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REVIEW ARTICLE
Indicators of life success from the perspective of individuals with traumatic brain
injury: a scoping review
Emily Nalder
a,b,c
, Gillian King
a,b,d
, Anne W. Hunt
a,b
, Laura R. Hartman
d
, Zara Szigeti
b,d
, Emma Drake
a
,
Riya Shah
a
, Maryam Sharzad
a
, Myles Resnick
a
, Giles Pereira
a
and Erica Lenton
e
a
Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada;
b
Rehabilitation Sciences Institute,
University of Toronto, Toronto, Canada;
c
March of Dimes Canada, East York, Canada;
d
Bloorview Research Institute & Holland Bloorview Kids
Rehabilitation Hospital, Toronto, Canada;
e
Gerstein Science Information Centre, University of Toronto, Toronto, Canada
ABSTRACT
Purpose: The purpose was to synthesize qualitative literature and identify indicators of life success (posi-
tive life outcomes and experiences) that can help in understanding resiliency in the context of traumatic
brain injury (TBI).
Methods: This scoping review involved searching nine online databases for population (TBI) and context
(qualitative literature). Searches retrieved 42 852 articles and, after two-stage screening, 76 articles met
the inclusion criteria of reporting indicators of life success from the perspective of individuals with TBI.
Results: Most studies were conducted in North America, Australia, or Europe. Participants were people liv-
ing with TBI (mild to severe), of all age ranges. Positive life experiences were organized within four
domains: understanding of oneself and one’s life, social relationships and interaction, doing (engagement
in activities, sense of control and accomplishment), and hope for the future.
Conclusions: The positive life experiences reflect both processes and outcomes (indicators of success)
and highlight the need for a multidimensional approach when seeking to understand resiliency following
TBI. The transactional framework of life experiences can be applied in future TBI resiliency research to
understand how individuals negotiate adversity through experiences promoting understanding of oneself
and the world, social relationships, engagement in activity and hope.
‰IMPLICATIONS FOR REHABILITATION
✏Rehabilitation services should consider how to afford opportunities for engagement in activity, social
interaction, meaning making (i.e., coming to new understandings), and hope.
✏With respect to engaging in activity and social relationships, having social interaction, being under-
stood, being active and productive, having autonomy, and having accomplishments, reflect important
experiences to enable within rehabilitation services.
✏Rehabilitation professionals should consider how providing opportunities for their clients to have
positive life experiences may contribute toward an adaptive and empowered mindset.
ARTICLE HISTORY
Received 24 November 2020
Revised 20 December 2021
Accepted 29 December 2021
KEYWORDS
Resiliency; adaptation;
participation; identity;
social; hope; review
Introduction
Traumatic brain injury (TBI) refers to “an alteration in brain func-
tion or other evidence of pathology, caused by an external force”
[1, p.1638], and has been described as a chronic condition [2].
Conceptualizing TBI as a chronic condition challenges the view
that following the acute event, and initial recovery period, individ-
uals’ functioning is relatively stable. Such conceptualization recog-
nizes that functioning and environmental conditions change over
time [2,3], influencing many aspects of life, including relationships,
participation, sense of self and satisfaction with life. Resiliency,
defined as an adaptive life-long process involving person–environ-
ment transactions that enable individuals to bounce back follow-
ing triggering adversities [4], is therefore important to study to
explicate how individuals negotiate the TBI-related adversity (e.g.,
participation restrictions, changes to sense of self) as it unfolds
over time [5].
Current conceptualizations of resiliency view it as an umbrella
term reflecting a system of protective factors and processes oper-
ating in response to adversity and leading toward adaptive out-
comes [4]. Resiliency is contextualized, which means the adaptive
outcomes vary depending on the nature of the adversity and the
cultural and social contexts shaping individuals’ experiences
[4,6,7]. Studies of resiliency involving disadvantaged children, for
example, discuss a range of outcomes as indicators of resiliency,
including competence in developmental tasks, school achieve-
ment, psychological wellbeing, and positive relationships with
peers [8]. Following traumatic events, resiliency is indicated by a
return to pre-adversity levels of psychological functioning, the
capacity for positive emotion, and functioning well in other
aspects of life (e.g., physical health and social functioning) [9].
