Marianne Løvstad

• Rohrer-Baumgartner, Nina; Brandt, Reidun; Holthe, Ingvil Laberg; Brunborg, Cathrine; Kendall, Sally & Svendsen, Edel Jannecke [Show all 7 contributors for this article] (2026). Validation of the Norwegian Version of the Tool to Measure Parenting Self-Efficacy (TOPSE) Questionnaire in Families With Children and Adolescents With Acquired Brain Injury. Child: Care, Health and Development. ISSN 0305-1862. 52(5), p. 1–10. doi: 10.1111/cch.70348. Full text in Research Archive
• Modell, Børge S.; Pacheco, Matheus M.; Opheim, Arve Isak; Hestetun-Mandrup, Ann Marie; Løvstad, Marianne & Øra, Hege Prag [Show all 8 contributors for this article] (2026). A reduced sensor configuration for upper extremity monitoring after stroke. Journal of NeuroEngineering and Rehabilitation. doi: 10.1186/s12984-026-02149-6. Full text in Research Archive Show summary

  Abstract Background Home rehabilitation for stroke survivors is crucial for promoting upper extremity (UE) movements, improving functional ability, and enhancing independence and quality of life. Wearable sensors enable monitoring of movement trends and progress during home rehabilitation. The feasibility of using sensors in the homes of stroke survivors depends both on user acceptability and the accuracy of the sensors in capturing the complexity of movement. The aim of this study was to identify a reduced and more practical sensor configuration that preserves the ability to capture movement complexity for monitoring UE movements in stroke survivors during daily activities at home. This was informed by aligning user acceptability data with movement complexity measures derived from a nine-sensor reference configuration in a home-like environment. Methods Eleven chronic stroke survivors were observed in a natural or simulated home environment while attempting to attach and detach sensors and wearing them while performing self-chosen activities of daily living. Nine inertial measurement unit sensors were placed on the participants’ UEs and sternum. Acceptability was assessed with a custom-made questionnaire consisting of 14 items scored on a 1–5 Likert scale, and five open-ended questions. Furthermore, information entropy was calculated to determine the minimal number of sensors needed to capture movement complexity. Results Total acceptability of wearing the 9 sensors was high, with a median score of 57 out of 70 (81%; IQR = 11), whereas usability was moderate, with a median score of 11 out of 20 (55%; IQR = 5.5). The usability challenges were related mostly to attaching and detaching sensors on the hands and non-affected UE. The minimal sensor configuration to capture behavior complexity consisted of three-to-four sensors, placed on the sternum, non-affected and affected forearms, with or without affected upper arm. Conclusions The 9-sensor configuration had high acceptability, but lower usability. A reduced configuration with three-to-four sensors was sufficient to maintain the accuracy of the sensors, while potentially increasing stroke survivors’ usability. In turn, this may increase the feasibility of wearing sensors at home for stroke survivors.

• Opheim, Arve Isak; Oppici, Luca; Hestetun-Mandrup, Ann Marie; Sunnerhagen, Katharina Stibrant; Rafsten, Lena & Bērziņa, Guna [Show all 14 contributors for this article] (2026). Pedagogy and Enriched Environment for Rehabilitation in the HOME After Stroke (PEER-HOMEcare): Study Protocol for a Single-Group Feasibility Study. Translational Stroke Research. ISSN 1868-4483. 17(4). doi: 10.1007/s12975-026-01459-0. Full text in Research Archive
• Johansen, Truls Sveløkken; Matre, Martin Engen; Løvstad, Marianne; Olsen, Alexander; Lund, Anne & Martinsen, Anne Catrine Trægde [Show all 10 contributors for this article] (2026). Predictors of improved attentional control after Virtual Reality-based cognitive rehabilitation in chronic traumatic brain injury. Disability and Rehabilitation. ISSN 0963-8288. doi: 10.1080/09638288.2026.2663968. Full text in Research Archive
• Rohrer-Baumgartner, Nina; Holthe, Ingvil Laberg; Svendsen, Edel Jannecke; DAHL, HILDE MARGRETE; Borgen, Ida Maria Henriksen & Hauger, Solveig L. [Show all 12 contributors for this article] (2026). Effects of an individualized and goal-oriented intervention in the chronic phase of pediatric acquired brain injury: the Child in Context Intervention (CICI)—a randomized controlled trial. BMC Pediatrics. doi: 10.1186/s12887-026-06997-y. Full text in Research Archive
• Hadzic-Andelic, Nada; Lu, Juan; Fure, Silje Christine Reistad; Brunborg, Cathrine; Løvstad, Marianne & Røe, Cecilie [Show all 7 contributors for this article] (2026). Effects of cognitive–vocational rehabilitation on post-concussion symptoms and emotional distress: a secondary RCT analysis. Brain Injury. ISSN 0269-9052. doi: 10.1080/02699052.2026.2654829. Full text in Research Archive
• Matre, Martin Engen; Johansen, Truls Sveløkken; Olsen, Alexander; Tornås, Sveinung; Martinsen, Anne Catrine & Lund, Anne [Show all 13 contributors for this article] (2026). Ecological validity of a Norwegian version of the Awareness of Social Inference Test. Applied neuropsychology: Adult. ISSN 2327-9095. doi: 10.1080/23279095.2026.2631123. Full text in Research Archive
• Oppici, Luca; Hestetun-Mandrup, Ann Marie; Pacheco, Matheus M.; Simonsen, Emilie Halmrast; Opheim, Arve Isak & Rafsten, Lena [Show all 10 contributors for this article] (2026). Strengths, limitations, and way forward of home-based rehabilitation practices after stroke: a scoping review. BMC Health Services Research. 26(1), p. 1–11. doi: 10.1186/s12913-026-14139-4. Full text in Research Archive Show summary

  Background Home-based motor rehabilitation after stroke has a great potential to promote task-specific and context-specific training in a familiar, functionally rich context, supporting more personalised, engaging, and adaptable rehabilitation experiences. This review aims to map existing practices in home-based motor rehabilitation after stroke and critically examine whether this potential is fully utilized and identify strengths and limitations. It further explores how healthcare professionals can optimise their planning and delivery of interventions. Methods A scoping review was conducted following the PRISMA guidelines. Comprehensive searches were conducted in 5 databases: PubMed, CINAHL, MEDLINE, APA PsycINFO and Web of Science. Two reviewers independently screened the studies for eligibility and extracted characteristics of each study into a data charting table. Results Sixty-six studies met the inclusion criteria. The results highlighted a consistent implementation of task-specific exercises but limited implementation of context-specific stimuli, inadequate training dosage, and limited contextual adaptation to the home environment. Further, instructional methods tended to be overly prescriptive, co-design strategies applied inconsistently, and caregiver engagement often underutilised. Conclusions Existing practices do not fully utilize the potential of home-based rehabilitation. We argue clinical work should prioritise early-phase interventions with adequate intensity and develop pedagogical frameworks to guide home modifications and instructional methods. The framework should support progressive and engaging practice, and fully adopt co-designed, person-centred approaches that meaningfully involve family caregivers.

• Matre, Martin Engen; Johansen, Truls Sveløkken; Tornås, Sveinung; Martinsen, Anne Catrine Trægde; Olsen, Alexander & Lund, Anne [Show all 13 contributors for this article] (2025). Reliability and validity of a Norwegian version of the awareness of social inference test. Neuropsychological Rehabilitation. ISSN 0960-2011. doi: 10.1080/09602011.2025.2558872. Full text in Research Archive Show summary

  To establish reliability and construct validity of a Norwegian version of the social cognition test, the Awareness of Social Inference Test (N-TASIT). Participants with traumatic brain injury (TBI; n = 101) and 50 matched healthy controls performed either a virtual reality (VR) or 2D version of N-TASIT at baseline and 16 weeks later. Reliability measures were test-retest reliability and internal consistency. Intraclass correlation (ICC) and Cronbach’s alpha (α) were calculated for the overall sample and both groups separately. Construct validity was tested with known groups validity, convergent and discriminant validity. Known groups analysis was conducted for both versions separately and combined. Convergent and discriminant validity were determined by associations between N-TASIT and established measures of social cognition and with measures of cognition, emotional distress and fatigue. ICC for the total sample was 0.63 (95% CI 0.49–0.73), and α was 0.88, when presentation modes (VR and 2D) were combined. The healthy control group outperformed the TBI group in both presentation modes. Medium-to-large associations were found between N-TASIT performance and social cognitive measures, and mostly weak or no significant correlations with non-social domains. N-TASIT appears psychometrically sound and comparable to the original. The influence of presentation mode on performance remains unclear.

• Johansen, Truls Sveløkken; Matre, Martin Engen; Løvstad, Marianne; Olsen, Alexander; Lund, Anne & Martinsen, Anne Catrine Trægde [Show all 13 contributors for this article] (2025). Virtual Reality in Training of Sustained Attention, Processing Speed, and Working Memory After Traumatic Brain Injury: A Randomized Controlled Trial. Archives of Physical Medicine and Rehabilitation. ISSN 0003-9993. 107(1), p. 31–31. doi: 10.1016/j.apmr.2025.07.005. Full text in Research Archive
• Sundet, Anja Schanke; Løvstad, Marianne; Havnes, Ingrid Amalia; Andelic, Nada; Ustvedt, Caroline & Månum, Grethe [Show all 12 contributors for this article] (2025). Rates and temporal onset of mental health disorders during inpatient rehabilitation after acute physical injury or illness: An observational cohort study. PLOS ONE. 20(12). doi: 10.1371/journal.pone.0338207. Full text in Research Archive Show summary

  Purpose Patients exposed to acute injury or illness are at increased risk of developing mental health disorders, and at the same time, mental health disorders increase the risk for injury and illness. This study aimed to determine the rate and onset of mental health disorders in a mixed patient group receiving inpatient specialized rehabilitation following acute physical injury or illness and to assess whether mental health disorders emerged before or after the injury or illness. Methods Patients were recruited over a one-year period (2020–2021) during inpatient rehabilitation. To follow the patients` lifetime history of psychiatric morbidity, mental health disorders, including substance use disorders, were assessed using the M.I.N.I Plus structured diagnostic interview over two periods: 1) retrospective report of mental health disorders before injury or illness and 2) mental health disorders present during rehabilitation. In the latter case, we also took into account whether the condition was present at the time of injury or illness. Demographic and injury data were retrieved from medical charts, patient interviews, and the Oslo University Hospital Trauma Registry. Results The study included 130 patients, of whom 49% had a lifetime history, and 38% met the diagnostic criteria for one or more mental health disorders during inpatient rehabilitation. Specifically, the vast majority (72%) of patients with a current disorder had the condition already at the time of injury or illness. Only 5% developed a mental health disorder after injury or illness without having a lifetime history. Conclusion Mental health disorders are common and often predate patients physical injury or illness. Assessing patients` mental health in the sub-acute phase, without considering their mental health history, and especially their mental state at the time of injury or illness, may lead to an overestimation of injury or illness’s impact on mental health.

• Howe, Emilie Isager; Søberg, Helene L.; Røe, Cecilie; Løvstad, Marianne & Andelic, Nada (2025). “What standard should we set?”: A qualitative study of rehabilitation professionals’ perspectives on rehabilitation needs after traumatic injuries. Journal of Rehabilitation Medicine. ISSN 1650-1977. 57. doi: 10.2340/jrm.v57.44087. Full text in Research Archive Show summary

  Objective: To assess rehabilitation professionals’ perspectives on unmet rehabilitation needs in patients with traumatic injuries and how to bridge the gap between met and unmet needs. Design: Semi-structured focus-group interviews analysed using a reflexive thematic approach. Methods: Eighteen strategically sampled health professionals (67% female, aged 27–56 years) from specialist and community-based rehabilitation services in Northern and South-Eastern Norway were interviewed regarding their perspectives on alignment of current rehabilitation services with patient needs, reasons for misalignment, and potential service improvements. Results: Care continuity and multidisciplinary collaboration was identified as essential for high-quality rehabilitation services. Unmet needs were noted in community-based services for cognitive and mental health support, as well as financial assistance for patients. Health professionals faced challenges prioritizing patient needs and expressed frustration with not being able to provide legally mandated services. Contributing factors included insufficient resources, lack of competency standards, and weak organizational structure. Suggested improvements were early rehabilitation assessments and stronger collaboration between specialist and community services. Conclusions: Strengthening community-based rehabilitation for traumatic injuries requires establishing professional competency standards, stronger coordination across care levels, and greater integration of psychosocial support. Advancing these dimensions calls for critical reflection on clinical practice, service organization, and health policy.

• Madsen, Benedikte Årebrot; Fure, Silje Christine Reistad; Røe, Cecilie; Løke, Daniel; Løvstad, Marianne & Andelic, Nada [Show all 7 contributors for this article] (2025). The relationship between personality traits and health-related quality of life after mild-to-moderate traumatic brain injury. BMC Neurology. 25. doi: 10.1186/s12883-025-04153-0. Full text in Research Archive Show summary

  Background Traumatic brain injury (TBI) causes major societal burden and may negatively influence an individual’s health-related quality of life (HRQoL). Personality factors have been linked to persistent post-concussion symptoms (PPCS), and PPCS have been found to affect HRQoL. However, there is a knowledge gap concerning the association between personality traits and HRQoL after mild-to-moderate TBI. Thus, this study aims to investigate the association between personality traits and HRQoL in patients with mild-to-moderate TBI at 15 months post-injury, while controlling for socio-demographic characteristics, injury-related factors and symptom burden. Methods Data from 86 participants with mild- to-moderate TBI from a previous randomised controlled trial were analysed. Sociodemographic, injury-related and psychological factors were recorded 2–3 months post-injury. Personality traits were measured at 15 months post-injury with The NEO Five-factor Inventory-3. The Quality of Life after Brain Injury– Overall Scale (QOLIBRI-OS) and the EuroQol-visual analogue scale (EQ-VAS) were used to measure HRQoL at 15 months post-injury. Two separate multiple linear regression models were performed for the outcome variables; QOLIBRI-OS (model 1) and EQ-VAS (model 2). Results The factors associated with lower HRQoL were more severe PPCS, higher levels of the personality traits neuroticism and conscientiousness (model 1), female sex and being single/living alone (model 2). Higher levels of the personality trait extraversion were associated with higher HRQoL in both models. Conclusion The results highlight how non-injury factors may be associated with recovery and HRQoL after TBI. Considering personality factors may be helpful when identifying individual risk and protective factors for outcomes after mild-to-moderate TBI.

