http://hdl.handle.net/11434/9 2026-06-12T22:54:12Z 2026-06-12T22:54:12Z Hill, Bridget Williams, Gavin Banky, Megan http://hdl.handle.net/11434/2430 2026-05-08T11:02:09Z 2025-12-01T00:00:00Z

Title: Development of a core outcome set for the assessment of spasticity in adults: a study protocol. Epworth Authors: Hill, Bridget; Williams, Gavin; Banky, Megan Abstract: Background: Muscle spasticity is common in adult-onset neurological conditions such as stroke, traumatic brain injury, multiple sclerosis, and spinal cord injury. Although effective interventions exist, studies evaluating interventions to improve rehabilitation or management outcomes for those with spasticity are methodologically heterogeneous, making meta-analysis impossible. This paper reports a protocol to develop a spasticity core outcome set (COS) to standardise the reporting of clinical trials and enable better evidence synthesis in future studies. Further, a spasticity COS may facilitate better patient assessment, guide treatment planning and goal setting, and further support evaluation of treatment outcomes in clinical practice. Methods: This protocol has been developed according to the Core Outcome Measures in Effectiveness Trial (COMET) initiative guidelines. It has been prospectively registered on the COMET website. Outcome measures for inclusion in the COS will be based on COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). The study will adhere to the minimum standards for the design of a COS study (Core Outcome Set-Standards for Development [COS-STAD]). This project involves four phases. Phase 1 involves semi-structured interviews of people with a lived experience of spasticity to determine important areas for outcome evaluation. Phase 2 is a Delphi survey with experts in spasticity, together with people with lived experience, to select the outcome domains for inclusion in the COS. Phase 3 consists of systematic reviews of the literature to identify outcome measures specific to each of the domains selected in phase 2 and their psychometric properties. Phase 4 is a second Delphi survey with the spasticity experts, conducted to obtain consensus on outcome measures included in the COS. Discussion: This proposal represents the first spasticity COS to improve the consistency in outcome measurement selection and reporting in clinical trials to enable future meta-analyses and reduce research waste. It will also provide clinicians with a resource for documenting and reporting patient outcomes that can be used for benchmarking and optimising care. Trial registration: https://www.comet-initiative.org/Studies/Details/3345 . 31st January, 2025.

2025-12-01T00:00:00Z Ponsford, Jennie http://hdl.handle.net/11434/2426 2026-05-06T04:10:15Z 2026-04-01T00:00:00Z

Title: Predictors of improved attentional control after virtual reality-based cognitive rehabilitation in chronic traumatic brain injury. Epworth Authors: Ponsford, Jennie Abstract: The purpose of this paper was to explore predictors of change in attentional control observed in a randomized controlled trial (RCT) investigating VR-based cognitive training, using the game BeatSaber. Materials and methods: Data were collected at baseline of the RCT, including 100 participants in the chronic phase of TBI, defined as at least one year post-injury. The 51 participants randomized to the VR group were included in this analysis. Primary outcome measure was based on the main significant finding from the RCT, a ratio score between speed and accuracy, Inverse Efficiency Score (IES). To explore potential predictors of post-treatment change in IES, a multivariable regression analysis was performed. Based on previous research, age, years since injury, executive functioning, level of abstract thinking, and immersive tendencies were selected as predictors. Results: The model explained 40% of the variance of the post treatment change in IES. More years since injury, lower baseline executive functioning and higher immersive tendencies towards games explained greater change in VR-training. However, after bootstrapping, only years since injury remained a significant predictor. Conclusion: In light of the bootstrapped analyses, the findings should be interpreted as exploratory and considered hypothesis-generating, warranting further investigation in larger samples.

2026-04-01T00:00:00Z Nalaye, Halima Downing, Marina Ponsford, Jennie http://hdl.handle.net/11434/2368 2025-08-27T11:02:26Z 2025-08-01T00:00:00Z

Title: Rehabilitation through a cultural lens: the experience of cultural and linguistically diverse (CALD) traumatic brain injury (TBI) survivors in Australia. Epworth Authors: Nalaye, Halima; Downing, Marina; Ponsford, Jennie Abstract: CALD TBI survivors face poorer functional outcomes post-injury, however, the reasons for this are poorly understood. The body of qualitative research in Western countries (e.g., Australia) is limited: to date it has not captured the experiences of those who speak little/no English or been in Australia for a short period of time. There has also been limited focus on how culturally bound factors (e.g. beliefs and understanding of injury) may interact with their experience. A deeper understanding can aid clinicians in tailoring culturally safe rehabilitation and potentially improve outcomes.

2025-08-01T00:00:00Z Ponsford, Jennie Spitz, Gershon http://hdl.handle.net/11434/2328 2025-05-08T04:31:21Z 2025-04-01T00:00:00Z

Title: A transdiagnostic, hierarchical taxonomy of psychopathology following traumatic brain injury (HiTOP-TBI). Epworth Authors: Ponsford, Jennie; Spitz, Gershon Abstract: Psychopathology, including depression, anxiety, and post-traumatic stress, is a significant yet inadequately addressed feature of moderate-severe traumatic brain injury (TBI). Progress in understanding and treating post-TBI psychopathology may be hindered by limitations associated with conventional diagnostic approaches, specifically the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD). The Hierarchical Taxonomy of Psychopathology (HiTOP) offers a promising, transdiagnostic alternative to psychiatric classification that may more effectively capture the experiences of individuals with TBI. However, HiTOP lacks validation in the TBI population. To address this gap, we administered a comprehensive questionnaire battery, including 56 scales assessing homogeneous symptom components and maladaptive traits within HiTOP, to 410 individuals with moderate-severe TBI. We evaluated the reliability and unidimensionality of each scale and revised those with psychometric problems. Using a top-down, exploratory latent variable approach (bass-ackwards modeling), we subsequently constructed a hierarchical model of psychopathological dimensions tailored to TBI. The results showed that, relative to norms, participants with moderate-severe TBI experienced greater problems in the established HiTOP internalizing and detachment spectra, but fewer problems with thought disorder and antagonism. Fourteen of the 56 scales demonstrated psychometric problems, which often appeared reflective of the TBI experience and associated disability. The Hierarchical Taxonomy of Psychopathology Following Traumatic Brain Injury (HiTOP-TBI) model encompassed broad internalizing and externalizing spectra, splitting into seven narrower dimensions: Detachment, Dysregulated Negative Emotionality, Somatic Symptoms, Compensatory and Phobic Reactions, Self-Harm and Psychoticism, Rigid Constraint, and Harmful Substance Use. This study presents the most comprehensive empirical classification of psychopathology after TBI to date. It introduces a novel, TBI-specific transdiagnostic questionnaire battery and model, which addresses the limitations of conventional DSM and ICD diagnoses. The empirical structure of psychopathology after TBI largely aligned with the established HiTOP model (e.g., a detachment spectrum). However, these constructs need to be interpreted in relation to the unique experiences associated with TBI (e.g., considering the injury's impact on the person's social functioning). By overcoming the limitations of conventional diagnostic approaches, the HiTOP-TBI model has the potential to accelerate our understanding of the causes, correlates, consequences, and treatment of psychopathology after TBI.

2025-04-01T00:00:00Z