Importantly, resiliency does not imply an absence of negative
emotions, but rather it is characterized by a combination of transi-
ent experiences of difficulty with a return to pre-adversity levels
of functioning, and a range of positive experiences [9]. Adaptive
CONTACT Emily Nalder emily.nalder@utoronto.ca 160-500 University Avenue, Toronto, Ontario M5G 1V7, Canada
fl 2022 Informa UK Limited, trading as Taylor & Francis Group
DISABILITY AND REHABILITATION
https://doi.org/10.1080/09638288.2021.2025274
outcomes must therefore be considered holistically and not just
as the absence of distress/negative emotion. Given the contex-
tualized nature of resiliency, it is important to characterize the
adaptive outcomes and experiences that are indicative of life suc-
cess following TBI.
In the TBI literature, quantitative studies assess a wide variety
of outcomes to describe the effects that experiencing TBI has on
individuals’ lives, and to evaluate the efficacy of interventions and
support services. Honan et al. [10], through consultation with
experts in TBI rehabilitation, identified 11 priority areas for psy-
chosocial research, namely global outcome (overall impact of the
TBI), communication, social cognition, behavioral and executive
function, neuropsychological functioning, psychological status, TBI
related symptoms, activities and participation, support and rela-
tionships, sense of self, and health-related quality of life. Laxe
et al. [11] conducted a systematic review to identify outcome
measures used in TBI rehabilitation. Those measures, used in at
least 20% of studies, assessed body functions (e.g., cognitive func-
tioning), level of disability and community integration [11].
Community integration has been defined in objective terms,
such as a person’s frequency of participation and level of inde-
pendence in performing activities in the home and community
[12], and in subjective terms, assessing the meaning or perceived
importance of participation to individuals [13], or feelings of
acceptance and belonging to a community [14]. Other research
has considered positive changes following TBI, including post-
traumatic growth [15], quality of life [16], and resilience [17].
Resiliency, understood as the capacity to bounce back from adver-
sity, can therefore be understood as an outcome that, if devel-
oped in rehabilitation, would prepare individuals to adapt to life’s
ongoing challenges and experience other life successes [17].
Collectively, these studies highlight the broad range of outcomes
considered important following TBI, ranging from the level of
function/disability, to positive psychological concepts, to participa-
tion in life situations. These studies employed quantitative designs
and therefore test relationships between constructs identified by
professionals or researchers. In contrast, qualitative literature,
which explores the perspectives and lived experiences of individu-
als with TBI, may help to explicate their views regarding indicators
of life success or what it means to do well in life.
Levack et al. completed a synthesis of qualitative evidence on
experiences of recovery and outcome following TBI [18]. A signifi-
cant finding was the pervasive sense of loss experienced by indi-
viduals with TBI. This loss was represented in three themes: loss
of pre-injury sense of self (i.e., losing a sense of connection to the
person one was before the injury), mind-body disconnect (loss of
abilities and productivity), and social disconnect (which included
experiences of losing relationships, social roles, and participation
opportunities, and of being treated in a de-humanizing way).
Three processes were discussed, speaking to how individuals navi-
gate these losses: reconstruction of identity, reconstruction of a
place in the world, and reconstruction of personhood [18]. The
notion of processes unfolding over time is evident in other quali-
tative studies with themes showing individuals changing their pri-
orities in life [19], developing a concept of living with TBI [20],
and reconstructing their identity [21].
A range of other experiences are referenced as influencing per-
ceptions of community integration and sense of self; however, to
our knowledge, this evidence has not been synthesized. For
instance, qualitative studies note the importance of social inter-
action, having reciprocity in relationships, and feeling understood
by others, as these experiences shape how individuals perceive
their life and community integration [14,18,22]. Engagement in
activities and sense of control (being self-determining) were also
experiences connected to how individuals with TBI perceived their
life [19], their community integration [14], and their sense of
self [23].
Collectively, this literature illustrates the challenges and losses
that individuals with TBI experience (e.g., loss of roles and sense
of self) and the processes through which they respond to, or navi-
gate, these challenging situations. Synthesizing qualitative evi-
dence to identify indicators of life success, or what it means to do
well in life following TBI, will provide further context to studying
resiliency by illuminating potential adaptive outcomes that are
important to individuals themselves. To our knowledge, only one
synthesis of qualitative literature has been published which
focuses broadly on experiences following TBI [18]. As this synthe-
sis was published over 10 years ago and, to a large extent, char-
acterized experiences of loss rather than positive experiences it is
timely to conduct an updated review of the qualitative literature.