• Kennedy, Eamonn; Vadlamani, Shashank; Lindsey, Hannah M.; Peterson, Kelly S.; O'Connor, Kristen Dams & Agarwal, Ronak [Show all 81 contributors for this article] (2025). Linking Symptom Inventories Using Semantic Textual Similarity. Journal of Neurotrauma. ISSN 0897-7151. 42(11-12), p. 913–1020. doi: 10.1089/neu.2024.0301. Full text in Research Archive Show summary

  An extensive library of symptom inventories has been developed over time to measure clinical symptoms of traumatic brain injury (TBI), but this variety has led to several long-standing issues. Most notably, results drawn from different settings and studies are not comparable. This creates a fundamental problem in TBI diagnostics and outcome prediction, namely that it is not possible to equate results drawn from distinct tools and symptom inventories. Here, we present an approach using semantic textual similarity (STS) to link symptoms and scores across previously incongruous symptom inventories by ranking item text similarities according to their conceptual likeness. We tested the ability of four pretrained deep learning models to screen thousands of symptom description pairs for related content—a challenging task typically requiring expert panels. Models were tasked to predict symptom severity across four different inventories for 6,607 participants drawn from 16 international data sources. The STS approach achieved 74.8% accuracy across five tasks, outperforming other models tested. Correlation and factor analysis found the properties of the scales were broadly preserved under conversion. This work suggests that incorporating contextual, semantic information can assist expert decision-making processes, yielding broad gains for the harmonization of TBI assessment.

• Oppici, Luca; Bērziņa, Guna; Hestetun-Mandrup, Ann Marie; Løvstad, Marianne; Opheim, Arve Isak & Pacheco, Matheus [Show all 9 contributors for this article] (2025). A Scoping Review of Preclinical Environmental Enrichment Protocols in Models of Poststroke to Set the Foundations for Translating the Paradigm to Clinical Settings. Translational Stroke Research. ISSN 1868-4483. 16, p. 1850–1873. doi: 10.1007/s12975-025-01335-3. Full text in Research Archive Show summary

  The translation of the highly effective Environmental Enrichment (EE) paradigm from preclinical animal models to human clinical settings has been slow and showed inconsistent results. The primary translational challenge lies in defining what constitutes an EE for humans. To tackle this challenge, this study conducted a scoping review of preclinical EE protocols to explore what constitutes EE for animal models of stroke, laying the foundation for the translation of EE to human application. A systematic search was conducted in the MEDLINE, PsycINFO, and Web of Science databases to identify studies that conducted an EE intervention in the post-stroke animal model. A total of 116 studies were included in the review. A critical reflection of the characteristics of the included studies revealed that EE for post-stroke is a strategy that frequently modifies the animals’ daily environment to create a richness of spatial, structural, and/or social opportunities to engage in a variety of daily life-related motor, cognitive, and social exploratory activities. These activities are relevant to the inhabiting individual and involve the activation of the body function(s) affected by the stroke. This review also identified six principles that underpinned the EE protocols: complexity (spatial and social), variety, novelty, targeting needs, scaffolding, and integration of rehabilitation tasks. These findings can be used as steppingstones to define what constitutes EE in human clinical applications and to develop a set of principles that can inform the design of EE protocols for patients after a stroke.

• Killi, Eli Marie; Holthe, Ingvil Laberg; Rohrer-Baumgartner, Nina; Wade, Shari L.; Løvstad, Marianne & Svendsen, Edel Jannecke (2025). Children's participation in school and leisure activities after paediatric acquired brain injury—Children's, parents' and teachers' experiences. Journal of Research in Special Educational Needs. doi: 10.1111/1471-3802.70006. Full text in Research Archive
• Johansen, Truls Sveløkken; Matre, Martin Engen; Tornås, Sveinung; Løvstad, Marianne; Ponsford, Jennie L. & Olsen, Alexander [Show all 7 contributors for this article] (2025). I thought it would be difficult, but this is actually something I can do–experiences with Virtual Reality-based cognitive training in persons with TBI. Annals of Medicine. ISSN 0785-3890. 57(1). doi: 10.1080/07853890.2025.2490218. Full text in Research Archive
• Raudeberg, Rune; Maroni, Stian; Løvstad, Marianne; Skogan, Annette Holth; Hansen, Tor Ivar & Olsen, Alexander [Show all 7 contributors for this article] (2025). Adoption of the American Academy of Clinical Neuropsychology uniform labeling of performance test scores in Norway: Towards a global standard? The Clinical Neuropsychologist. ISSN 1385-4046. doi: 10.1080/13854046.2025.2547012. Full text in Research Archive Show summary

  Objectives: To describe the process resulting in the implementation of the American Academy of Clinical Neuropsychology’s (AACN) recommendations of uniform labeling of performance test scores in Norway and the challenges encountered in translating the AACN test score labels into Norwegian. In 2021, the Norwegian Neuropsychological Society (NNS) launched a working group to establish and recommend a system of qualitative labels to describe results from performance-based tests with normal and non-normal distributions. This initiative was largely inspired by the AACN consensus statement, published in The Clinical Neuropsychologist by Guilmette et al. in 2020. Results: The working group recommended that the NNS should adopt the AACN uniform test score labels. However, the test score labels proved challenging to translate into Norwegian and several alternatives were considered. At the NNS annual meeting in 2023 consensus was reached and the recommended test labels were subsequently published in the NNS Guidelines and Principles for Clinical Neuropsychological Practice in 2024. Conclusions/Importance: This is the second formal attempt by a professional neuropsychological community to make recommendations for uniform performance test score labels. This might also represent the first small step towards a global standard of test labeling.

• Fagereng, Elisabeth; Lidal, Ingeborg Beate; Larsen, Kerstin Lundberg; Løvstad, Marianne; Rekand, Tiina & Hauger, Solveig Lægreid (2024). Cognition and emotional distress in middle-aged and older adults with spina bifida myelomeningocele. PLOS ONE. 19(2). doi: 10.1371/journal.pone.0298891. Full text in Research Archive
• Eide, Line Sophie; Rike, Per-Ola; Reme, Silje Endresen; Snekkevik, Hildegun; Rossner, Stephan Karl Otto & Rosen, Gunnar [Show all 8 contributors for this article] (2024). Using hypnotic suggestion in the rehabilitation of working memory capacity after acquired brain injury: study protocol for a randomized controlled trial. Trials. 25, p. 1–10. doi: 10.1186/s13063-023-07867-z. Full text in Research Archive Show summary

  Objectives Establishment of effective evidence-based interventions in rehabilitation of working memory (WM) deficits after acquired brain injury (ABI) is sorely needed. Despite robust evidence for the efficiency of clinical hypnosis in a wide range of clinical conditions, and improved understanding of mechanisms underlying its effects, the potential of clinical hypnosis in cognitive rehabilitation is underexplored. A recent study has shown large effects of hypnotic suggestion on WM capacity following ABI. This randomized controlled trial aims to evaluate and explore the replicability of these findings and examine the generalization of treatment effects. The study will also explore possible mechanisms of change. Methods Ninety patients will be recruited from the Sunnaas Rehabilitation Hospital. Inclusion criteria are nonprogressive ABI, minimum 12-month post-injury, ongoing WM deficits, and age between 18 and 67 years. Patients will be randomized to either (a) an intervention group receiving four weekly 1-h sessions with induction and hypnosis, (b) an active control group receiving four weekly 1-h sessions of induction and mindfulness, or (c) a passive control group without intervention. The targeted procedure consists of suggestions about enhancing WM functions, for example through the instantiation of preinjury WM capacity in the present using age regression or through visualizations of brain plasticity. The non-targeted suggestions contain no explicit mention of ABI- or WM-related abilities. Each participant will be assessed at baseline, immediately after intervention, and 6 months after baseline. The primary outcome is the WM index from WAIS-IV and self- and informant-reported WM subscale from BRIEF-A, a questionnaire exploring executive functioning in everyday life. Secondary outcomes include a cognitive composite score derived from tests measuring processing speed, executive functions, learning capacity and memory, and self-reported measures of emotional distress, quality of life, and community integration. Exploratory measures include self-rated ABI and WM-related self-efficacy. Discussion Rehabilitation of impaired WM after ABI has hitherto yielded limited transfer effects beyond the training material, i.e., improvement effects on everyday WM capacity, and clinical trials of new interventions are thus warranted. Long-standing empirical evidence demonstrates that hypnosis is an effective therapeutic technique in a wide range of conditions, and recent exploratory research has suggested a high efficacy of hypnosis in improving WM capacity in patients with ABI. However, these extraordinary findings need replication in studies applying scientifically rigorous designs. If successful, our ambition is to provide recommendations and materials to implement hypnotic suggestion as an adjunct treatment following ABI. Study findings may inform future studies exploring the use of clinical hypnosis in other areas of rehabilitation, such as mild TBI, and in other neurological conditions where WM deficit is prominent. Trial registration ClinicalTrials.gov NCT05287542. Registered on March 2022 Protocol version Protocol version 2.0, December 2023.

• Kleffelgård, Ingerid; Forslund, Marit Vindal; Hauger, Solveig Lægreid; Røe, Cecilie; Bragstad, Line Kildal & Søberg, Helene L. [Show all 8 contributors for this article] (2024). Process evaluation of a complex intervention evaluating the effectiveness of home-based rehabilitation in the chronic phase of traumatic brain injury. Disability and Rehabilitation. ISSN 0963-8288. doi: 10.1080/09638288.2024.2324119. Full text in Research Archive Show summary

  Purpose To perform a process evaluation of a randomized controlled trial (RCT) evaluating a manualized intervention aiming to ameliorate long-term symptoms of traumatic brain injury (TBI) by assessing implementation fidelity, delivery context and acceptability of the intervention. Methods Data from 60 participants were collected during recruitment, intervention delivery and outcome data collection in the RCT. Enrollment records, logs and checklists documented the delivery of the intervention (implementation fidelity) and the collaboration with family members and outside collaborators (delivery context). Attendance-rate, self-reported acceptability and willingness to participate in future studies were used to assess the acceptability of the intervention. Results The main elements and dose of the intervention were delivered as intended with an excellent adherence to the manual items. Family members co-participated in the intervention for 39 (65%) of the participants. Outside collaborators were contacted for 32 (53%) of the participants. Acceptability scores were high for participants, family members and therapists. Conclusions The intervention was successfully delivered with high acceptability. This process evaluation informs researchers, clinicians and stakeholders about important factors influencing the outcomes of the intervention that should be considered in clinical implementation of rehabilitation interventions.

• Røe, Cecilie; Borgen, Ida Maria Henriksen; Fure, Silje Christine Reistad; Forslund, Marit Vindal; Kleffelgård, Ingerid & Andelic, Nada [Show all 8 contributors for this article] (2024). The Participation Assessment with Recombined Tools-Objective (PART-O): measurement properties of the Norwegian version after traumatic brain injury. Brain Injury. ISSN 0269-9052. doi: 10.1080/02699052.2024.2304855. Full text in Research Archive Show summary

  Objective To translate and evaluate the validity of the Participation Assessment with Recombined Tools-Objective (PART-O) in a Norwegian context. Methods One hundred and twenty persons with TBI with verified intracranial lesions and persistent symptoms lasting more than 2 years, included in a randomized controlled trial, rated their participation using the PART-O at baseline. The PART-O with its three subscales (Productivity, Out and About, and Social Relations) was translated to Norwegian. Descriptive statistics, Cronbach's alpha, Rasch analysis, and correlation analysis were applied. Results The Rasch analysis indicated a unidimensional construct of PART-O and its subscales (χ2 < 12.69, p > 0.28). The internal consistency was moderate (Cronbach's alpha 0.48–0.52) and there was a need to reduce scaling options for most of the items. The Out and About and Productivity subscales had considerable floor effects. PART-O showed moderate positive correlation to TBI-related quality of life and global functioning. Conclusions PART-O and its subscales reflect unidimensional aspects of participation. In the present Norwegian TBI population the original scaling of PART-O was too detailed for all subscales. The floor effects and suboptimal targeting between items and subjects participation level of the Out and About subscale is a matter of concern.

• Løvstad, Marianne; Borgen, Ida Maria Henriksen; Hauger, Solveig; Kleffelgård, Ingerid; Brunborg, Cathrine & Røe, Cecilie [Show all 8 contributors for this article] (2024). Family member reported symptom burden, predictors of caregiver burden and treatment effects in a goal-oriented community-based randomized controlled trial in the chronic phase of traumatic brain injury. BMC Neurology. 24(1). doi: 10.1186/s12883-024-03841-7. Full text in Research Archive Show summary

  Background Family members are often affected by the long-term consequences of traumatic brain injury, but are rarely involved in rehabilitation programs in the chronic phase. We thus do not know what family members´ main concerns are in the chronic phase, what factors are associated with perceived caregiver burden, and whether family members´ health and functioning improves due to rehabilitation efforts received by the patients. This study explored family-members` functioning, predictors of caregiver burden and effect for family members of a goal-oriented intervention in the chronic phase of traumatic brain injury. Methods Family members self-reported data measuring their caregiver burden, depression, general health, loneliness, and their evaluation of patient competency in everyday life, patient awareness levels, main problem areas (target outcomes) for the patient related to the brain injury, and demographic data were collected. Regression models were used to explore predictors of caregiver burden, and mixed models analysis was used to explore treatment effects. Results In total, 73 family members were included, 39 in the intervention group and 34 in the control group. Moderate to high caregiver burden was reported by 40% of family members, and 16% experienced clinical levels of depression. Family member loneliness and their evaluation of the patient`s level of functional competency explained 57% of the variability in caregiver burden. There were no treatment-related changes in caregiver burden, family member depression or general health. At T2 there was however a significant reduction in how family members rated severity of target outcomes that the family members had nominated at baseline (-0.38, 95% CI, -0.75 to -0.02, p = 0.04), but not for the target outcomes the patients had nominated. Conclusions A significant proportion of family members to patients in the chronic phase of TBI continue to experience challenging caregiver burden and emotional symptoms. Both family member-related and patient factors contribute to caregiver burden. Interventions targeting patient complaints do not automatically alleviate family members´ burden. It is important to address social support for family members early after injury, and there is a need for more interventions specifically targeting family members´ needs.

• Kennedy, Eamonn; Vadlamani, Shashank; Lindsey, Hannah M.; Lei, Pui-Wa; Jo-Pugh, Mary & Thompson, Paul M. [Show all 143 contributors for this article] (2024). Bridging big data in the ENIGMA consortium to combine non-equivalent cognitive measures. Scientific Reports. 14(1). doi: 10.1038/s41598-024-72968-x. Full text in Research Archive Show summary

  Investigators in neuroscience have turned to Big Data to address replication and reliability issues by increasing sample size. These efforts unveil new questions about how to integrate data across distinct sources and instruments. The goal of this study was to link scores across common auditory verbal learning tasks (AVLTs). This international secondary analysis aggregated multisite raw data for AVLTs across 53 studies totaling 10,505 individuals. Using the ComBat-GAM algorithm, we isolated and removed the component of memory scores associated with site effects while preserving instrumental effects. After adjustment, a continuous item response theory model used multiple memory items of varying difficulty to estimate each individual’s latent verbal learning ability on a single scale. Equivalent raw scores across AVLTs were then found by linking individuals through the ability scale. Harmonization reduced total cross-site score variance by 37% while preserving meaningful memory effects. Age had the largest impact on scores overall (− 11.4%), while race/ethnicity variable was not significant (p > 0.05). The resulting tools were validated on dually administered tests. The conversion tool is available online so researchers and clinicians can convert memory scores across instruments. This work demonstrates that global harmonization initiatives can address reproducibility challenges across the behavioral sciences.

