Quality of life and physical outcomes following an exercise intervention in individuals with a traumatic brain injury : a pilot study

O'Carroll, Grace Catherine

Abstract

Traumatic brain injuries (TBI) are becoming one of the leading causes of long-term disability worldwide, with more than 200,000 people attending emergency departments in the UK each year following a head injury. This creates immense strain on the individual’s life as well as the healthcare system. The long-term symptoms associated with TBI include depression, anxiety, headaches, dizziness, personality changes, increased aggression, and nausea. These symptoms can lead to job losses, relationship breakdowns and even homelessness. Traumatic brain injuries cannot always be avoided so evidence-based guidelines for suitable and effective rehabilitation interventions are important. The overall aim of this thesis was to pilot an original, multi-component exercise intervention on the mental and physical outcomes in individuals following a TBI. Secondly it aimed to identify disparities in the current rehabilitation guidelines and propose future changes. Finally it intended to lay foundations for a future larger RCT to be conducted across the UK with the implementation of exercise programmes within the community. A systematic review of the literature on the effects of exercise on the quality of life (QOL) in individuals with a TBI can be found in Chapter 3. It found limited conclusive data on the best exercise modality to illicit significant QOL improvements. Therefore, this highlighted the gap in the research and the need for more robust RCTs within this area.

Sixteen healthy adults (non-TBI) took part in the first empirical study (Chapter 5) investigating the effects of a 4-week multi-component exercise intervention on physical and health-related quality of life outcomes. The intervention consisted of circuit-based sessions 1x/week working on balance, strength, coordination, and dual-tasking with the second session per week involving aerobic, reaction time and agility exercises. The findings indicated significant improvements in sit-to-stand tests (p = 0.04, g = 0.34) and reaction time on the Fitlight Trainer (p = 0.00, g = 2.94) in the exercise group. This was also the case during the 15-minute cycling time-trial, where the exercise group demonstrated significant improvements in the total distance cycled and average power over the four weeks (p = 0.008, g = 0.24 and p = 0.00, g = 0.28, respectively). These results revealed the opportunity for physical improvements in a TBI population and justified the second empirical study (Chapter 6). The first part of this chapter looked at the TBI admissions into the Hull Royal Infirmary A&E department highlighting trends in patient and injury characteristics. In addition it demonstrated a wide range of potential participants and emphasised the rationale for an exercise rehabilitation programme. The findings from the audit informed the second part of this chapter, where seven participants (with a TBI) were recruited, with four individuals allocated into the novel exercise programme and three into the standard treatment (control) group. The exercise group attended two session a week for twelve weeks. Participants in the exercise group demonstrated significant improvements (decreased scores) in anxiety (p = 0.05) and depression (p = 0.04) compared to the control group as measured using the Hospital Anxiety and Depression Scale (HADS). Health-related QOL score as measured with the SF- 36 revealed significant improvements for role-limited physical (p = 0.02) and vitality domains (p = 0.03) as a result of the exercise intervention. Significant improvements were also recorded for total distance covered during the cycling time trials (p = 0.03), number of sit-to-stands in 30 seconds (p = 0.02), resting heart rate (p = 0.03), and maximum workload during the aerobic fitness test (p = 0.001). An isokinetic dynamometer was used to measure lower limb average power at two angular speeds (60 deg/sec and 180 deg/sec). The exercise group demonstrated significant improvements during both leg extension (p = 0.04) and flexion (p = 0.05) at 180 deg/sec. In the final study (Chapter 7), a qualitative approach was used to understand the main facilitators to exercise following TBI. These included motivation, gaining an understanding of recovery, and improving physical fitness. The barriers to exercise were also explored, such as lack of confidence/ motivation and cost.

Overall this thesis demonstrated the potential benefits of a 12-week multi-component exercise intervention on QOL and physical well-being outcomes in a cohort of TBI individuals. It also identified disparities in the current TBI rehabilitation guidelines and proposed future recommendations for long-term support for TBI individuals.

Citation

O'Carroll, G. C. Quality of life and physical outcomes following an exercise intervention in individuals with a traumatic brain injury : a pilot study. (Thesis). University of Hull. https://hull-repository.worktribe.com/output/4222570

• Thesis Type: Thesis
• Deposit Date: Jul 22, 2020
• Publicly Available Date: Feb 23, 2023
• Keywords: Sports science
• Public URL: https://hull-repository.worktribe.com/output/4222570
• Additional Information: Department of Sport, Health & Exercise Science, The University of Hull
• Award Date: Sep 1, 2019