The primary objective for this review was to determine indicators
of life success evident in qualitative literature reporting the expe-
riences of individuals with TBI. Secondary objectives were to
describe the nature of the qualitative literature in terms of study
design and methods of data generation, and to describe the con-
texts of the studies, in terms of countries where the research was
conducted and participant characteristics.
Materials and methods
A scoping review was conducted in accordance with the meth-
odological approaches reported by Arksey and O’Malley [24], and
Levac et al. [25]. A scoping review was selected as this style of
review suits studies involving broad research questions where the
aim is to describe the nature of evidence on a topic, and to map
and define the concepts underpinning a research area (in this
case indicators of life success identified by individuals with TBI)
[26]. Our process included: (1) identifying the research question;
(2) identifying relevant studies; (3) selecting studies for detailed
analysis; (4) charting the data; and (5) collating, summarizing, and
reporting the results. No appraisal of the quality of included stud-
ies was completed as this is not a standard part of scoping review
methodology [25].
Identify relevant studies
A three-stage process was used to identify relevant articles as per
the Joanna Briggs Institute recommendation [26]. The first step
was an initial limited search of two online databases, MEDLINE
and CINAHL, to identify qualitative studies in TBI that mentioned
indicators of life success. The intent of the initial limited search
was to refine the search strategy and determine whether and
how to search for literature describing life outcomes or experien-
ces that reflect indicators of success in life for individuals with TBI.
Four authors (EN, GK, AH, and LH) together screened approxi-
mately 300 total sources and analyzed text words in the title and
abstracts of retrieved papers, generating a list of keywords that
reflected relevant life concepts. Keywords emerging through this
process included: terms reflecting a perception of one’s life (e.g.,
quality of life, life satisfaction), various life domains (e.g., social/
relationships, activities/participation), adjustment processes (e.g.,
re-integration, adaptation), and self-terms (e.g., self-esteem, self-
understanding). The list of terms was compared to index terms
used to describe the articles. The authors determined that includ-
ing “indicators of life success” (concept) in the search would not
significantly improve the sensitivity or specificity, as compared to
2 E. NALDER ET AL.
searching for population (TBI) and context (qualitative literature)
alone. The keywords were used to establish the inclusion criteria
used during the article selection phase.
As a second step, the authors identified a test-set of 26 studies
that (a) captured indicators of life success (i.e., positive outcomes
or experiences that reflect what it means to do well in life) and
(b) used qualitative methodology. This test-set of articles was
used to identify textword queries and controlled vocabulary terms
for the concepts of TBI and qualitative methods. In step three,
Ovid MEDLINE: Epub Ahead of Print, In-Process & Other Non-
Indexed Citations, Ovid MEDLINE Daily and Ovid MEDLINE, OVID
Embase, OVID AMED (Allied and Complementary Medicine), OVID
PsycINFO, EBSCO CINAHL, and EBSCO SportDiscus were searched
from database inception to present to identify qualitative studies
of TBI. Search strategies were developed by an academic health
science librarian (EL) with experience in scoping review methods
in collaboration with the authors. The search strategies were
translated using each database platform’s command language,
controlled vocabulary, and appropriate search fields. MeSH terms,
EMTREE terms, AMED thesauri terms, APA thesauri terms, CINAHL
headings, SIRC terms, and textwords were used for the search
concepts of TBI and qualitative methods. The concepts were com-
bined with a Boolean “AND”. Final searches were completed in
December 2017 and updated in August 2021. For an example of
the search strategies, see Appendix A.
Selecting studies
Retrieved sources from the search were compiled using the soft-
ware program Endnote X7 and duplications were removed.