• Kleven, Jeanette; Sundet, Anja Schanke; Hauger, Solveig Lægreid; Løvstad, Marianne & Toreld, Eva Marie (2024). Rus- og psykiske helseplager etter alvorlig sykdom eller skade – pasienters erfaringer fra recoveryprosessen. Fontene forskning. ISSN 1890-9868. 17(1), p. 46–59. Full text in Research Archive
• Holthe, Ingvil Laberg; Rohrer-Baumgartner, Nina Marit; Svendsen, Edel Jannecke; Røe, Cecilie; Borgen, Ida Maria Henriksen & Hauger, Solveig [Show all 10 contributors for this article] (2024). SMART-goal domains and goal attainment in an individualized, goal-oriented intervention for children with acquired brain injury and their families. Neuropsychological Rehabilitation. ISSN 0960-2011. 35(6), p. 1229–1253. doi: 10.1080/09602011.2024.2402095. Full text in Research Archive Show summary

  Pediatric acquired brain injury (pABI) may lead to long-lasting challenges in need of rehabilitation-efforts years after the insult. The Child in Context Intervention (CICI) is an individualized, goal-oriented intervention targeting children with pABI, their families and schools in the chronic phase. This paper describes the goals that patients and families in the CICI intervention group identified to work on. The 29 participating families worked on 90 goals that were predominantly coded to the domains of Body functioning (46.6%) and Activities and participation (40.5%), according to the International Classification of functioning, Disability and Health (ICF). The most frequently used codes focused on fatigue and emotional symptoms, in addition to codes in the AP domain describing the need for increased independence in everyday life at school, at home, and socially. Goal attainment in the intervention group was high, with positive progress on 94.4% of the goals and positive goal achievement for all included families. The high level of goal attainment provides promising evidence of the CICI programme’s efficacy, and highlights the need to further develop evidence-based rehabilitation programs for children with pABI in the chronic stage of recovery.

• DAHL, HILDE MARGRETE; Holthe, Ingvil Laberg; Andelic, Nada; Løvstad, Marianne & Myhre, Mia Cathrine (2024). Unmet health care needs over the first 2 years after pediatric traumatic brain injury. European journal of paediatric neurology. ISSN 1090-3798. 49, p. 73–81. doi: 10.1016/j.ejpn.2024.01.002. Full text in Research Archive
• Moksnes, Håkon Øgreid; Andelic, Nada; Schäfer, Christoph; Anke, Audny Gabriele Wagner; Søberg, Helene L. & Røe, Cecilie [Show all 17 contributors for this article] (2024). Unmet rehabilitation needs in the first 6 months post-injury in a trauma centre population with moderate-to-severe traumatic injuries. Journal of Rehabilitation Medicine. ISSN 1650-1977. 56, p. 1–10. doi: 10.2340/jrm.v56.40078. Full text in Research Archive Show summary

  Objective: To describe the needs for subacute inpatient rehabilitation and community-based healthcare services, rehabilitation, and social support in patients with moderate-to-severe traumatic injury in the first 6 months post-injury. Further, to explore associations between sociodemographic and clinical characteristics and unmet needs.<p> <p>Design: Multicentre prospective cohort study. <p>Subjects: Of 601 persons (75% males), mean (standard deviation) age 47 (21) years, admitted to trauma centres in 2020 with moderate-to-severe injury, 501 patients responded at the 6-month follow-up and thus were included in the analyses. <p>Methods: Sociodemographic and injury-related characteristics were recorded at inclusion. Estimation of needs was assessed with the Rehabilitation Complexity Scale Extended–Trauma and the Needs and Provision Complexity Scale on hospital discharge. Provision of services was recorded 6 months post-injury. Multivariable logistic regressions explored associations between baseline variables and unmet inpatient rehabilitation and community-based service needs. <p>Results: In total, 20% exhibited unmet needs for subacute inpatient rehabilitation, compared with 60% for community-based services. Predictors for unmet community-based service needs included residing in less central areas, profound injury severity, severe head injury, and rehabilitation referral before returning home. <p>Conclusion: Inadequate provision of healthcare and rehabilitation services, particularly in the municipalities, resulted in substantial unmet needs in the first 6 months following injury.

• Kleffelgård, Ingerid; Borgen, Ida Maria Henriksen; Forslund, Marit Vindal; Søberg, Helene Lundgaard; Røe, Cecilie & Løvstad, Marianne [Show all 7 contributors for this article] (2024). Målorientert og individualisert rehabilitering for hjemmeboende personer i senfase etter traumatisk hodeskade. Fysioterapeuten. ISSN 0016-3384. Full text in Research Archive
• Rohrer-Baumgartner, Nina Marit; Holthe, Ingvil Laberg; Svendsen, Edel Jannecke; DAHL, HILDE MARGRETE; Borgen, Ida Maria Henriksen & Hauger, Solveig [Show all 10 contributors for this article] (2024). Children and families with chronic pediatric acquired brain injury in need of rehabilitation: characteristics and main challenges in daily life. Disability and Rehabilitation. ISSN 0963-8288. p. 1–10. doi: 10.1080/09638288.2024.2376936. Full text in Research Archive Show summary

  Purpose: to increase our understanding of child and parent characteristics, family functioning and main challenges in daily life in children and families in need of rehabilitation in the chronic phase of pediatric acquired brain injury (paBi). Methods: Fifty-eight children (aged 6–16, 48% girls) were included at least one year post aBi. Demographics and questionnaire data regarding children’s symptom burden, parents’ emotional symptoms and family functioning were collected. children and parents named their main paBi-related challenges in daily life, and these were categorized in accordance with the international classification of Functioning, Disability and health (icF). Descriptive statistical analyses were performed. Results: Parents’ emotional symptom loads were high; 22.3% had moderate, moderate-severe or severe depression symptoms while the equivalent number for anxiety symptoms was 17.9%. Problematic family functioning was reported by 32.1% of parents. When asked about their main paBi-related challenges in daily life, 69% of children named school. the most frequent icF chapters for children and parents were school education, energy and drive functions (mainly fatigue), and emotional functions. codes spanned across all icF-domains. Conclusions: Rehabilitation for paBi should have a broad, interdisciplinary, and family-centered approach, with school, fatigue, and emotional functioning of parents and children as potential core elements.

• Nilsen, Ragnhild; Johansen, Truls Sveløkken; Løvstad, Marianne & Linnestad, Anne-Margrethe (2024). Playing online videogames—more than just entertainment? A qualitative study of virtual social participation in persons with spinal cord injury. Frontiers in Rehabilitation Sciences. 5. doi: 10.3389/fresc.2024.1395678. Full text in Research Archive
• Kennedy, Eamonn; Liebel, Spencer W.; Lindsey, Hannah M.; Vadlamani, Shashank; Lei, Pui-Wa & Adamson, Maheen M. [Show all 145 contributors for this article] (2024). Verbal Learning and Memory Deficits across Neurological and Neuropsychiatric Disorders: Insights from an ENIGMA Mega Analysis. Brain Sciences. 14(7). doi: 10.3390/brainsci14070669. Full text in Research Archive Show summary

  Deficits in memory performance have been linked to a wide range of neurological and neuropsychiatric conditions. While many studies have assessed the memory impacts of individual conditions, this study considers a broader perspective by evaluating how memory recall is differentially associated with nine common neuropsychiatric conditions using data drawn from 55 international studies, aggregating 15,883 unique participants aged 15–90. The effects of dementia, mild cognitive impairment, Parkinson’s disease, traumatic brain injury, stroke, depression, attention-deficit/hyperactivity disorder (ADHD), schizophrenia, and bipolar disorder on immediate, short-, and long-delay verbal learning and memory (VLM) scores were estimated relative to matched healthy individuals. Random forest models identified age, years of education, and site as important VLM covariates. A Bayesian harmonization approach was used to isolate and remove site effects. Regression estimated the adjusted association of each clinical group with VLM scores. Memory deficits were strongly associated with dementia and schizophrenia (p < 0.001), while neither depression nor ADHD showed consistent associations with VLM scores (p > 0.05). Differences associated with clinical conditions were larger for longer delayed recall duration items. By comparing VLM across clinical conditions, this study provides a foundation for enhanced diagnostic precision and offers new insights into disease management of comorbid disorders.

• Lu, Juan; Rasmussen, Mari Storli; Sigurdardottir, Solrun; Forslund, Marit Vindal; Howe, Emilie & Fure, Silje Christine Reistad [Show all 10 contributors for this article] (2023). Community Integration and Associated Factors 10 Years after Moderate-to-Severe Traumatic Brain Injury. Journal of Clinical Medicine. 12(2), p. 1–10. doi: 10.3390/jcm12020405. Full text in Research Archive Show summary

  This study evaluated the impact of baseline injury characteristics and one-year functional level on the 10-year community integration outcomes for working-age patients with moderate-to- severe traumatic brain injury (TBI). Patients aged 16–55 and diagnosed with moderate-to-severe TBI within 24 h of injury were eligible for the study. Multivariable hierarchical linear regression was utilized to assess the impact of baseline characteristics and one-year functional measures on the mean Community Integration Questionnaire (CIQ) scores 10 years after injury. Of 133 original study participants, 97 survived 10 years, and 75 were available for this study. The mean total CIQ score changed positively from one to 10 years post-injury, from 18.7 (±5.5) to 19.8 (±4.8) (p = 0.04 ). The results suggested that age (β = −0.260, p = 0.013), FIM-Cognitive subscale (β = 0.608, p = 0.002), and the bodily pain subscale (BP) (β = 0.277, p = 0.017) of the SF-36 were significantly associated with the mean CIQ scores. In conclusion, this study demonstrated improved community integration from one to 10 years in a sample of working-age patients with moderate-to-severe TBI. The findings also showed that age, cognitive function, and bodily pain were significant predictors of long-term community integration, suggesting post-acute rehabilitation should focus on factors related to long- term risk and protective factors to improve long-term outcomes.

• Spjelkavik, Øystein; Enehaug, Heidi; Klethagen, Pål; TERJESEN, Hans Christoffer Aargaard; Howe, Emilie Isager & Fure, Silje Christine Reistad [Show all 8 contributors for this article] (2023). Workplace accommodation in return to work after mild traumatic brain injury. WORK: A Journal of Prevention, Assessment & Rehabilitation. ISSN 1051-9815. 74(3), p. 1149–1163. doi: 10.3233/WOR-211440. Full text in Research Archive Show summary

  Background: While a vast amount of research focuses on unmodifiable and individual factors that may impact return to work (RTW) for patients with traumatic brain injury (TBI), less knowledge exists of the relationship between specific workplace factors and work retention. Objective: Identify types of accommodation in the workplace that influence the RTW process for employees with TBI and the challenges associated with them. Methods: A multiple case study consisting of 38 cases and 109 interviews of employees with TBI and their managers conducted between 2017 and 2020 at two time points. Results: Accommodation of both the organizational and psychosocial work environment influences RTW for employees with TBI. Social support and supportive management may have positive and negative effects. RTW is often not a linear process. Over time, maintaining and developing customized accommodation in the work organization is challenging. Conclusions: Uncertainty about accommodation in RTW for employees with TBI is closely linked to lack of knowledge in the workplace of how to handle complex and nonlinear RTW processes. Work-oriented rehabilitation should to a greater extent provide managers with relevant information and support to develop the person-environment fit over time.

• DAHL, HILDE MARGRETE; Holthe, Ingvil Laberg; Løvstad, Marianne; Tverdal, Cathrine Buaas; Andelic, Nada & Myhre, Mia Cathrine (2023). Almost half of children and adolescents had unmet need 6 months after their traumatic brain injury. Acta Paediatrica. ISSN 0803-5253. 112. doi: 10.1111/apa.16693. Full text in Research Archive
• Madsen, Benedikte Årebrot; Fure, Silje Christine Reistad; Andelic, Nada; Løke, Daniel; Løvstad, Marianne & Røe, Cecilie [Show all 7 contributors for this article] (2023). Exploring the Association between Personality Traits, Symptom Burden, and Return to Work after Mild-to-Moderate Traumatic Brain Injury. Journal of Clinical Medicine. 12(14). doi: 10.3390/jcm12144654. Full text in Research Archive
• Svendsen, Edel Jannecke; Killi, Eli Marie; Rohrer-Baumgartner, Nina Marit; Holthe, Ingvil Laberg; Sandhaug, Maria & Borgen, Ida Maria Henriksen [Show all 10 contributors for this article] (2023). Children’s, parents’, and teachers’ experiences of the feasibility of a telerehabilitation intervention for children with acquired brain injury in the chronic phase – a qualitative study of acceptability and participation in the Child In Context Intervention (CICI). BMC Health Services Research. 23. doi: 10.1186/s12913-023-09589-z. Full text in Research Archive Show summary

  Background This is a qualitative feasibility study of the Child in Context Intervention (CICI). The CICI is an individual‐ ized, goal‐oriented and home‐based tele‐rehabilitation intervention which targets everyday functioning of children (6–16 years) with acquired brain injury in the chronic stage, and their families, one year or more after insult, who have ongoing challenges (physical, cognitive, behavioral, social and/or psychological). The aim of this study is to better understand how children, parents and teachers experienced participation and acceptability; to develop knowledge about the mechanisms of change, and to explore how the CICI was tailored to the context. Methods Six families and schools participated in the intervention, which comprised seven tele‐rehabilitation ses‐ sions in which the child and parent participated, one in‐person parent seminar and four digital school meetings. A multidisciplinary team delivered the intervention to 23 participants over a 4‐ to 5‐month period. The intervention involved psychoeducation about targeted acquired brain injury‐related problems, such as fatigue, pain, or social challenges. All but one consented to participate in the current digital interview study. The data were analyzed using content analysis. Results The experience of participation and acceptability varied among the children. Attendance was consistently high; the child participants felt mostly listened to and could influence goal setting and strategies. However, engaging and motivating the child participants proved somewhat challenging. The parents found the CICI rewarding, useful and relevant. However, they had different experiences regarding which intervention component they perceived as most helpful. Some argued in favor of the ‘whole intervention’, while others highlighted new knowledge, SMART goals or the school collaboration. The teachers found the intervention acceptable and useful but wanted a better meeting plan. They had difficulties in finding time for meetings, emphasized the involvement of school leaders, and appreci‐ ated the digital format. Conclusions Overall, the intervention was perceived as acceptable, and the participants felt that the various inter‐ vention components contributed to improvements. The CICI’s flexibility facilitated tailoring to different contexts based on the children’s functional level. The digital format saved time and provided flexibility regarding the amount of attendance but limited full participation from children with more severe cognitive impairments.

