Jennie L Ponsford’s research while affiliated with Monash University (Australia) and other places

Purpose: Despite devastating financial and psychosocial consequences, no tailored cyberscam psychosocial recovery treatments for people with acquired brain injury (ABI) exist. We aimed to 1) co-design a cyberscam psychosocial intervention framework with and for people with ABI, and 2) explore co-design process experiences of people with ABI, close others and clinicians. Methods: Using co-design frameworks, fifteen adults (nABI=5, nclose others= 3, nclinicians/service providers=7) participated in 20 hours of hybrid focus groups (2.5h x 8 meetings) to develop content, measures, and sustainability plans. Of these, five were part of the project team (nABI=1, nclinicians/service providers=4). Clinicians participated in eight additional meetings. Fourteen semi-structured qualitative interviews and reflexive thematic analysis explored the co-design process. Results: The co-designed cyberscam psychosocial adjustment intervention framework addresses cybersafety and adjustment to scam-related impacts on finances, emotions, relationships and lifestyle. Five themes were identified: "Overwhelming number of ideas"; "Value of skilled facilitation"; "Respectful and inclusive"; "Power of sharing scam experiences"; "Creating a practical scam intervention framework." Conclusions: A world-first co-designed cyberscam adjustment intervention framework was developed and will be piloted for feasibility and preliminary efficacy. Although co-designing interventions is complex and time-intensive, it is achievable with appropriate structure and facilitation. Future co-design projects can replicate this model.

Objectives: This study aimed to identify outcome clusters among individuals with traumatic brain injury (TBI), 6 months to 10 years post-injury, in an Australian rehabilitation sample, and determine whether scores on 12 dimensions, combined with demographic and injury severity variables, could predict outcome cluster membership 1 to 3 years post-injury. Setting: Rehabilitation hospital. Participants: A total of 467 individuals with TBI, aged 17 to 87 (M = 44.2 years), 70% male, with mean post-traumatic amnesia 24 days (range 0.5-455 days), were assessed a mean of 3.4 years post-injury (range 0.5-10 years). A subgroup of 138 participants was also evaluated as rehabilitation inpatients and followed up 1 year post-injury. Design: Prospective observational study. Main measures: TBI Quality of Life subscales (Upper Extremity, Pain Interference, Headache Pain, Anxiety, Resilience, Emotional and Behavioral Dyscontrol, General Cognitive Concerns, Independence, and Economic Quality of Life Scale), Neurobehavioral Symptom Inventory, Family Assessment Device General Functioning Scale, Wechsler Adult Intelligence Scale-IV Letter-Number-Sequencing and Coding, Rey Auditory Verbal Learning Test, Trail Making Test Part A, Verbal Fluency Test, Word Memory Test, Participation Assessment with Recombined Tools-Objective, and Glasgow Outcome Scale-Extended. Results: K-means cluster analysis revealed 5 clusters across 12 dimensions: Good Outcome, High Cognition, Poor Cognition, Poor Outcome, and Poor Adjustment, aligning with Sherer and colleagues' clusters. Inpatient assessments (n = 138) identified profiles predictive of outcome group membership. Participants with Good Outcomes exhibited lower anxiety and higher independence, self-esteem, and resilience, despite some cognitive deficits. High Cognition correlated with robust Economic and Family Support. Poor Cognition aligned with impaired cognitive function but positive psychosocial ratings suggest limited self-awareness. Poor Outcome featured low initial cognitive scores and poor psychosocial adjustment. Poor Adjustment participants, without inpatient cognitive impairments, reported persistent pain, physical symptoms, and emotional distress. Conclusions: Findings support the evaluation of cognitive and psychosocial factors during rehabilitation to predict outcomes with potential to inform rehabilitative interventions to optimize outcomes.

Background While injuries remain a leading cause of childhood death, increasing proportions of children survive life-threatening injuries. However, robust epidemiological data on their risks of long-term disability are scant, undermining comprehensive injury control efforts. This population-based prospective cohort study investigated the functional status and health-related quality of life of seriously injured Australian children over a 5-year period. Methods Patients aged <18 years hospitalised for major trauma (Injury Severity Score >12) in the State of Victoria over a 12-month period were followed-up at 6, 12, 24, 36, 48 and 60-months post-injury. Primary outcomes were assessed using the PedsQL, King’s Outcome Scale for Childhood Head Injury and the Glasgow Outcome Scale-Extended. Multivariable regression models investigated factors associated with outcomes. Results Of the 186 participants, 71% were retained to 60 months post-injury. At five years post-injury, only 39% had fully recovered while 39% experienced moderate to severe disability. Despite gains in functional status across the five years, psychosocial recovery lagged improvements in physical health. Factors associated with adverse outcomes included older age at injury, female sex, socio-economic disadvantage, remote/regional (versus urban) residence, pre-existing comorbidities, and injuries deemed compensable, intentional, or involving head trauma. Implications The high risks of long-term disability following serious childhood injury highlight the need for robust injury control efforts that monitor and address the inequitable burden of childhood injury, including the social determinants influencing the occurrence as well as sequelae following injury.