Bibliographic information, titles, and abstracts were then exported
into a spreadsheet for screening. Screening of the study title and
abstract was completed by a group of nine reviewers (researchers,
and graduate students in rehabilitation science). All received train-
ing in the inclusion/exclusion criteria (specified below) and then
worked in pairs to review a proportion of the retrieved titles and
abstracts independently, and then to discuss and resolve discrep-
ancies. Where insufficient detail was available in the title/abstract
to make a decision, the paper was subject to level 2 screening
(full-texts). Level 2 screening was completed by a group of 13
reviewers (researchers and graduate students in rehabilitation sci-
ences of whom seven had completed the title and abstract
screening). The review process followed the same procedures as
described above. In cases where the two reviewers were unable
to come to agreement, the paper was reviewed in full by the first
author (EN) who made the final decision.
The following types of papers were included: (1) articles using
a qualitative design, or both qualitative methods of data gener-
ation and analysis if the design was mixed methods or not speci-
fied; (2) articles that included individuals who had experienced a
TBI of any severity and at any stage in life; (3) articles that
described positive life outcomes or experiences that reflect indica-
tors of life success from the perspective of individuals with TBI,
including subjective experiences or perceptions of one’s life (qual-
ity of life, satisfaction, wellbeing, happiness); adaptation processes
(e.g., integration, re-construction, adjustment); participation (prod-
uctivity, community integration, social participation); or views of
self (identity, coherence, sense of self); and (4) articles published
in English in a peer reviewed source. We excluded: (1) studies
that did not present the perspective of individuals with TBI; (2) lit-
erature reviews or other knowledge syntheses; (3) published
abstracts or dissertations; and (4) articles pertaining to
experiences that did not reflect indicators of life success, for
instance impairment or service-related experiences (e.g., process
of care).
Charting the data
Two reviewers (EN and GP) developed and tested a data extrac-
tion form, piloting the form by each extracting data from selected
articles and comparing information for consistency in what data
was extracted and how it was recorded in the form. Once the
data extraction form had been piloted, extraction began for all
included articles. The following items were extracted for data ana-
lysis: (1) bibliographic information (i.e., author, year of publication,
publication name); (2) study characteristics (i.e., research question/
study aims, design, methods of data collection); (3) study context
(i.e., country where the research occurred); (4) participant informa-
tion (i.e., sample size, age, gender, severity of TBI, time since
injury); and (5) themes, or descriptors, of indicators of life success
discussed in the original article, and illustrative quotes from par-
ticipants included in the studies. The extracted data focused on
life experiences that were meaningful to the participants and
reflected indicators of life success. A group of eight graduate stu-
dents, and researchers in rehabilitation sciences, all involved in
screening completed data extraction independently. One author
(EN) then checked all extracted data to ensure consistency by
reviewing and comparing extracted information to what was
reported in the original articles.
Collating, summarizing, and reporting the results
To address the primary objective, qualitative content analysis was
used to identify and describe the indicators of life success [27].
Extracted data (themes and participant quotes from the original
studies) were reviewed and coded by four authors (EN, GK, GP,
ZS). The authors generated codes to represent different life expe-
riences and grouped data discussing similar concepts together
into categories. The four authors then met to discuss their coding
and to come to consensus on higher and lower order categories.
A second stage of analysis looked for possible relationships
between the categories and at how frequently each was dis-
cussed across all the included studies. Information pertaining to
the secondary objectives (e.g., study design, country, and partici-
pant information) were summarized in tables.
Results
The implemented search identified 42 852 potentially relevant
articles, and 76 met inclusion criteria and were ultimately included
for analysis [19–23,28–98] (see Figure 1). The most common rea-
sons for exclusion were that the source was not a peer reviewed
journal article (nà69), the article did not report or discuss indica-
tors of life success (nà68), did not report the perspective of indi-
viduals with TBI (nà47), or did not use qualitative methods of
data generation and analysis (nà26). Five articles [40,41,80,87,90]
appeared to report results from a larger or previously published
study, and as such, the 76 included articles present findings from
71 primary studies. Figure 2 presents the proportion of included
articles based on the year of publication, with the majority (95%)
having been published since 2000. The earliest publication was
from 1993.