• Borgen, Ida Maria Henriksen; Løvstad, Marianne; Hauger, Solveig Lægreid; Forslund, Marit Vindal; Kleffelgård, Ingerid & Andelic, Nada [Show all 13 contributors for this article] (2023). Effect of an Individually Tailored and Home-Based Intervention in the Chronic Phase of Traumatic Brain Injury: A Randomized Clinical Trial. JAMA Network Open. 6(5), p. 1–14. doi: 10.1001/jamanetworkopen.2023.10821. Full text in Research Archive Show summary

  Importance Traumatic brain injury (TBI) can cause long-lasting and heterogeneous difficulties that require an individually tailored approach to rehabilitation. However, high-quality studies of treatment options in the chronic phase of TBI are lacking. Objective To evaluate the effect of a home-based, individualized, and goal-oriented rehabilitation intervention in the chronic phase of TBI. Design, Setting, and Participants This study was an intention-to-treat parallel-group assessor-blinded randomized clinical trial with 1:1 randomization to an intervention or control group. Participants included adults in southeastern Norway who had sustained a TBI more than 2 years earlier, lived at home, and had ongoing TBI-related difficulties. A population-based sample of 555 individuals were invited, and 120 were included. Participants were assessed at baseline, 4 months, and 12 months after inclusion. Specialized rehabilitation therapists provided the intervention in patients’ homes or via video conference and telephone. Data collection was conducted between June 5, 2018, and December 14, 2021. Interventions The intervention group received an 8-session individually tailored and goal-oriented rehabilitation program over 4 months. The control group received usual care in their municipality. Main Outcomes and Measures Preestablished primary outcomes were disease-specific health-related quality of life (HRQOL; measured by the Quality of Life After Brain Injury [QOLIBRI] overall scale) and social participation (measured by the Participation Assessment With Recombined Tools–Objective [PART-O] social subscale). Preestablished secondary outcomes included generic HRQOL (measured by the EuroQol 5-dimension 5-level [EQ-5D-5L] questionnaire), difficulty with TBI-related problem management (target outcomes; mean severity calculated across 3 main self-identified problem areas that were individually measured using a 4-point Likert scale), TBI symptoms (measured by the Rivermead Post Concussion Symptoms Questionnaire [RPQ]), psychological distress (depression and anxiety; measured by the Patient Health Questionnaire 9-item scale and the Generalized Anxiety Disorder 7-item scale [GAD-7], respectively), and functional competency (measured by the Patient Competency Rating Scale). Results Among 120 participants in the chronic phase of TBI, the median (IQR) age was 47.5 (31.0-55.8) years, and the median (IQR) time since injury was 4 (3-6) years; 85 (70.8%) were male. A total of 60 participants were randomized to the intervention group, and 60 were randomized to the control group. Between baseline and 12 months, no significant between-group effects were found for the primary outcomes of disease-specific HRQOL (QOLIBRI overall scale score: 2.82; 97.5% CI, −3.23 to 8.88; P = .30) or social participation (PART-O social subscale score: 0.12; 97.5% CI, −0.14 to 0.38; P = .29). At 12 months, the intervention group (n = 57) had significantly higher generic HRQOL (EQ-5D-5L score: 0.05; 95% CI, 0.002-0.10; P = .04) and fewer symptoms of TBI (RPQ total score: −3.54; 95% CI, −6.94 to −0.14; P = .04) and anxiety (GAD-7 score: −1.39; 95% CI, −2.60 to −0.19; P = .02) compared with the control group (n = 55). At 4 months only, the intervention group (n = 59) had significantly less difficulty managing TBI-related problems (target outcomes mean severity score: −0.46, 95% CI, −0.76 to −0.15; P = .003) compared with the control group (n = 59). No adverse events were reported. Conclusions and Relevance In this study, no significant results were observed for the primary outcomes of disease-specific HRQOL or social participation. However, the intervention group reported improvements in secondary outcomes (generic HRQOL and symptoms of TBI and anxiety) that were maintained at 12-month follow-up. These findings suggest that rehabilitation interventions could help patients even in the chronic phase of TBI. Trial Registration ClinicalTrials.gov Identifier: NCT03545594

• Rivelsrud, Maribeth; Hartelius, Lena; Speyer, Renée & Løvstad, Marianne (2023). Qualifications, professional roles and service practices of nurses, occupational therapists and speech-language pathologists in the management of adults with oropharyngeal dysphagia: a Nordic survey. Logopedics, Phoniatrics, Vocology. ISSN 1401-5439. doi: 10.1080/14015439.2023.2173288. Full text in Research Archive
• Hauger, Solveig Lægreid; Borgen, Ida Maria Henriksen; Forslund, Marit Vindal; Kleffelgård, Ingerid; Hadzic-Andelic, Nada & Løvstad, Marianne [Show all 9 contributors for this article] (2023). Participation in the Chronic Phase after Traumatic Brain Injury: Variations and Key Predictors. Journal of Clinical Medicine. 12(17). doi: 10.3390/jcm12175584. Full text in Research Archive
• Holthe, Ingvil Laberg; Rohrer-Baumgartner, Nina; Svendsen, Edel Jannecke; Hauger, Solveig Lægreid; Forslund, Marit Vindal & Borgen, Ida Maria Henriksen [Show all 13 contributors for this article] (2022). Feasibility and Acceptability of a Complex Telerehabilitation Intervention for Pediatric Acquired Brain Injury: The Child in Context Intervention (CICI). Journal of Clinical Medicine. 11(9), p. 1–23. doi: 10.3390/jcm11092564. Full text in Research Archive Show summary

  The current study is a feasibility study of a randomized controlled trial (RCT): the Child in Context Intervention (CICI). The CICI study is an individualized, goal-oriented and home-based intervention conducted mainly through videoconference. It targets children with ongoing challenges (physical, cognitive, behavioral, social and/or psychological) after acquired brain injury (ABI) and their families at least one year post injury. The CICI feasibility study included six children aged 11–16 years with verified ABI-diagnosis, their families and their schools. The aim was to evaluate the feasibility of the intervention components, child and parent perceptions of usefulness and relevance of the intervention as well as the assessment protocol through a priori defined criteria. Overall, the families and therapists rated the intervention as feasible and acceptable, including the videoconference treatment delivery. However, the burden of assessment was too high. The SMART-goal approach was rated as useful, and goal attainment was high. The parents’ ratings of acceptability of the intervention were somewhat higher than the children’s. In conclusion, the CICI protocol proved feasible and acceptable to families, schools and therapists. The assessment burden was reduced, and adjustments in primary outcomes were made for the definitive RCT.

• Borgen, Ida Maria Henriksen; Hauger, Solveig Lægreid; Forslund, Marit Vindal; Kleffelgård, Ingerid; Brunborg, Cathrine & Andelic, Nada [Show all 11 contributors for this article] (2022). Goal Attainment in an Individually Tailored and Home-Based Intervention in the Chronic Phase after Traumatic Brain Injury. Journal of Clinical Medicine. 11(4), p. 1–17. doi: 10.3390/jcm11040958. Full text in Research Archive Show summary

  Traumatic brain injury (TBI) is a heterogeneous condition with long-term consequences for individuals and families. Goal-oriented rehabilitation is often applied, but there is scarce knowledge regarding types of goals and goal attainment. This study describes goal attainment in persons in the chronic phase of TBI who have received an individualized, SMART goal-oriented and home-based intervention, compares goal attainment in different functional domains, and examines indicators of goal attainment. Goal attainment scaling (GAS) was recorded in the intervention group (n = 59) at the final session. The goal attainment was high, with 93.3% increased goal attainment across all goals at the final session. The level of goal attainment was comparable across domains (cognitive, physical/somatic, emotional, social). Gender, anxiety symptoms, self-reported executive dysfunction, and therapy expectations were indicators of goal attainment. These results indicate a potential for the high level of goal attainment in the ch

• Olsen, Alexander; Dennis, Emily L.; Stubberud, Jan Egil; Hovenden, Elizabeth S.; Solbakk, Anne-Kristin & Endestad, Tor [Show all 10 contributors for this article] (2022). Regional brain volume prior to treatment is linked to outcome after cognitive rehabilitation in traumatic brain injury. NeuroImage: Clinical. 35. doi: 10.1016/j.nicl.2022.103126. Full text in Research Archive Show summary

  Cognitive rehabilitation is useful for many after traumatic brain injury (TBI), but we lack critical knowledge about which patients benefit the most from different approaches. Advanced neuroimaging techniques have provided important insight into brain pathology and systems plasticity after TBI, and have potential to inform new practices in cognitive rehabilitation. In this study, we aimed to identify candidate structural brain measures with relevance for rehabilitation of cognitive control (executive) function after TBI. Twenty-eight patients (9 female, mean age 40.5 (SD = 13.04) years) with TBI (>21 months since injury) that participated in a randomized controlled cognitive rehabilitation trial (NCT02692352) were included in the analyses. Regional brain volume was extracted from T1-weighted MRI scans before treatment using tensor-based morphometry. Both positive and negative associations between treatment outcome (everyday cognitive control function) and regional brain volume were observed. The most robust associations between regional brain volume and improvement in function were observed in midline fronto-parietal regions, including the anterior and posterior cingulate cortices. The study provides proof of concept and valuable insight for planning future studies focusing on neuroimaging in cognitive rehabilitation after TBI.

• Sagstad, Kjersti; Howe, Emilie; Fure, Silje Christine Reistad; Løvstad, Marianne; Enehaug, Heidi & Ugelstad, Helene [Show all 9 contributors for this article] (2022). Transition back to work after mild TBI: a qualitative study. Scandinavian Journal of Occupational Therapy. ISSN 1103-8128. doi: 10.1080/11038128.2022.2120067. Full text in Research Archive Show summary

  Background While many persons who sustain a mild traumatic brain injury (MTBI) can resume work shortly after their injury, some experience persisting symptoms leading to longer-term sickness absence. In-depth knowledge about how these persons experience the return to work (RTW) process is needed. Aims To explore how persons with MTBI experience the process of returning to ordinary competitive work after a prolonged period of sickness absence. Material and methods Semi-structured interviews were conducted with six persons (four women) approximately 12 months after sustaining an MTBI. Data were analysed using a stepwise-deductive inductive method. Results When starting work the participants experienced a crisis. They described the importance of making the actual decision to RTW. Being present at the workplace was significant. In the process of increased workload, they expressed having challenges related to time perception and capacity restrictions. The importance of being seen and valued was emphasised. When reintegrated into the workplace revaluing work tasks and priorities shaped the RTW process as well as a further professional career. Conclusions and significance The process of RTW contained the experience of unpredictability and incompatibility with own identity and performance. Working had an impact on social participation, self-worth, daily structure, as well as reconstructing occupational biography.

• Fure, Silje Christine Reistad; Howe, Emilie; Andelic, Nada; Brunborg, Cathrine; Olsen, Alexander & Rike, Per-Ola [Show all 10 contributors for this article] (2022). Workplace Factors Associated With Return to Work After Mild-to-Moderate Traumatic Brain Injury. The journal of head trauma rehabilitation. ISSN 0885-9701. 38(1), p. 1–9. doi: 10.1097/HTR.0000000000000772. Full text in Research Archive Show summary

  Abstract Objective: Sociodemographic and injury-related predictors for return to work (RTW) after mild-to-moderate traumatic brain injury (TBI) have been extensively explored. However, there is a knowledge gap regarding work-related predictors of RTW. The main aim of this study was to explore work-related predictors of work participation 6 and 12 months after mild-to-moderate TBI. Setting: Data were collected at baseline 8 to 12 weeks after injury, and 3, 6, and 12 months after baseline, at a specialized TBI rehabilitation outpatient clinic at Oslo University Hospital, Oslo, Norway. Participants: Eligible patients had suffered a mild-to-moderate TBI 8 to 12 weeks previously, were employed 50% or more at time of injury, were between 18 and 60 years of age, and sick listed 50% or more at time of inclusion due to symptoms of TBI (based on the Rivermead Post-Concussion Symptoms Questionnaire). In total, 116 patients were included in a randomized controlled trial, of whom 113 were included in the 1-year analysis. Design: Patients were originally included in a randomized controlled trial. There were no between-group differences in RTW after 1 year. Thus, the participants were evaluated as one cohort in this study. Main measures: The primary outcome measure was work participation 1 year after study inclusion. Work-related predictors were chosen on the basis of previous research and expert opinion and entered into a multivariable linear regression model. The model controlled for sociodemographic and injury-related factors. Results: The best-fitting model explained 25% of variation in work participation at 1 year. Significant predictors were predictability, quantitative demands and rewards (recognition) at the workplace, private or public employment, symptom burden at baseline, and sex. Conclusion: In this study, several work-related predictors outperformed some of the established sociodemographic and injury-related predictors of RTW after TBI, thus stressing the need for further focus and research on amendable predictors of RTW after mild-to-moderate TBI.

• Maurer-Karattup, Petra; Zasler, Nathan; Thibaut, Aurore; Poulsen, Ingrid; Lejeune, Nicolas & Formisano, Rita [Show all 9 contributors for this article] (2022). Neurorehabilitation for people with disorders of consciousness: an international survey of health-care structures and access to treatment, (Part 1). Brain Injury. ISSN 0269-9052. 36(7), p. 850–859. doi: 10.1080/02699052.2022.2059813. Full text in Research Archive
• Enehaug, Heidi; Spjelkavik, Øystein; Alves, Daniele Evelin; Fure, Silje Christine Reistad; Howe, Emilie & Andelic, Nada [Show all 7 contributors for this article] (2022). Workplace Barriers to Return-to-Work Processes. Nordic Journal of Working Life Studies. 13(2), p. 39–62. doi: 10.18291/njwls.134895. Full text in Research Archive Show summary

  This study identified workplace barriers to return-to-work (RTW) processes through a multiple case study consisting of 38 cases. Sixty-four interviews with employees with mild traumatic brain injury (TBI) and 45 interviews with their managers were conducted in 2017–2020 at T1 (1–3 months after the employees returned to work) and T2 (12–16 months after T1). Workplace barriers were associated with the organizational and psychosocial work environments, TBI knowledge, and char- acteristics of the employee. The role of management was a key aspect across all barriers. Workplace barriers often co-occurred and became increasingly important at T2. At T2, most employees increased their workload, but some still experienced unsupportive management, workplace conflicts, and a low degree of job control. The psychosocial work environment is a main area for workplace barriers. The managers’ knowledge of RTW processes and TBI-related challenges potentially reduce barriers and thereby contribute to balance the needs of the organization and the individual.

