Caregiver Traits, Attachment Styles, and Patient Outcomes in a Brain Injury Rehabilitation Program



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Background: Acquired brain injuries (ABI) are a critical health concern, as they disrupt brain activity and impact individual functioning. Presentations vary, and injuries are inherently unpredictable. Injured persons can experience an array of significant impairments and difficulties in physical, cognitive, behavioral, emotional, and social functioning, as well as activities of daily living. Following injury, patients can achieve improvements in functioning across domains through evidence-based comprehensive post-acute brain injury rehabilitation programs (PABIR) which specialize in community integration. Family members and caregivers are essential to this recovery process by providing necessary social and emotional support. Purpose: Previous research suggests that caregiver mental health and functioning influence the quality of care and mood of the brain injured individual. Caregiver engagement promotes better quality of life and buoy of mood, but little research has investigated the caregiver factors which promote or inhibit functioning and rehabilitation progress in brain injured persons. Personality traits, which shape affect, cognition, and behavior, may account for differences in individual caregiving and thereby patient functioning. Furthermore, attachment styles drive variability in relationship closeness and security. Because caregiving represents an essential relationship in recovery, differences in caregiver attachment styles may impact patient progress. This study aims to examine the influence of caregiver personality traits and attachment styles on patient trajectories and outcomes. It is hypothesized: (1) that caregiver agreeableness will promote increased functioning and treatment gains and (2) that patients with caregivers who have an insecure attachment style will see limited treatment gains compared to patients with securely attached caregivers. Methods: Data was collected at a post-acute brain injury rehabilitation programs in the state of Texas. Fifty-nine pairs of caregivers and ABI patients were assessed. Caregivers completed demographic questionnaires, and self-report measures of personality factors and attachment styles. Rehabilitation staff assessed patient ability, adjustment, and participation at the beginning and end of treatment to measure patient trajectories. Results: Pearson’s correlation and a hierarchal multiple linear regression analysis were used to examine the relationships between caregiver personality factors and attachment styles and patient rehabilitation gains. Secure attachment and anxious attachment styles, as well as caregiver intensity and duration of rehabilitation were significantly correlated with patient rehabilitation gains. However, attachment styles and personality traits did not predict patient outcomes over caregiver intensity and duration of rehabilitation. Conclusion: Caregiver intensity was the best predictor of rehabilitation followed by duration of rehabilitation treatment. Caregiver intensity also correlated with agreeableness, conscientiousness, and direct in-person contact hours. Limitations, future directions, and clinical implications are discussed.



acquired brain injury, rehabilitation outcomes, families, caregivers