INDICATORS OF LIFE SUCCESS FOLLOWING BRAIN INJURY 3
Nature of the qualitative literature
Table 1 includes details of the included articles and the various
study designs employed. The study designs varied, including
qualitative design (with no further descriptors (nà23)), grounded
theory (nà15), phenomenology (nà13), case studies (nà6),
qualitative descriptive (nà3), narrative (nà3), autoethnography
(nà2), and a phenomenographic design (nà1). Some articles
used mixed or multiple methods and reported findings from the
qualitative phase (nà8). Two articles did not report the study
design. A variety of theoretical perspectives guided the research,
including an interpretive perspective [19,21,36,41,53,58,70,76,80,
85,97], hermeneutics [34,56,77], realism [29,47], constructivism
[22,45,59,87,90,91], symbolic interactionism [71,88], pragmatism
[35,92], post-structural feminism [31], post-positivism [20], and
critical realism [96]. The most common method of data generation
was through interviews (nà68, 89%), followed by focus groups
(nà3, 4%), document analysis of email correspondence and jour-
nal entries (nà2, 3%), and analysis of personal narratives (nà2,
3%). One study [67] used a combination of participant observa-
tion and interview (2%). Four studies employed longitudinal
methods of data collection. Conneeley [39–41] collected data at
hospital discharge and 6 and 12 months later. Fadyl et al. [20] col-
lected data 6, 12, and 24-months post-injury. Chhuom and
Thompson [95] collected data at 1, 3, 6, and 12-months post-
injury. Mealings et al. [90,91] collected data in a series of inter-
views over 3–15 months as participants engaged in educa-
tional courses.
Contexts shaping the research and life outcomes discussed
Table 2 details the countries where the studies were conducted,
with the majority completed in Australia (nà18), and the USA
Figure 1. PRISMA diagram.
4 E. NALDER ET AL.
(nà16). No included articles were published in Asia or South
America, and the only African country represented was South
Africa (nà4).
Table 3 includes details regarding the participant characteris-
tics from included articles. The median sample size across the
included articles was 10 and the range was from 1 to 144 partici-
pants who had experienced TBI. The majority of studies (nà47,
66%) reported data from adults with TBI (aged 18–65). Children
and young adults (aged 25 and under) were the focus of five
studies (7%), and older adults (aged 65 and over) were the focus
of two studies (3%) (see Table 3). In the studies with children and
older adults the indicators of life success were similar to those
identified in studies with adults, however, different participation
contexts (e.g., school/working and approaching retirement) were
described as being important in shaping experiences, sense of
self, and hopes for the future [65,95].
Table 3 also describes the participant characteristics in terms
of gender, severity of TBI and time since injury. The ratio of male
to female participants ranged from 1:1 to 9:1, and 13 studies
(18%) had more females than males. Fourteen papers included
only male participants, and six included only females. Most stud-
ies included participants with all severities of TBI (nà20, 28%) or
severe TBI (nà15, 21%). Injury severity was ascertained based on
either initial Glasgow Coma Scale score, duration of posttraumatic
amnesia (PTA) or the author’s description of injury severity. Nine
studies (13%) included participants less than 1-year post injury on
average, and 21 studies (30%) included participants on average
10 or more years post-injury (see Table 3). Thus, based on the
studies, the indicators of life success discussed next are potentially
relevant to people experiencing TBI regardless of severity, or time
post-injury, though given the small number of longitudinal stud-
ies more attention is needed to capture changes in experiences
over time.
Positive life experiences that reflect indicators of life success
Nine categories of positive life experiences were identified (see
Table 4), and were organized within four domains, understanding
of oneself and the world, social, doing, and hope. Each domain
represented a distinct sphere of individuals’ lives but were inter-
related. The understanding domain encompasses experiences
related to how one understands who they are (identity) and their
life. The social domain encompasses experiences relating to social
relationships and how individuals fit in with other people. The
Figure 2. Year of publication.
Table 1. Study designs.
Methodology (frequency) Articles
Qualitative design (nà23) [29,36,37,39,97]
a
, [42,44,86,83,47,50,
58,93,28,98,64,63,66,84,67,76,77,78]
Grounded theory (nà15) [23,35,45,48,51,54,55,59,65,75,90,91]
a
,
[89,70,92]
Phenomenology (nà13) [34,40,41,82]
a
, [21,22,53,56,61,
69,80,94]
a
, [74]
Mixed or multi-method (nà8) [30,96,31,32,38,46,57,19]
Qualitative descriptive (nà3) [20,43]
a
, [87]
a
Other case study (nà6) [95,68,71,49,85,72]
Narrative (nà3) [79,52,81]
Autoethnography (nà2) [88,60]
Phenomenographic approach (nà1) [62]
Methodology/design not specified (nà2) [33,73]
a
Conneeley [39–41] reports on findings from the same study. Soeker et al.