• Løke, Daniel; Andelic, Nada; Helseth, Eirik; Vassend, Olav Mandt; Andersson, Stein & Ponsford, Jennie [Show all 9 contributors for this article] (2022). Stability and Change in Biopsychosocial Factors Associated With Fatigue 6 and 12 Months After Traumatic Brain Injury: An Exploratory Multilevel Study. The journal of head trauma rehabilitation. ISSN 0885-9701. 38(4). doi: 10.1097/HTR.0000000000000847. Full text in Research Archive
• Howe, Emilie; Zeldovich, Marina; Andelic, Nada; Steinbuechel, Nicole von; Fure, Silje Christine Reistad & Borgen, Ida Maria Henriksen [Show all 51 contributors for this article] (2022). Rehabilitation and outcomes after complicated vs uncomplicated mild TBI: results from the CENTER-TBI study. BMC Health Services Research. 22(1), p. 1–16. doi: 10.1186/s12913-022-08908-0. Full text in Research Archive Show summary

  Background Despite existing guidelines for managing mild traumatic brain injury (mTBI), evidence-based treatments are still scarce and large-scale studies on the provision and impact of specific rehabilitation services are needed. This study aimed to describe the provision of rehabilitation to patients after complicated and uncomplicated mTBI and investigate factors associated with functional outcome, symptom burden, and TBI-specific health-related quality of life (HRQOL) up to six months after injury. Methods Patients (n = 1379) with mTBI from the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study who reported whether they received rehabilitation services during the first six months post-injury and who participated in outcome assessments were included. Functional outcome was measured with the Glasgow Outcome Scale – Extended (GOSE), symptom burden with the Rivermead Post Concussion Symptoms Questionnaire (RPQ), and HRQOL with the Quality of Life after Brain Injury – Overall

• Rivelsrud, Maribeth Caya; Hartelius, Lena; Bergström, Liza; Løvstad, Marianne & Speyer, Renée (2022). Prevalence of Oropharyngeal Dysphagia in Adults in Different Healthcare Settings: A Systematic Review and Meta-analyses. Dysphagia (New York. Print). ISSN 0179-051X. doi: 10.1007/s00455-022-10465-x. Full text in Research Archive
• Holthe, Ingvil Laberg; DAHL, HILDE MARGRETE; Rohrer-Baumgartner, Nina; Eichler, Sandra; Elseth, Marthe & Holthe, Øyvor [Show all 10 contributors for this article] (2022). Neuropsychological Impairment, Brain Injury Symptoms, and Health-Related Quality of Life After Pediatric TBI in Oslo. Frontiers in Neurology. 12. doi: 10.3389/fneur.2021.719915. Full text in Research Archive Show summary

  Descriptions of clinical outcomes in pediatric traumatic brain injury (pTBI) in Scandinavia are sparse. The Oslo site of the European CENTER-TBI study has performed a pTBI outcome study in a hospitalized population. The main objective was to investigate neuropsychological outcomes, self- and parent-reported symptoms associated with brain injury, and quality of life in children aged 1–15 years, 5–8 months after injury. Fifty-two children were included, and 45 completed the assessments. The sample consisted of 15.4% severe, 21.2% moderate, and 63.4% mild TBI. Subjectively experienced problems with concentration and fatigue were reported by the parents of nearly half of the children. Higher brain injury symptom load was associated with lower quality of life, but was unrelated to injury severity. Group average scores of the sample on neuropsychological testing appeared unimpaired relative to normative means aside from lower performance in working memory. However, based on an impairment index (i.e., 2 or more tests being >1.5 SD below the normative mean), the presence of weak cognitive performance was evident in as many as 45.4% of the sample. Two-thirds of the sample also showed abnormally large intraindividual variability in cognitive functioning (i.e., significant WISC-IV index discrepancies). The findings highlight the need to look beyond group averages on neuropsychological testing. Utilizing an impairment index and considering intraindividual performance variability conveyed deficits that may warrant clinical follow-up. The association of brain injury symptoms with quality of life but not injury severity emphasizes the need to consider symptoms after TBI within a biopsychosocial framework.

• Eriksen, Håvard; Linnestad, Anne-Margrethe; Holthe, Ingvil Laberg; Rohrer-Baumgartner, Nina; Løvstad, Marianne & Tuntland, Hanne (2022). Oversettelse av spørreskjemaet «The Family Needs Questionnaire - Pediatric» til norsk. Ergoterapeuten. ISSN 0800-3475. 65(6), p. 76–84. Full text in Research Archive
• Hauger, Solveig Lægreid; Borgen, Ida Maria Henriksen; Løvstad, Marianne; Lu, Juan; Forslund, Marit Vindal & Kleffelgård, Ingerid [Show all 8 contributors for this article] (2022). Community-Based Interventions after Acquired Brain Injury - A Systematic Review of Intervention Types and Their Effectiveness. The journal of head trauma rehabilitation. ISSN 0885-9701. 37(5), p. E355–E369. doi: 10.1097/HTR.0000000000000765. Full text in Research Archive Show summary

  Objectives: Comprehensive review of existing types and effectiveness of community-based interventions delivered to adults (mean age 18-65 years) with long-lasting (≥6 months) difficulties following acquired brain injury (ABI). Design: Systematic review of controlled intervention studies published until February 2021. Main Measures: Systematic searches in databases (MEDLINE, PsycINFO, Database of Abstracts of Reviews of Effects [Cochrane Library], and Cochrane Central Register of Controlled Trials [Cochrane Library]) and inclusion of English peer-reviewed full-text articles; randomized or controlled community-based intervention studies; sample size of 20 or more participants; and 3 or more intervention sessions. Two reviewers independently extracted data for the synthesis and assessed the methodological quality. Data extraction included study characteristics, demographics of participants, content and dose of intervention, outcome measures, and findings. Result: The search returned 7386 publications, of which 49 eligible studies were included, revealing a diverse range of community-based interventions and a myriad of outcome measures applied for assessing functional capacities, participation, and quality of life in the chronic phase of ABI. Intervention types encompassed 14 holistic, 23 physical, and 12 specific interventions. A large heterogeneity regarding intervention frequency and intensity was found. Meta-analyses performed on the holistic, physical, and specific interventions did not indicate any significant pooled effects but showed highly variable effects between individuals, both in persons with traumatic and nontraumatic brain injuries. Conclusions: Because of lack of pooled effects within types of community-based interventions, specific evidence-based recommendations within holistic, physical, and specific interventions designed to mitigate long-lasting ABI problems cannot be made. This review highlights the need for future studies to address methodological issues concerning larger sample size, lack of clear description interventions and comparator, missing reports of effects in change scores, need for consistent use of recommended outcome measures, and investigating the wide variety in intervention responsiveness among participants with ABI. Systematic review registration: PROSPERO (CRD42019124949).

• Løke, Daniel; Løvstad, Marianne; Andelic, Nada; Andersson, Stein; Ystrøm, Eivind & Vassend, Olav Mandt (2022). The role of pain and psychological distress in fatigue: a co-twin and within-person analysis of confounding and causal relations. Health Psychology and Behavioral Medicine. 10(1), p. 160–179. doi: 10.1080/21642850.2022.2033121. Full text in Research Archive Show summary

  Objective: Fatigue is a common symptom in somatic and mental illness. Musculoskeletal pain and psychological distress have in turn frequently been shown to be associated with fatigue across clinical conditions and in the general population. The study aims to disentangle direct effects from those due to mere confounding from shared etiologies. Design: The study used genetically informative longitudinal twin data, through a co-twin control design with an additional within-person dimension. Methods: Data on fatigue, pain and distress from 2196 mono – and dizygotic twins from the Norwegian Twin Registry examined at two time points five years apart was analyzed using multilevel generalized linear regression modeling. Fatigue was regressed on pain and distress, with further controls added for confounding from genetic and stable non-shared environmental sources. Results: Pain and distress had a significant impact on fatigue at genetic, stable non-shared environmental and time-varying levels, even when controlling for somatic comorbidity. Conclusion: The findings indicate that a significant proportion of the association between fatigue, pain and distress is due to genetic and environmental confounding. Pain and distress exert significant, albeit smaller effects on fatigue even when controlling for genetic and stable environmental contributions, indicating direct effects. Potential etiological pathways and underlying mechanisms are discussed.

• Linnestad, Anne-Margrethe; Løvstad, Marianne; Groven, Karen Synne; Howe, Emilie; Fure, Silje Christine Reistad & Spjelkavik, Øystein [Show all 7 contributors for this article] (2022). "Manoeuvring in uncharted waters - a balancing act": A qualitative exploration of treatment and improvement after mild traumatic brain injury. Neuropsychological Rehabilitation. ISSN 0960-2011. p. 1–21. doi: 10.1080/09602011.2022.2034651. Full text in Research Archive
• Howe, Emilie; Andelic, Nada; Fure, Silje Christine Reistad; Røe, Cecilie; Søberg, Helene L. & Hellstrøm, Torgeir [Show all 12 contributors for this article] (2022). Cost-effectiveness analysis of combined cognitive and vocational rehabilitation in patients with mild-to-moderate TBI: results from a randomized controlled trial. BMC Health Services Research. 22(22). doi: 10.1186/s12913-022-07585-3. Full text in Research Archive Show summary

  Background: Traumatic brain injury (TBI) represents a fnancial burden to the healthcare system, patients, their families and society. Rehabilitation interventions with the potential for reducing costs associated with TBI are demanded. This study evaluated the cost-effectiveness of a randomized, controlled, parallel group trial that compared the effectiveness of a combined cognitive and vocational intervention to treatment as usual (TAU) on vocational outcomes. Methods: One-hundred sixteen participants with mild-to-moderate TBI were recruited from an outpatient clinic at Oslo University Hospital, Norway. They were randomized to a cognitive rehabilitation intervention (Compensatory Cognitive Training, CCT) and Supported Employment (SE) or TAU in a 1:1 ratio. Costs of CCT-SE and TAU, healthcare services, informal care and productivity loss were assessed 3, 6 and 12 months after study inclusion. Cost-effectiveness was evaluated from the difference in number of days until return to pre-injury work levels between CCT-SE and TAU and quality-adjusted life years (QALYs) derived from the EQ-5D-5L across 12 months follow-up. Cost-utility was expressed in incremental cost-effectiveness ratio (ICER). Results: The mean total costs of healthcare services was € 3,281 in the CCT-SE group and € 2,300 in TAU, informal care was € 2,761 in CCT-SE and € 3,591 in TAU, and productivity loss was € 30,738 in CCT-SE and € 33,401 in TAU. Costs related to productivity loss accounted for 84% of the total costs. From a healthcare perspective, the ICER was € 56 per day earlier back to work in the CCT-SE group. Given a threshold of € 27,500 per QALY gained, adjusting for baseline difference in EQ-5D-5L index values revealed a net monetary beneft (NMB) of € -561 (0.009*27,500–979) from the healthcare perspective, indicating higher incremental costs for the CCT-SE group. From the societal perspective, the NMB was € 1,566 (0.009*27,500-(-1,319)), indicating that the CCT-SE intervention was a cost-effective alternative to TAU. Conclusions: Costs associated with productivity loss accounted for the majority of costs in both groups and were lower in the CCT-SE group. The CCT-SE intervention was a cost-effective alternative to TAU when considering the societal perspective, but not from a healthcare perspective.

• Løke, Daniel; Andelic, Nada; Helseth, Eirik; Vassend, Olav Mandt; Andersson, Stein & Ponsford, Jennie L. [Show all 9 contributors for this article] (2022). Impact of Somatic Vulnerability, Psychosocial Robustness and Injury-Related Factors on Fatigue following Traumatic Brain Injury—A Cross-Sectional Study. Journal of Clinical Medicine. 11(6), p. 1–19. doi: 10.3390/jcm11061733. Full text in Research Archive Show summary

  Fatigue is a common symptom after traumatic brain injuries (TBI) and a crucial target of rehabilitation. The subjective and multifactorial nature of fatigue necessitates a biopsychosocial approach in understanding the mechanisms involved in its development. The aim of this study is to provide a comprehensive exploration of factors relevant to identification and rehabilitation of fatigue following TBI. Ninety-six patients with TBI and confirmed intracranial injuries were assessed on average 200 days post-injury with regard to injury-related factors, several patient-reported outcome measures (PROMS) of fatigue, neuropsychological measures, and PROMS of implicated biopsychosocial mechanisms. Factor analytic approaches yielded three underlying factors, termed Psychosocial Robustness, Somatic Vulnerability and Injury Severity. All three dimensions were significantly associated with fatigue in multiple regression analyses and explained 44.2% of variance in fatigue. Post hoc analyses examined univariate contributions of the associations between the factors and fatigue to illuminate the relative contributions of each biopsychosocial variable. Implications for clinical practice and future research are discussed.

• DAHL, HILDE MARGRETE; Andelic, Nada; Løvstad, Marianne; Holthe, Ingvil Laberg; Hestnes, Morten & Diseth, Trond H [Show all 7 contributors for this article] (2021). Epidemiology of traumatic brain injury in children 15 years and younger in South-Eastern Norway in 2015–16. Implications for prevention and follow-up needs. European journal of paediatric neurology. ISSN 1090-3798. 31, p. 70–77. doi: 10.1016/j.ejpn.2021.02.002. Full text in Research Archive Show summary

  Objective This retrospective study aimed to describe the volume, severity, and injury mechanism of all hospital-admitted pediatric traumatic brain injury (pTBI) at Oslo University Hospital (OUH), emphasizing consequences for prevention and factors indicating a need for follow-up programs. Method Data were extracted from the OUH Trauma registry on 176 children, 0–15 years old, admitted to OUH in 2015 and 2016 with a pTBI diagnosis. The dataset contains demographic data, injury mechanism, type, and severity (Glasgow coma scale, GCS; abbreviated injury scale, AIS; injury severity score, ISS), ICD-10 diagnosis codes, level of treatment, and destination of discharge. Results 79.5% had mild, 9% moderate, and 11.4% severe TBI. The incidence of hospital-treated pTBI in Oslo was 29 per 100,000 per year. The boy: girl ratio was 1.9:1, but in the young teenage group (14–15 years), the ratio was 1:1. Intracranial injury (ICI) identified on CT/MRI was associated with extended hospital stays, with a median of 6 days compared to 1 day for patients without ICI. 27% of the patients assessed as mild TBI at admission had ICI. Children below eight years of age had a higher incidence of moderate and severe ICI from trauma (53% v.s. 28% in children ≥ eight years). Conclusion The injury characteristics of hospital-treated pTBI are in line with other European countries, but we find the boy-girl ratio different as young teenage girls seem to be catching up with the boys. ICI and length of stay should be considered when deciding which patients need follow-up and rehabilitation.

