|Background: Community integration for traumatic brain injury (TBI) is an important and challenging issue. Nearly 1.3 million brain injuries occur each year in the United States, and nearly 5.3 million persons with a brain injury are living in community settings. Community integration (CI) is a primary goal of many rehabilitation programs, and numerous research studies have indicated that individuals with TBI can live in community settings. However, there is a need to determine the factors that predict CI and the most effective instruments to measure CI.
Objectives: The purpose of this systematic review is to appraise the evidence on what is known about community integration (CI) for persons with brain injury.
Search strategy: The authors conducted a search of data sources including PubMed, CINAHL, Sociological Abstracts, and the Cochrane Library for research on community integration and brain injury. The authors considered articles written in English and published between 1990 and 2004. Hand searching of prominent rehabilitation journals for 2003 through January 2004 was also conducted.
Selection criteria: Studies included in this review pertained to adults 19 years or older. The researchers included quantitative and qualitative studies in their review. Selected studies related CI measurement, predictors of CI, the role of social and activity level on CI, and CI's effect on quality of life and satisfaction with life.
Data collection and analysis: The authors reviewed 72 empirical research articles. Two reviewers determined eligibility for inclusion. The authors developed a quality review rubric for assessing quantitative and qualitative studies.
Main results: The authors report on several instruments that are used to provide objective and subjective measures of CI. For objective measures, the authors indicate the Community Integration Questionnaire (CIQ) was the most frequently used and valid instrument. The authors report the CIQ has been translated into Spanish. In addition to CIQ, the Craig Handicap Assessment Reporting Technique (CHART) was also frequently used as a measure of CI. The authors report that CHART provides additional information regarding social integration and cognitive abilities that CIQ does not provide. The authors report the following variables are most associated with CI: severity of injury, age and gender, education, and post-traumatic amnesia.
Conclusions: While there are several instruments to measure CI, the authors report that consistently predicting CI can be difficult because many variables or characteristics may influence or predict CI. This review also describes evidence pertaining to gender, confounders, and factors associated with social performance and improvement in CI. The authors report there is some indication that part-time employment helps social and home integration for persons with TBI. The authors note that research on quality-of-life research does not indicate definitive evidence, whereas the life satisfaction research is a bit clearer. In particular, the authors report that social integration is associated with life satisfaction.