful target for treatment.