• Borgen, Ida Maria Henriksen; Kleffelgård, Ingerid; Hauger, Solveig Lægreid; Forslund, Marit Vindal; Søberg, Helene L. & Andelic, Nada [Show all 10 contributors for this article] (2021). Patient-Reported Problem Areas in Chronic Traumatic Brain Injury. The journal of head trauma rehabilitation. ISSN 0885-9701. 37(5). doi: 10.1097/HTR.0000000000000744. Full text in Research Archive Show summary

  Objective: The aims of this study were to (1) assess self-reported main problem areas reported by patients with traumatic brain injury (TBI) and their family members in the chronic phase, and (2) compare the self-prioritized problems with difficulties captured by questionnaires and neuropsychological screening through linking to the International Classification of Functioning, Disability and Health (ICF). Setting: Outpatient clinic at the Oslo University Hospital, Norway. Participants: In total, 120 patients with TBI were recruited, of whom, 78 had a participating family member. Eligibility criteria were a clinical TBI diagnosis with verified intracranial injury, living at home, aged 18 to 72 years, 2 years or more postinjury, and experiencing perceived TBI-related difficulties, reduced physical and mental health, or difficulties with participation in everyday life. Patients with severe psychiatric or neurological disorders or inability to participate in goal-setting processes were excluded. Design: Cross-sectional. Main Measures: Target Outcomes, that is, 3 main TBI-related problem areas reported by patients and family members, collected in a semistructured interview; standardized questionnaires of TBI-related symptoms, anxiety, depression, functioning, and health-related quality of life; neuropsychological screening battery. Results: Target Outcomes were related to cognitive, physical, emotional, and social difficulties. Target Outcomes were linked to 12 chapters and 112 distinct categories in the ICF, while standardized measures only covered 10 chapters and 28 categories. Some aspects of post-TBI adjustment were found to be insufficiently covered by the ICF classification, such as identity issues, lack of meaningful activities, and feeling lonely. Conclusion: The Target Outcomes approach is a useful assessment method in a population with chronic TBI. The standardized questionnaires capture the spectrum of problems, whereas the Target Outcomes approach captures the prioritized individual problems hindering everyday life after TBI. While the standardized measures are an irreplaceable part of the assessment, Target Outcomes ensures patient involvement and may help clinicians better tailor relevant rehabilitation efforts. Key words: chronic TBI, community-based rehabilitation, outcome measurement, Target Outcomes, traumatic brain injury

• Søberg, Helene Lundgaard; Moksnes, Håkon Øgreid; Anke, Audny; Røise, Olav; Røe, Ellen-Cecilie Treu & Aas, Eline [Show all 20 contributors for this article] (2021). Rehabilitation Needs, Service Provision, and Costs in the First Year Following Traumatic Injuries: Protocol for a Prospective Cohort Study. JMIR Research Protocols. 10(4), p. 1–10. doi: 10.2196/25980. Full text in Research Archive Show summary

  Background: Traumatic injuries, defined as physical injuries with sudden onset, are a major public health problem worldwide. There is a paucity of knowledge regarding rehabilitation needs and service provision for patients with moderate and major trauma, even if rehabilitation research on a spectrum of specific injuries is available.<p> <p>Objective: This study aims to describe the prevalence of rehabilitation needs, the provided services, and functional outcomes across all age groups, levels of injury severity, and geographical regions in the first year after trauma. Direct and indirect costs of rehabilitation provision will also be assessed. The overarching aim is to better understand where to target future efforts.<p> <p>Methods: This is a population-based prospective follow-up study. It encompasses patients of all ages with moderate and severe acute traumatic injury (New Injury Severity Score >9) admitted to the regional trauma centers in southeastern and northern Norway over a 1-year period (2020). Sociodemographic and injury data will be collected. Upon hospital discharge, rehabilitation physicians estimate rehabilitation needs. Rehabilitation needs are assessed by the Rehabilitation Complexity Scale Extended–Trauma (RCS E–Trauma; specialized inpatient rehabilitation), Needs and Provision Complexity Scale (NPCS; community-based rehabilitation and health care service delivery), and Family Needs Questionnaire–Pediatric Version (FNQ-P). Patients, family caregivers, or both will complete questionnaires at 6- and 12-month follow-ups, which are supplemented by telephone interviews. Data on functioning and disability, mental health, health-related quality of life measured by the EuroQol Questionnaire (EQ-5D), and needs and provision of rehabilitation and health care services are collected by validated outcome measures. Unmet needs are represented by the discrepancies between the estimates of the RCS E–Trauma and NPCS at the time of a patient’s discharge and the rehabilitation services the patient has actually received. Formal service provision (including admission to inpatient- or outpatient-based rehabilitation), informal care, and associated costs will be collected.<p> <p>Results: The project was funded in December 2018 and approved by the Regional Committee for Medical and Health Research Ethics in October 2019. Inclusion of patients began at Oslo University Hospital on January 1, 2020, and at the University Hospital of North Norway on February 1, 2020. As of February 2021, we have enrolled 612 patients, and for 286 patients the 6-month follow-up has been completed. Papers will be drafted for publication throughout 2021 and 2022.<p> <p>Conclusions: This study will improve our understanding of existing service provision, the gaps between needs and services, and the associated costs for treating patients with moderate and major trauma. This may guide the improvement of rehabilitation and health care resource planning and allocation.

• Fure, Silje Christine Reistad; Howe, Emilie; Andelic, Nada; Brunborg, Cathrine; Sveen, Unni & Røe, Cecilie [Show all 15 contributors for this article] (2021). Cognitive and vocational rehabilitation after mild-to-moderate traumatic brain injury: A randomised controlled trial. Annals of Physical and Rehabilitation Medicine. ISSN 1877-0657. 64(5). doi: 10.1016/j.rehab.2021.101538. Full text in Research Archive Show summary

  Background Returning to work is often a primary rehabilitation goal after traumatic brain injury (TBI). However, the evidence base for treatment options regarding return to work (RTW) and stable work maintenance remains scarce. Objective This study aimed to examine the effect of a combined cognitive and vocational intervention on work-related outcomes after mild-to-moderate TBI. Methods In this study, we compared 6 months of a combined compensatory cognitive training and supported employment (CCT-SE) intervention with 6 months of treatment as usual (TAU) in a randomised controlled trial to examine the effect on time to RTW, work percentage, hours worked per week and work stability. Eligible patients were those with mild-to-moderate TBI who were employed ≥ 50% at the time of injury, 18 to 60 years old and sick-listed ≥ 50% at 8 to 12 weeks after injury due to post-concussion symptoms, assessed by the Rivermead Post Concussion Symptoms Questionnaire. Both treatments were provided at the outpatient TBI department at Oslo University Hospital, and follow-ups were conducted at 3, 6 and 12 months after inclusion. Results We included 116 individuals, 60 randomised to CCT-SE and 56 to TAU. The groups did not differ in characteristics at the 12-month follow-up. Overall, a high proportion had returned to work at 12 months (CCT-SE, 90%; TAU, 84%, P = 0.40), and all except 3 were stably employed after the RTW. However, a significantly higher proportion of participants in the CCT-SE than TAU group had returned to stable employment at 3 months (81% vs. 60%, P = 0.02). Conclusion These results suggest that the CCT-SE intervention might help patients with mild-to-moderate TBI who are still sick-listed 8 to 12 weeks after injury in an earlier return to stable employment. However, the results should be replicated and a cost-benefit analysis performed before concluding.

• Fure, Silje Christine Reistad; Howe, Emilie; Spjelkavik, Øystein; Røe, Cecilie; Rike, Per-Ola & Olsen, Alexander [Show all 9 contributors for this article] (2021). Post-concussion symptoms three months after mild-to-moderate TBI: characteristics of sick-listed patients referred to specialized treatment and consequences of intracranial injury. Brain Injury. ISSN 0269-9052. 35(9). doi: 10.1080/02699052.2021.1953593. Full text in Research Archive Show summary

  Objective: To present pre-injury, injury-related, work-related and post-injury characteristics, and to compare patients with and without traumatic intracranial abnormalities, in a treatment-seeking sample with persistent post-concussion symptoms (PPCS) after mild-to-moderate TBI. Methods: Cross-sectional design in the context of a specialized TBI outpatient clinic. Eligible patients were aged 18–60 years, employed ≥ 50% at time of injury, and sick listed ≥ 50% at inclusion due to PPCS. Data were collected 8–12 weeks after injury through review of medical records, semi-structured interviews, questionnaires, and neuropsychological screening. Results: The study included 116 patients, of whom 60% were women, and predominantly white-collar workers in full-time positions. Ninety-four percent had a mild TBI, and 23% had intracranial abnormalities. The full sample reported high somatic, emotional, and cognitive symptom burden, and decreased healthrelated quality of life. Patients with normal CT/MRI results reported higher overall symptom burden, while patients with intracranial abnormalities had worse memory function. Conclusion: Injury severity and traumatic intracranial radiological findings should not be the sole ground for planning of rehabilitation service provision in patients with PPCS, as subjective complaints do not necessarily co-vary with these variables.

• Andelic, Nada; Røe, Cecilie; Brunborg, Cathrine; Zeldovich, Marina; Løvstad, Marianne & Løke, Daniel [Show all 49 contributors for this article] (2020). Frequency of fatigue and its changes in the first 6 months after traumatic brain injury: results from the CENTER-TBI study. Journal of Neurology. ISSN 0340-5354. 268. doi: 10.1007/s00415-020-10022-2. Full text in Research Archive Show summary

  Background: Fatigue is one of the most commonly reported subjective symptoms following traumatic brain injury (TBI). The aims were to assess frequency of fatigue over the first 6 months after TBI, and examine whether fatigue changes could be predicted by demographic characteristics, injury severity and comorbidities. Methods: Patients with acute TBI admitted to 65 trauma centers were enrolled in the study Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI). Subjective fatigue was measured by single item on the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), administered at baseline, three and 6 months postinjury. Patients were categorized by clinical care pathway: admitted to an emergency room (ER), a ward (ADM) or an intensive care unit (ICU). Injury severity, preinjury somatic- and psychiatric conditions, depressive and sleep problems were registered at baseline. For prediction of fatigue changes, descriptive statistics and mixed effect logistic regression analysis are reported. Results: Fatigue was experienced by 47% of patients at baseline, 48% at 3 months and 46% at 6 months. Patients admitted to ICU had a higher probability of experiencing fatigue than those in ER and ADM strata. Females and individuals with lower age, higher education, more severe intracranial injury, preinjury somatic and psychiatric conditions, sleep disturbance and feeling depressed postinjury had a higher probability of fatigue. Conclusion: A high and stable frequency of fatigue was found during the first 6 months after TBI. Specific socio-demographic factors, comorbidities and injury severity characteristics were predictors of fatigue in this study.

• Borgen, Ida Maria Henriksen; Løvstad, Marianne; Røe, Cecilie; Forslund, Marit Vindal; Hauger, Solveig & Sigurdardottir, Solrun [Show all 8 contributors for this article] (2020). Needs and treatment options in chronic traumatic brain injury: A feasibility trial of a community-based intervention. Cogent Medicine. 7(1). doi: 10.1080/2331205X.2020.1731222. Full text in Research Archive
• Alves, Daniele Evelin; Nilsen, Wendy; Fure, Silje Christine Reistad; Enehaug, Heidi; Howe, Emilie Isager & Løvstad, Marianne [Show all 9 contributors for this article] (2020). What characterizes work and workplaces that retain their employees following acquired brain injury? Systematic review. Annals of Occupational and Environmental Medicine (AOEM). 77, p. 122–130. doi: 10.1136/oemed-2019-106102. Full text in Research Archive Show summary

  Objectives: The objective of this study was to conduct a systematic review assessing workplace factors related to work retention (or return to work) in employees with acquired brain injury (ABI). Additionally, we aimed to synthesise the evidence and state of knowledge on this subject. Methods: A database search was performed in nine relevant electronic databases. Inclusion criteria were quantitative peer-reviewed publications empirically investigating the relationship between work/workplace factors and work retention in employees following ABI. The methodological quality was determined by Effective Public Health Practice Project scoring, and evidence was synthesised narratively. Results: Thirteen studies were included. We found moderate evidence for a negative relationship between manual work and work retention. We also found limited evidence for a U-shaped relationship between workload and complete work retention at 6 months and no relationship at 12 months; a positive relationship between managers, compared with non-managers, and faster work retention; a positive relationship between large enterprise size defined as ≥250 employees, and no relationship between large enterprise size, defined as ≥1000 employees, and work retention. Conclusion: Relative to individual factors, there is little evidence on specific workplace factors’ relationship to work retention among employees with ABI. For most workplace factors, there were too few high-quality studies to designate evidence as more than limited or insufficient. Future studies should replicate rigorous studies of well-defined modifiable workplace factors related to work retention.

• Howe, Emilie; Fure, Silje Christine Reistad; Løvstad, Marianne; Enehaug, Heidi; Sagstad, Kjersti & Hellstrøm, Torgeir [Show all 13 contributors for this article] (2020). Effectiveness of Combining Compensatory Cognitive Training and Vocational Intervention vs. Treatment as Usual on Return to Work Following Mild-to-Moderate Traumatic Brain Injury: Interim Analysis at 3 and 6 Month Follow-Up. Frontiers in Neurology. doi: 10.3389/fneur.2020.561400. Full text in Research Archive Show summary

  Aims: Knowledge regarding the most effective return to work (RTW) approaches after traumatic brain injury (TBI) is lacking. This trial aimed to compare the effectiveness of a combined cognitive and vocational intervention to treatment as usual (TAU) on RTW and work stability after TBI. Methods: We performed a parallel-group randomized controlled trial (RCT) at a TBI outpatient clinic at Oslo University Hospital (OUH), Norway. Patients with a history of mild-to-moderate TBI (n = 116) aged 18–60 were randomized (1:1) by an independent investigator to receive group-based compensatory cognitive training (CCT) and supported employment (SE) (n = 60) or TAU consisting of individualized multidisciplinary treatment (n = 56). Participants were enrolled 2–3 months post-injury. The nature of the intervention prevented blinding of patients and therapists, however, outcome assessors were blinded to group allocation. The primary outcome measure was RTW at 3 and 6 months following study inclusion. Secondary outcomes were work percentage, stability, and productivity. The present study provides results from an interim analysis from the first two planned follow ups, while subsequent publications will present results up to 12 months following study inclusion. Results: Mixed effects models showed no between-group differences in the RTW proportion, work percentage, and hours worked between CCT-SE and TAU from baseline to 6 months. A significantly higher proportion of participants in CCT-SE had returned to work at 3 months when adjusting for baseline differences. The majority of participants who were employed at 3 and 6 months were stably employed. There was a statistically significant within-group improvement on RTW proportion, hours worked and work percentage in both groups. Conclusion: The results revealed no difference between CCT-SE and TAU on work-related outcomes from baseline to 6 months. However, there was a higher RTW proportion in the CCT-SE group compared to TAU at 3 months. Future publications will assess the effectiveness of CCT-SE vs. TAU up to 12 months. Clinical Trial Registration: US National Institutes of Health ClinicalTrials.gov, identifier #NCT03092713.

• Geard, Anne; Kirkevold, Marit; Løvstad, Marianne & Schanke, Anne-Kristine (2020). How do family members of individuals with spinal cord and acquired brain injuries make sense of their experiences: A qualitative study of meaning making processes. Health Psychology Open (HPO). doi: 10.1177/2055102920913477. Full text in Research Archive
• Olsen, Alexander; Babikian, Talin; Bigler, Erin D.; Caeyenberghs, Karen; Conde, Virginia & Dams-O’Connor, Kristen [Show all 37 contributors for this article] (2020). Toward a global and reproducible science for brain imaging in neurotrauma: the ENIGMA adult moderate/severe traumatic brain injury working group. Brain Imaging and Behavior. ISSN 1931-7557. p. 1–29. doi: 10.1007/s11682-020-00313-7. Full text in Research Archive Show summary

  The global burden of mortality and morbidity caused by traumatic brain injury (TBI) is significant, and the heterogeneity of TBI patients and the relatively small sample sizes of most current neuroimaging studies is a major challenge for scientific advances and clinical translation. The ENIGMA (Enhancing NeuroImaging Genetics through Meta-Analysis) Adult moderate/severe TBI (AMS-TBI) working group aims to be a driving force for new discoveries in AMS-TBI by providing researchers world-wide with an effective framework and platform for large-scale cross-border collaboration and data sharing. Based on the principles of transparency, rigor, reproducibility and collaboration, we will facilitate the development and dissemination of multiscale and big data analysis pipelines for harmonized analyses in AMS-TBI using structural and functional neuroimaging in combination with non-imaging biomarkers, genetics, as well as clinical and behavioral measures. Ultimately, we will offer investigators an unprecedented opportunity to test important hypotheses about recovery and morbidity in AMS-TBI by taking advantage of our robust methods for large-scale neuroimaging data analysis. In this consensus statement we outline the working group’s short-term, intermediate, and long-term goals.