Background Little is known about health literacy in traumatic brain injury (TBI) survivors. The aims of this study were to compare health literacy in individuals with TBI with that of a control group; to examine the association between health literacy in individuals with TBI and demographic, injury, and cognitive factors; and compare the relationship between health literacy and physical and mental health outcomes. Methods A cross-sectional observational study design was used. Adults (≥18 years) were recruited from an outpatient research centre in Victoria, Australia. There were 209 participants with a complicated mild to severe TBI at least 1 year previously (up to 30 years 6 months) and 206 control participants. Results Individuals with TBI did not have poorer health literacy than controls (IRR = 1.31, P = 0.102, CI95% [0.947, 1.812]). Further analysis could not be completed due to the highly skewed Health Literacy Assessment Using Talking Touchscreen Technology – Short Form (Health LiTT-SF) data. Conclusion Health literacy performance in individuals with TBI was not significantly different to controls. Premorbid education may provide a critical cognitive reserve upon which TBI survivors can draw to aid their health literacy. These findings are specific to the Health LiTT-SF measure only and require replication using more comprehensive health literacy measures in culturally diverse samples.

Blood biomarkers are an emerging diagnostic and prognostic tool that reflect a range of neuropathological processes following traumatic brain injury (TBI). Their effectiveness in identifying long-term neuropathological processes after TBI is unclear. Studying biomarkers in the chronic phase is vital because elevated levels in TBI might result from distinct neuropathological mechanisms during acute and chronic phases. Here, we examine plasma biomarkers in the chronic period following TBI and their association with amyloid and tau PET, white matter microarchitecture, brain age and cognition. We recruited participants ≥40 years of age who had suffered a single moderate–severe TBI ≥10 years previously between January 2018 and March 2021. We measured plasma biomarkers using single molecule array technology [ubiquitin C-terminal hydrolase L1 (UCH-L1), neurofilament light (NfL), tau, glial fibrillary acidic protein (GFAP) and phosphorylated tau (P-tau181)]; PET tracers to measure amyloid-β (18F-NAV4694) and tau neurofibrillary tangles (18F-MK6240); MRI to assess white matter microstructure and brain age; and the Rey Auditory Verbal Learning Test to measure verbal-episodic memory. A total of 90 post-TBI participants (73% male; mean = 58.2 years) were recruited on average 22 years (range = 10–33 years) post-injury, and 32 non-TBI control participants (66% male; mean = 57.9 years) were recruited. Plasma UCH-L1 levels were 67% higher {exp(b) = 1.67, P = 0.018, adjusted P = 0.044, 95% confidence interval (CI) [10% to 155%], area under the curve = 0.616} and P-tau181 were 27% higher {exp(b) = 1.24, P = 0.011, adjusted P = 0.044, 95% CI [5% to 46%], area under the curve = 0.632} in TBI participants compared with controls. Amyloid and tau PET were not elevated in TBI participants. Higher concentrations of plasma P-tau181, UCH-L1, GFAP and NfL were significantly associated with worse white matter microstructure but not brain age in TBI participants. For TBI participants, poorer verbal-episodic memory was associated with higher concentration of P-tau181 {short delay: b = −2.17, SE = 1.06, P = 0.043, 95% CI [−4.28, −0.07]; long delay: bP-tau = −2.56, SE = 1.08, P = 0.020, 95% CI [−4.71, −0.41]}, tau {immediate memory: bTau = −6.22, SE = 2.47, P = 0.014, 95% CI [−11.14, −1.30]} and UCH-L1 {immediate memory: bUCH-L1 = −2.14, SE = 1.07, P = 0.048, 95% CI [−4.26, −0.01]}, but was not associated with functional outcome. Elevated plasma markers related to neuronal damage and accumulation of phosphorylated tau suggest the presence of ongoing neuropathology in the chronic phase following a single moderate–severe TBI. Plasma biomarkers were associated with measures of microstructural brain disruption on MRI and disordered cognition, further highlighting their utility as potential objective tools to monitor evolving neuropathology post-TBI.

The aim of the Australian Traumatic Brain Injury Initiative (AUS-TBI) is to design a data dictionary to inform data collection and facilitate prediction of outcomes for moderate-severe traumatic brain injury (TBI) across Australia. The process has engaged diverse stakeholders across six areas: social, health, clinical, biological, acute interventions, and long-term outcomes. Here, we report the results of the clinical review. Standardized searches were implemented across databases to April 2022. English-language reports of studies evaluating an association between a clinical factor and any clinical outcome in at least 100 patients with moderate-severe TBI were included. Abstracts, and full-text records, were independently screened by at least two reviewers in Covidence. The findings were assessed through a consensus process to determine inclusion in the AUS-TBI data resource. The searches retrieved 22,441 records, of which 1137 were screened at full text and 313 papers were included. The clinical outcomes identified were predominantly measures of survival and disability. The clinical predictors most frequently associated with these outcomes were the Glasgow Coma Scale, pupil reactivity, and blood pressure measures. Following discussion with an expert consensus group, 15 were recommended for inclusion in the data dictionary. This review identified numerous studies evaluating associations between clinical factors and outcomes in patients with moderate-severe TBI. A small number of factors were reported consistently, however, how and when these factors were assessed varied. The findings of this review and the subsequent consensus process have informed the development of an evidence-informed data dictionary for moderate-severe TBI in Australia.