COSMIN database

Community integration after traumatic brain injury: a systematic review of the clinical implications of measurement and service provision for older adults

Ritchie, L., Wright-St Clair, V. A., Keogh, J., and Gray, M.
OBJECTIVE: To explore the scope, reliability, and validity of community integration measures for older adults after traumatic brain injury (TBI).

DATA SOURCES: A search of peer-reviewed articles in English from 1990 to April 2011 was conducted using the EBSCO Health and Scopus databases. Search terms included were community integration, traumatic brain injury or TBI, 65 plus or older adults, and assessment.

STUDY SELECTION: Forty-three eligible articles were identified, with 11 selected for full review using a standardized critical review method.

DATA EXTRACTION: Common community integration measures were identified and ranked for relevance and psychometric properties. Of the 43 eligible articles, studies reporting community integration outcomes post-TBI were identified and critically reviewed. Older adults' community integration needs post-TBI from high quality studies were summarized.

DATA SYNTHESIS: There is a relative lack of evidence pertaining to older adults post-TBI, but indicators are that older adults have poorer outcomes than their younger counterparts. The Community Integration Questionnaire (CIQ) is the most widely used community integration measurement tool used in research for people with TBI. Because of some limitations, many studies have used the CIQ in conjunction with other measures to better quantify and/or monitor changes in community integration.

CONCLUSIONS: Enhancing integration of older adults after TBI into their community of choice, with particular emphasis on social integration and quality of life, should be a primary rehabilitation goal. However, more research is needed to inform best practice guidelines to meet the needs of this growing TBI population. It is recommended that subjective tools, such as quality of life measures, are used in conjunction with well-established community integration measures, such as the CIQ, during the assessment process.
Arch Phys Med Rehabil
1532-821X (Electronic)
Publication year:
Functional status:
Role functioning
Social functioning
Overall quality of life:
Overall quality of life
Seniors (65+)
Diseases of and symptoms related to the nervous system
External causes of morbidity and mortality
Injury, poisoning and certain other consequences of external causes
PRO / non-PRO:
Patient Reported Outcome
Type of measurement instrument:
1 - Questionnaires
2 - Interviews
CHART - Craig Handicap Assessment and Reporting Technique   
CIM - Community Integration Measure
CIQ - Community Integration Questionnaire   
SWLS - Satisfaction With Life Scale
WHODAS II - World Health Organization Disability Assessment Schedule II (versions: WHODAS-12)   
WHOQOL-OLD - World Health Organization Quality Of Life of older persones (versions: WHOQOL-AGE)