• Matre, Martin Engen; Johansen, Truls & Løvstad, Marianne (2020). Kognitiv trening med Virtual Reality. Nevropsykologi : Medlemsblad for Norsk Nevropsykologisk Forening. ISSN 1500-8347. 1, p. 4–11. Full text in Research Archive
• Stubberud, Jan; Løvstad, Marianne; Solbakk, Anne-Kristin; Schanke, Anne-Kristine & Tornås, Sveinung (2020). Emotional regulation following acquired brain injury: Associations with executive functioning in daily life and symptoms of anxiety and depression. Frontiers in Neurology. 11:1011, p. 1–7. doi: 10.3389/fneur.2020.01011. Full text in Research Archive Show summary

  Objective: To examine whether a questionnaire measuring emotional regulation after acquired brain injury adds clinical information beyond what can be obtained with a comprehensive executive function questionnaire and an anxiety and depression measure. Method: Seventy adult persons (age 19-66 years, M age = 43, SD age = 13) with acquired brain injury in the chronic phase and executive function complaints. All were recruited to participate in a randomized controlled trial (NCT02692352) evaluating the effects of cognitive rehabilitation. Traumatic brain injury was the dominant cause of injury (64%), and mean time since injury was 8 years. Emotional regulation was assessed with the Brain Injury Trust Regulation of Emotions Questionnaire (BREQ). Executive function was assessed with the Behavior Rating Inventory of Executive Function Adult Version (BRIEF-A). The Hopkins Symptom Checklist 25 (HCSL-25) was employed to measure anxiety and depression symptoms. Results: Overall, significant correlations were found between reports of emotional regulation (BREQ) and executive function in daily life (BRIEF-A). Furthermore, our analyses revealed a significant relationship between self-reported scores of emotional regulation (BREQ) and symptoms of anxiety and depression (HSCL-25). Conclusion: The significant associations between the BREQ and most of the other clinical measures indicate that, for patients with acquired brain injury, the BREQ does not add substantial information beyond what can be assessed with the BRIEF-A and the HSCL-25.

• Høye, Helene; Jahnsen, Reidun Birgitta; Løvstad, Marianne; Grøttland, Jeanette Hartveit; Sørli, Hilde & Tornås, Sveinung [Show all 7 contributors for this article] (2020). A Mindfulness-Based Stress Reduction Program via Group Video Conferencing for Adults With Cerebral Palsy ? A Pilot Study. Frontiers in Neurology. doi: 10.3389/fneur.2020.00195. Full text in Research Archive Show summary

  Purpose: Adults with cerebral palsy experience challenges related to lifelong disability, such as stress, fatigue, pain and emotional issues. E-health services can be delivered regardless of residence and level of functioning. The aim of this pilot study was to explore the potential benefits and feasibility of a mindfulness-based program delivered to adults with cerebral palsy via group video conferencing. Methods: Six adults with cerebral palsy received an 8 week mindfulness group-based program via video conferencing. A multiple single-case study design was applied, including quantitative and qualitative elements. Pain was assessed 16 times through the study period. Questionnaires were administered to gather data on pain catastrophizing, stress, fatigue, emotional distress, positive and negative affect, and quality of life. A focus group interview addressed experiences with the intervention and the mode of delivery. Results: The participants' pain levels showed varied trajectories. Pain catastrophizing and negative affect were statistically significant decreased. Qualitative data indicated benefits from mindfulness in coping and stress management. The video conferencing delivery was evaluated as feasible, with no major adverse effects. Conclusion: Since the pilot study had a small sample size, potential treatment benefits should be interpreted with caution. However, this pilot study provides important information in the planning of future larger and controlled studies on mindfulness-based interventions programs via video conferencing for adults with cerebral palsy and other persons living with long-term disability.

• Borgen, Ida Maria Henriksen; Løvstad, Marianne; Andelic, Nada; Hauger, Solveig; Sigurdardottir, Solrun & Søberg, Helene L. [Show all 12 contributors for this article] (2020). Traumatic brain injury-needs and treatment options in the chronic phase: Study protocol for a randomized controlled community-based intervention. Trials. 21(1). doi: 10.1186/s13063-020-4195-5. Full text in Research Archive Show summary

  Background Traumatic brain injury (TBI) is often associated with life-long medical, cognitive, emotional, and behavioral changes. Although long-lasting disabilities are expected, research on effective treatment options in the chronic phase of TBI is scarce. Methods/design This study protocol describes a randomized controlled trial (RCT) aimed at evaluating the effectiveness of a goal-oriented and community-based intervention for increasing community integration, quality of life, and functional independence in the chronic phase of complicated mild to severe TBI. Participants will be recruited from Oslo University Hospital, Norway. Patients aged 18–72 years living at home with MRI/CT-verified intracranial abnormalities, a TBI diagnosis, a time since injury of ≥ 2 years, and who experience either current TBI-related problems or restrictions in community integration will be included. The 120 participants will be randomized 1:1 to either (a) an intervention group, which will receive an in-home intervention program over 4 months, or (b) a control group receiving standard care in the municipalities. The intervention will consist of six home visits and two telephone contacts with a rehabilitation professional. A SMART-goal approach will be adopted to target the individual’s self-reported TBI difficulties in everyday life. Primary outcomes will be self-reported quality of life and participation. Secondary outcomes include symptom burden, emotional functioning, and clinician-assessed global outcome and need for rehabilitation services. Outcomes will be evaluated at baseline and 4–5 and 12 months after baseline. Caregiver burden and general health will be assessed in participating family members. Goal attainment and acceptability will be evaluated in the intervention group. A process evaluation will be carried out to evaluate protocol adherence, and a cost-effectiveness analysis will be applied if the intervention is found to be effective. Discussion The current study provides an innovative approach to rehabilitation in the chronic phase of TBI evaluated using an RCT design that may inform treatment planning, health policies, and coordination of patient care. Further, the study may demonstrate new modes of establishing collaboration and knowledge transition between specialized rehabilitation facilities and local rehabilitation services that may improve patient outcomes.

• Stubberud, Jan; Holthe, Ingvil Laberg; Løvstad, Marianne; Schanke, Anne-Kristine; Brandt, Anne Elisabeth & Finnanger, Torun Gangaune (2020). The feasibility and acceptability of Goal Management Training of executive functions in children with spina bifida and acquired brain injury. Neuropsychological Rehabilitation. ISSN 0960-2011. doi: 10.1080/09602011.2020.1723649. Full text in Research Archive Show summary

  Executive dysfunction causes significant real-life disability for children with spina bifida (SB) and acquired brain injury (ABI), and efficient interventions are needed. Goal Management Training (GMT) is a cognitive rehabilitation intervention for improving executive function (EF) that has received empirical support in studies of adults with SB and ABI. The purpose of this study was to determine the feasibility and acceptability of a newly developed pediatric GMT protocol (pGMT). Thirteen children (7 boys, 10–16 years) with SB (n = 4), traumatic brain injury (n = 8), and encephalitis (n = 1) were included, based upon the presence of EF problems as described by parents. The participants received 21 h of pGMT, using inpatient intervention periods, followed by 4 h of pGMT outpatient guidance over 8 weeks. Notably, pGMT was found to be both feasible and acceptable, with satisfactory compliance for the children, parents and teachers, in addition to being considered acceptable by all participants. Furthermore, a reliable change in daily life EF was reported by the parents for 2 children. And, some children obtained scores below clinical cut-off on a measure of parent reported real-life EF after intervention. Hence, findings suggest that a randomized controlled trial of pGMT, with a larger sample size, should be conducted.

• Stubberud, Jan; Edvardsen, Espen Madsen; Schanke, Anne-Kristine; Lerdal, Anners; Kjeverud, Anita & Schillinger, Andreas [Show all 7 contributors for this article] (2019). Description of a multifaceted intervention programme for fatigue after acquired brain injury: a pilot study. Neuropsychological Rehabilitation. ISSN 0960-2011. 29(6), p. 946–968. doi: 10.1080/09602011.2017.1344132. Full text in Research Archive Show summary

  ABSTRACT The purpose of this pilot study was to describe and explore a group-based multifaceted intervention for patients with fatigue after acquired brain injury (ABI). We hypothesised that post-intervention changes would result in reduced fatigue, in addition to improved emotional health, sleep and attentional control. Eight subjects with traumatic brain injury (n = 3) and cerebrovascular insults (n = 5) were included. Inclusion was based upon the presence of fatigue complaints. The participants received 36 hours of intervention. Changes related to fatigue, emotional health and sleep was assessed with self-rating measures. Additionally, a neuropsychological test (Conners’ Continuous Performance Test II) was included as a measure of attentional control. All subjects were assessed at baseline, post-intervention, and at 3 and 9 months follow-up. Findings indicated reduced fatigue levels (post-intervention and 3 months follow-up), anxiety (9 months follow-up), and daytime sleepiness (3 and 9 months follow-up). Pilot results suggest that multifaceted group-based interventions may have the potential to alleviate symptoms of fatigue, anxiety and sleepiness after ABI. At an individual level, a low load of psychological distress, insomnia symptoms, dysexecutive symptoms, in addition to a strong sense of self-efficacy, may be central in order to reduce levels of fatigue. KEYWORDS: Fatigue, cognitive rehabilitation, brain injury, goal management, self-efficacy

• Howe, Emilie; Løvstad, Marianne; Langlo, Knut-Petter; Hellstrøm, Torgeir; Spjelkavik, Øystein & Ugelstad, Helene [Show all 8 contributors for this article] (2019). Feasibility of a cognitive rehabilitation program for individuals with mild-to-moderate traumatic brain injury: Participants’ engagement and satisfaction. Cogent Medicine. p. 1–16. doi: 10.1080/2331205X.2019.1565614. Full text in Research Archive Show summary

  Purpose: To assess the feasibility of recruitment procedures and delivery of a Norwegian adaptation of a manualized cognitive intervention to a civilian sample with traumatic brain injury (TBI). Materials and methods: Six individuals received a 10-week group-based intervention (Compensatory Cognitive Training, CCT) targeting post-concussive symptom management and cognitive symptoms. Participant engagement (i.e. attendance, level of participation, ability to learn and apply strategies, and homework completion) and satisfaction were assessed by the Therapist Checklist and CCT Feedback Form. Results: All participants had a diagnosis of concussion, were enrolled on average 4 months post-injury, and were sick-listed at a range of 70–100% at the time of inclusion. Attendance across CCT sessions was 97%. Eight out of nine topics in the CCT-intervention received a rating above 3.5 on a 5-point scale (i.e. towards very helpful). The items that received the highest mean ratings were information about TBI and post-concussive symptoms, and strategies targeting fatigue, prospective memory, and memory and learning. All participants were rated as participating fully (3/6) or moderately (3/6), and most participants (5/6) attempted to apply the trained skills to real-life situations. Conclusions: The results support the feasibility of a Norwegian adaptation of the intervention for a civilian sample with TBI.

• Alves, Daniele Evelin; Nilsen, Wendy; Fure, Silje Christine Reistad; Enehaug, Heidi; Howe, Emilie & Løvstad, Marianne [Show all 9 contributors for this article] (2019). What characterises work and workplaces that retain their employees following acquired brain injury? Systematic review. Occupational and Environmental Medicine. ISSN 1351-0711. 77(2), p. 122–130. doi: 10.1136/oemed-2019-106102. Full text in Research Archive Show summary

  The objective of this study was to conduct a systematic review assessing workplace factors related to work retention (or return to work) in employees with acquired brain injury (ABI). Additionally, we aimed to synthesise the evidence and state of knowledge on this subject. A database search was performed in nine relevant electronic databases. Inclusion criteria were quantitative peer-reviewed publications empirically investigating the relationship between work/workplace factors and work retention in employees following ABI. The methodological quality was determined by Effective Public Health Practice Project scoring, and evidence was synthesised narratively. Thirteen studies were included. We found moderate evidence for a negative relationship between manual work and work retention. We also found limited evidence for a U-shaped relationship between workload and complete work retention at 6 months and no relationship at 12 months; a positive relationship between managers, compared with non-managers, and faster work retention; a positive relationship between large enterprise size defined as ≥250 employees, and no relationship between large enterprise size, defined as ≥1000 employees, and work retention. Relative to individual factors, there is little evidence on specific workplace factors’ relationship to work retention among employees with ABI. For most workplace factors, there were too few high-quality studies to designate evidence as more than limited or insufficient. Future studies should replicate rigorous studies of well-defined modifiable workplace factors related to work retention.

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• Oppici, Luca; Opheim, Arve Isak; Sunnerhagen, Kathrina Stibrant; Rafsten, Lena; Bērziņa, Guna & Kārkliņa, Agnese [Show all 13 contributors for this article] (2026). Enriching the home environment to improve rehabilitation after stroke: Introducing the PEER-HOMEcare project. Full text in Research Archive
• Rohrer-Baumgartner, Nina; Holthe, Ingvil Laberg; Svendsen, Edel Jannecke & Løvstad, Marianne (2025). The Child in Context Intervention (CICI studien): individualisert og målrettet rehabilitering etter ervervet hjerneskade hos barn. Full text in Research Archive
• Forslund, Marit Vindal; Borgen, Ida Maria Henriksen; Karic, Tanja; Kleffelgård, Ingerid; Hauger, Solveig Lægreid & Løvstad, Marianne [Show all 11 contributors for this article] (2024). Validity of the Norwegian Version of the Needs and Provision Complexity Scale (NPCS) in Patients with Traumatic Brain Injury and Atraumatic Subarachnoid Hemorrhage. Journal of Clinical Medicine. 13(3). doi: 10.3390/jcm13030752. Full text in Research Archive
• Rasmussen, Mari Storli; Andelic, Nada; Selj, Joanna Nordhagen; Danielsen, Vilde Marie; Løvstad, Marianne & Howe, Emilie Isager [Show all 30 contributors for this article] (2024). Self-management support program delivered in the sub-acute phase after traumatic injury-study protocol for a pragmatic randomized controlled trial. Trials. 25(1), p. 639–639. doi: 10.1186/s13063-024-08492-0. Full text in Research Archive Show summary

  Background Traumatic injuries, defined as physical injuries with sudden onset, are a major cause of distress and disability, with far-reaching societal consequences. A significant proportion of trauma survivors report persistent symptoms and difficulties after the injury, and studies show unmet health care needs. Self-management programs delivered in the sub-acute phase after traumatic injuries are scarcely evaluated. The aim of the present study is to evaluate the effectiveness of a self-management program (SEMPO), delivered 3–4 months after moderate-to-severe traumatic injury. Methods This study protocol describes a pragmatic randomized controlled trial (RCT) with two classical RCT arms (intervention and control) and an explorative self-selection arm. 220 patients will be recruited from Oslo University Hospital, the largest Trauma Referral Centre in Norway. Patients aged 18–72 years residing in the south-east region of Norway, admitted to the Trauma Centre directly or within 72 h after having sustained a moderate to severe traumatic injury, defined as a New Injury Severity Score > 9, having at least 2 days hospital stay, and reporting injury-related symptoms and impairment at discharge from the acute hospital will be included. Patients will be randomly assigned to either a classical RCT randomization arm (intervention or control arm) or to a self-selection arm. In the randomization arm, participants are further randomized into intervention or control group. Participants allocated to the self-selection arm will choose to partake either in the intervention or control arm. The primary outcome is the level of self-efficacy in trauma coping assessed 6 months after completion of the intervention, with a similar time point for the control group. Secondary outcomes include symptom burden, physical functioning and disability, return to work and health care utilization, health-related quality of life, and communication competency. In addition, patients will be asked to nominate one domain-related measurement as their preferred outcome measure. Discussion This RCT will determine the effect of a self-management program tailored to patients with moderate to severe physical trauma, and the self-selection arm incorporates the potential influence of patient treatment preferences on intervention results. If the intervention proves effective, cost-effectiveness and cost-utility analyses will be performed and thereby provide important information for clinicians and policy makers. Trial registration The study is registered in Clinical Trials with the identifier: NCT06305819. Registered on March 05, 2004.

