A critical analysis of measures of caregiver and family functioning following traumatic brain injury.

More than 5.3 million Americans are living with long-term disability following traumatic brain injury (TBI), and approximately 40% of TBI survivors report at least one unmet need at 1 year postinjury. The totality of the problem of TBI may therefore put increased responsibilities on the significant other and the family. The purpose of this work was to conduct an integrative review of the literature to identify available instruments that might be useful to researchers and clinicians interested in the effects of TBI on family functioning. A review of the literature was undertaken using CINAHL Plus, Family Systems Abstracts, and PubMed from 1998 to 2008. Thirty-five articles were identified in the initial search, and 8 were excluded, leaving 27 articles for full review and analysis. Conceptual and methodological issues identified across the studies resulted in an inability to recommend any of the instruments used in the present studies for use without further study. The issues identified included a lack of conceptual framework for construct validity, variability in injury characteristics, issues with sampling methodology, a lack of longitudinal designs, comparison group issues, and an inability to compare instruments across studies.