title: Community integration after traumatic brain injury: a systematic review of the clinical implications of measurement and service provision for older adults.
abstract: OBJECTIVE
  To explore the scope, reliability, and validity of community integration measures for older adults after traumatic brain injury (TBI).
  
  
  METHODS
  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.
  
  
  METHODS
  Forty-three eligible articles were identified, with 11 selected for full review using a standardized critical review method.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
authors.affiliation: Department of Occupational Science and Therapy, School of Rehabilitation and Occupation Studies, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.
authors.forename: Linda
authors.initials: L
authors.lastname: Ritchie
authors.affiliation: Department of Occupational Science and Therapy, School of Rehabilitation and Occupation Studies, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand. Electronic address: vwright@aut.ac.nz.
authors.forename: Valerie A
authors.initials: VA
authors.lastname: Wright-St Clair
authors.affiliation: Research Centre for Health, Exercise and Sports Sciences, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia; Human Potential Centre, Auckland University of Technology, Auckland, New Zealand.
authors.forename: Justin
authors.initials: J
authors.lastname: Keogh
authors.affiliation: Cluster for Health Improvement, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sippy Downs, QLD, Australia.
authors.forename: Marion
authors.initials: M
authors.lastname: Gray
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D001930:Brain Injuries / Q000534:rehabilitation*; D062309:Community Integration; D004185:Disability Evaluation; D015577:Geriatric Assessment / Q000379:methods*; D015600:Glasgow Coma Scale; D006801:Humans; D020380:Needs Assessment; D026741:Physical Therapy Modalities; D011788:Quality of Life; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires
keywords: Aged; Brain injuries; CHART; CI; CIM; CIQ; COOP; Community Integration Measure; Community Integration Questionnaire; Craig Handicap Assessment and Reporting Technique; Dartmouth COOP Functional Health Assessment Charts/World Organization of National Colleges, Academies, and Academic Associations of General Practices/Family Physicians; GCS; Glasgow Coma Scale; Medical Outcomes Study 36-Item Short-Form Health Survey; POPS; Participant Objective, Participant Subjective; Rehabilitation; SF-36; SWLS; Satisfaction with Life Scale; TBI; WHOQOL-BREF; WHOQOL-DIS; WHOQOL-OLD; World Health Organisation Quality of Life-Abbreviated 26 items; World Health Organization Quality of Life-Disabilities module; World Health Organization Quality of Life-Older Adult module; community integration; traumatic brain injury