• Rohrer-Baumgartner, Nina Marit; Holthe, Ingvil Laberg; Svendsen, Edel Jannecke; DAHL, HILDE MARGRETE; Borgen, Ida Maria Henriksen & Strand-Saugnes, Anine Pernille [Show all 13 contributors for this article] (2024). Results from a randomized controlled trial of an individualized and goal-oriented intervention in the chronic phase of pediatric acquired brain injury: the Child in Context Intervention (CICI). Full text in Research Archive
• Holthe, Ingvil Laberg; Svendsen, Edel Jannecke; Rohrer-Baumgartner, Nina Marit; Hauger, Solveig; Borgen, Ida Maria Henriksen & Forslund, Marit Vindal [Show all 12 contributors for this article] (2024). Acceptability of an individualized and goal-oriented intervention in the chronic phase of pediatric acquired brain injury: the Child in Context intervention (CICI). Full text in Research Archive
• Johansen, Truls Sveløkken; Matre, Martin; Løvstad, Marianne; Lund, Anne; Martinsen, Anne Catrine Trægde & Olsen, Alexander [Show all 12 contributors for this article] (2024). Virtual reality as a method of cognitive training of processing speed, working memory, and sustained attention in persons with acquired brain injury: a protocol for a randomized controlled trial. Trials. 25(1). doi: 10.1186/s13063-024-08178-7. Full text in Research Archive Show summary

  Background Acquired brain injury (ABI) often leads to persisting somatic, cognitive, and social impairments. Cognitive impairments of processing speed, sustained attention, and working memory are frequently reported and may negatively affect activities of daily living and quality of life. Rehabilitation efforts aiming to retrain these cognitive functions have often consisted of computerized training programs. However, few studies have demonstrated effects that transfer beyond the trained tasks. There is a growing optimism regarding the potential usefulness of virtual reality (VR) in cognitive rehabilitation. The research literature is sparse, and existing studies are characterized by considerable methodological weaknesses. There is also a lack of knowledge about the acceptance and tolerability of VR as an intervention method for people with ABI. The present study aims to investigate whether playing a commercially available VR game is effective in training cognitive functions after ABI and to explore if the possible effects transfer into everyday functioning. Methods One hundred participants (18–65 years), with a verified ABI, impairments of processing speed/attention, and/or working memory, and a minimum of 12 months post injury will be recruited. Participants with severe aphasia, apraxia, visual neglect, epilepsy, and severe mental illness will be excluded. Participants will be randomized into two parallel groups: (1) an intervention group playing a commercial VR game taxing processing speed, working memory, and sustained attention; (2) an active control group receiving psychoeducation regarding compensatory strategies, and general cognitive training tasks such as crossword puzzles or sudoku. The intervention period is 5 weeks. The VR group will be asked to train at home for 30 min 5 days per week. Each participant will be assessed at baseline with neuropsychological tests and questionnaires, after the end of the intervention (5 weeks), and 16 weeks after baseline. After the end of the intervention period, focus group interviews will be conducted with 10 of the participants in the intervention group, in order to investigate acceptance and tolerability of VR as a training method. Discussion This study will contribute to improve understanding of how VR is tolerated and experienced by the ABI population. If proven effective, the study can contribute to new rehabilitation methods that persons with ABI can utilize in a home setting, after the post-acute rehabilitation has ended.

• Forslund, Marit Vindal; Borgen, Ida Maria Henriksen; Rohrer-Baumgartner, Nina; Holthe, Ingvil Laberg; Hauger, Solveig Lægreid & Løvstad, Marianne [Show all 7 contributors for this article] (2023). Symposium: Goal-Oriented and Individualized Rehabilitation after Brain Injury. Full text in Research Archive
• Matre, Martin; Johansen, Truls Sveløkken; Olsen, Alexander; Tornås, Sveinung; Martinsen, Anne Catrine Trægde & Lund, Anne [Show all 13 contributors for this article] (2023). A protocol for the development and validation of a virtual reality-based clinical test of social cognition. BMC Digital Health. doi: 10.1186/s44247-023-00036-x. Full text in Research Archive Show summary

  Background Impairments in social cognition are common after traumatic brain injury (TBI) and may have severe negative consequences for patients and their families. Most tests of social cognition have limited ecological validity due to simplistic and contrived social stimuli with limited relevance to everyday social functioning. There is a need for measures of social cognition that reflect the dynamic, multimodal and contextualized nature of social situations and that predict real-world functioning. Three hundred sixty–degree (360°) Virtual Reality (VR) video can increase ecological validity through enhanced social presence, or a sense of “being there”. This paper describes the development and protocol design for validation of a Norwegian VR-version of The Awareness of Social Inference Test (TASIT), which is a widely used video-based test of social cognition. Methods Development of VR TASIT included filming 61 short videos depicting social interactions in both VR and desktop format, using a 360° camera. Software for standardized test administration and collection of performance data was developed in Unity, for administration on both VR and desktop interface. The validation study will test the reliability and validity of VR TASIT in participants with TBI (n = 100) and healthy controls (n = 100). Half of the participants will perform the desktop version, and the other half the VR version. Analyses will include known groups validity, convergent and divergent validity, as well as test–retest reliability of VR TASIT. A comparison of the ability of TASIT VR and desktop versions to predict real-world functioning (ecological validity) will be explored using the Social Skills Questionnaire for TBI and La Trobe Communication Questionnaire. Finally, the levels of perceived social presence of the stimulus materials and prevalence of cybersickness after exposure to the virtual environment will be documented. Discussion It is expected that VR TASIT will have comparable or better psychometric properties than the desktop version, and that the hypothesized increased level of social presence experienced in a virtual environment will result in improved ecological validity. More broadly, benefits and limitations of using VR video as stimulus material in assessment of social cognition and considerations for future development and clinical validation are discussed.

• Rohrer-Baumgartner, Nina; Holthe, Ingvil Laberg; Svendsen, Edel Jannecke; Borgen, Ida Maria Henriksen; Egeland, Jens & Wade, Shari L. [Show all 8 contributors for this article] (2023). Families´self-reported challenges in daily life in the chronic stage of pediatric brain injury. Full text in Research Archive
• Svendsen, Edel Jannecke; Holthe, Ingvil Laberg; Møretrø, Viljar; Killi, Eli Marie; Strand-Saugnes, Anine Pernille & Løvstad, Marianne [Show all 7 contributors for this article] (2023). The Child in Context Intervention (CICI) Study: special education and other educational support for children with acquired brain injury in the chronic stage - associations with cognition, brain injury symptoms and time since insult. Full text in Research Archive
• Rohrer-Baumgartner, Nina; Holthe, Ingvil Laberg; Svendsen, Edel Jannecke; Strand-Saugnes, Anine; Røe, Cecilie & Wade, Shari L. [Show all 13 contributors for this article] (2022). The Child in Context Intervention (CICI) Study: Protocol for a Randomized Controlled Trial Evaluating the Effectiveness of a Goal-Oriented and Individualized Rehabilitation for Children With Chronic Acquired Brain Injury. Full text in Research Archive
• Søberg, Helene L.; Moksnes, Håkon Øgreid; Anke, Audny Gabriele Wagner; Røise, Olav; Røe, Cecilie & Aas, Eline [Show all 20 contributors for this article] (2022). Erratum: Rehabilitation Needs, Service Provision, and Costs in the First Year following Traumatic Injuries: Protocol for a Prospective Cohort Study ((JMIR Res Protoc (2021) 10: 4 (e25980) DOI: 10.2196/25980). JMIR Research Protocols. 11(3). doi: 10.2196/37723. Full text in Research Archive
• Killi, Eli Marie; Svendsen, Edel Jannecke; Holthe, Ingvil Laberg; Rohrer-Baumgartner, Nina; Bragstad, Line Kildal & Sandhaug, Maria [Show all 7 contributors for this article] (2022). A qualitative interview study of feasibility and acceptability of a telerehabilitation intervention for children with acquired brain injury: The Child In Context Intervention (CICI). Full text in Research Archive
• Løvstad, Marianne & Rohrer-Baumgartner, Nina (2022). Skiulykken skadet Anna for livet - Vi famlet lenge. [Journal]. Dagsavisen. Full text in Research Archive
• Hauger, Solveig Lægreid; Borgen, Ida Maria Henriksen; Løvstad, Marianne; Lu, Juan; Forslund, Marit Vindal & Kleffelgård, Ingerid [Show all 8 contributors for this article] (2022). Community-based Interventions after Acquired Brain Injury -a Systematic Review of Interventions including Family Members. Full text in Research Archive
• Rohrer-Baumgartner, Nina; Holthe, Ingvil Laberg; Svendsen, Edel Jannecke; Røe, Cecilie; Egeland, Jens & Borgen, Ida Maria Henriksen [Show all 21 contributors for this article] (2022). Rehabilitation for children with chronic acquired brain injury in the Child in Context Intervention (CICI) study: study protocol for a randomized controlled trial. Trials. 23. doi: 10.1186/s13063-022-06048-8. Full text in Research Archive Show summary

  Background: Pediatric acquired brain injury (pABI) is associated with long-term cognitive, behavioral, social, and emotional problems, which may affect the quality of life, school, and family functioning. Yet, there is a lack of evidence-based community-centered rehabilitation programs for chronic pABI and these children do not systematically receive comprehensive rehabilitation. The Child In Context Intervention (CICI) study is a pragmatic randomized controlled trial (RCT) for children with chronic pABI, which aims to evaluate the effectiveness of an individualized and goal-oriented intervention targeting everyday functioning of the child and family. Methods: Children aged 6–16 years with MRI/CT-verified intracranial abnormalities will be included in the CICI study if they have persistent self- or parent-reported cognitive, emotional, and/or behavioral challenges 1 year or more after insult and attend school regularly. A total of 70 families will be randomized 1:1 to an intervention or a control group. The intervention consists of seven family sessions, one parent seminar, and four school sessions delivered over approximately 6 months. The parent seminar will be held in person, and the other sessions will mainly be video based. The children’s and families’ self-reported major challenges in everyday life will be targeted using SMART goals. Evidence-based strategies, when available, will be applied to achieve the goals, combined with psychoeducation. Goal attainment scaling (GAS) will be used to evaluate goal attainment. Data is collected at baseline and after approximately 6 and 9 months. External assessors are blinded to group allocation. Primary outcomes are parent-reported brain injury symptoms in children and parenting self-efficacy at 9 months of follow-up. Secondary outcomes include child-reported brain injury symptoms, quality of life, executive functioning in daily life, parent emotional symptoms, family functioning, and unmet family health care needs. A process evaluation will be conducted. Discussion: The current study provides an innovative approach to rehabilitation for children in the chronic phase of ABI and their families. This complex intervention may contribute to the development of evidence-based, high-quality rehabilitation for a large patient group, which is underrepresented in clinical research. It may also improve collaboration between specialized rehabilitation facilities, schools, and local health care services. Inclusion for the trial started in April 2021.

• Holthe, Ingvil Laberg; Rohrer-Baumgartner, Nina; Svendsen, Edel Jannecke; Strand-Saugnes, Anine; Hauger, Solveig Lægreid & Forslund, Marit [Show all 12 contributors for this article] (2022). Treating Chronic Symptoms of Pediatric Acquired Brain Injury Through a Telehealth Intervention:A feasibility Study of the Child in Context Intervention (CICI). Full text in Research Archive
• Rohrer-Baumgartner, Nina; Holthe, Ingvil Laberg & Løvstad, Marianne (2021). Hjernerådets forskningsdager. Møt en hjerneforsker: The Child in Context Intervention Study. Full text in Research Archive
• Holthe, Ingvil Laberg; Rohrer-Baumgartner, Nina; Svendsen, Edel Jannecke; Strand-Saugnes, Anine; Hauger, Solveig Lægreid & Forslund, Marit Vindal [Show all 12 contributors for this article] (2021). Treating Chronic Symptoms of Pediatric Acquired Brain Injury Through a Telehealth Intervention: A Feasibility Study of the Child in Context Intervention (CICI). Full text in Research Archive
• Rohrer-Baumgartner, Nina; Holthe, Ingvil Laberg; Svendsen, Edel Jannecke; Strand-Saugnes, Anine; Røe, Cecilie & Wade, Shari L. [Show all 13 contributors for this article] (2021). The Child in Context Intervention (CICI) Study: Protocol for a randomized controlled trial evaluating the effectiveness of a goal oriented and individualized rehabilitation for children with chronic acquired brain injury. Full text in Research Archive
• Killi, Eli Marie; Sandhaug, Maria; Kristoffersen, Ann-Elise; Bragstad, Line Kildal; Rohrer-Baumgartner, Nina & Holthe, Ingvil Laberg [Show all 8 contributors for this article] (2021). INTERVENTION ACCEPTABILITY AS EXPERIENCED FROM CHILDREN WITH ABI AND THEIR PARENTS AND TEACHERS Quality feasibility data related to The Child in Context Intervention (CICI) RCT study. Full text in Research Archive
• Andelic, Nada; Røe, Cecilie; Brunborg, Cathrine; Zeldovich, Marina; Løvstad, Marianne & Løke, Daniel [Show all 19 contributors for this article] (2020). Correction to: Frequency of fatigue and its changes in the first 6 months after traumatic brain injury: results from the CENTER-TBI study (Journal of Neurology, (2020), 10.1007/s00415-020-10022-2). Journal of Neurology. ISSN 0340-5354. 268, p. 74–76. doi: 10.1007/s00415-020-10174-1. Full text in Research Archive
• Fure, Silje Christine Reistad; Howe, Emilie; Røe, Cecilie; Hellstrøm, Torgeir; Uglestad, Helene & Enehaug, Heidi [Show all 9 contributors for this article] (2019). Combined Cognitive and Vocational Intervention After Mild-To-Moderate TBI: Baseline Characteristics. Archives of Physical Medicine and Rehabilitation. ISSN 0003-9993. doi: 10.1016/S0003-9993(19)31034-2. Full text in Research Archive

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