[76,80], report on findings from the same study. Mealings et al. [90,91], report
on findings from the same study. McPherson et al. [87] and Fadyl et al. [20]
pertain to the same larger study.
Table 2. Countries where research occurred.
Country (frequency) Articles
Australia (nà18) [31,38,42,44,45,86,50,54,55,59,98,75,65,90,91,21,19,69]
USA (nà16) [34,36,37,43,48,51,62,67,68,71,74,79,82,89,92,95]
a
Canada (nà13) [32,35,97,88,46,83,58,60,28,64,63,70,81]
UK (nà12) [66]
England (nà9) [29,39–41,47,49,22,73,85]
Scotland (nà1) [33]
Wales (nà1) [53]
New Zealand (nà5) [20,57,61,23,87]
South Africa (nà4) [72,76,79,80]
a
Sweden (nà3) [30,56,77]
Ireland (nà2) [96,84]
Netherlands (nà1) [52]
Norway (nà1) [78]
Germany (nà1) [93]
Denmark (nà1) [94]
a
Tasker [79] reported on data collected in both the USA and South Africa.
INDICATORS OF LIFE SUCCESS FOLLOWING BRAIN INJURY 5
doing domain encompasses experiences relating to engaging in
meaningful activities and subjective experiences of participation.
The hope domain encompasses experiences related to one’s
vision of the future. The understanding, social, and doing domains
were more frequently discussed, referenced in 62, 54, and 53
articles, respectively (70–82%). Hope was discussed in 33 articles
(43%). Life experiences within each domain are described below.
The extracted data included statements reflecting experiences
one has (e.g., “having social relationships”, “having a job”), how
one feels (e.g., “feeling loved”), and beliefs or thoughts about
one’s circumstances (e.g., “accepting changes in social inter-
actions”, “accepting the new me”). These statements reflect
behavioral, affective, and cognitive aspects of resiliency, or in
other words, how experiences are emotionally laden (affective),
involve meaning making (cognitive) and shape behavior and
motivation to engage with the environment [5,99]. In describing
the positive life experiences below the affective, cognitive, and
behavioral aspects are described to illustrate the different ways in
which these experiences shape perceptions of life success.
In the understanding domain [19–23,28–38,40–43,45,47–56,58,
61–63,65–67,69–72,76–82,84–92,94–96,98], three positive life expe-
riences were evident, having a coherent sense of self, having a
sense of self-worth, and having new perspectives on life.
Having a coherent sense of self refers to a person’s understand-
ing of who they are, feeling satisfied with who they are, having a
sense of identity, and understanding their needs and place in the
world. The category of having a coherent sense of self includes
cognitive aspects, such as having a sense of identity and accept-
ing “the new me”, as well as affective aspects (e.g., feeling satis-
fied with who they are as a person or feeling like a “complete
person”). Having a coherent sense of self and seeing some
continuity in one’s identity pre- to post-injury was reflected in the
following quote in an article by Allen et al. [96,p.6] “It’s taken me
some time to realize that I’m still here, I still hold the same princi-
ples, I still care about the same people” . Having a sense of self-
worth refers to having belief in oneself, seeing oneself as having
value, and having positive views of one’s strengths/abilities.
Having a sense of identity and self-worth are reflected in the fol-
lowing quote in an article by Douglas [45,p.66] “I’m glad I had my
accident because it’s made me into a better person. It’s made me
help people. If I see a lady across the road with shopping I will run
over and help her” . The category of having a sense of self-worth
includes affective aspects such as feeling good enough and cogni-
tive aspects (e.g., believing in oneself, seeing one’s capacity
for resiliency).
Having new perspectives on life refers to individuals coming to
view/understand themselves or their life in different (adaptive)
ways (e.g., seeing meaning in the TBI experience, viewing them-
selves as a better person, changing one’s priorities in life, and
having appreciation and gratitude for life and what one has).
Having new perspectives is reflected in the following quote in an
article by Sabat et al. [72,p.22] “I used to be very naive and care-
free. The accident has transformed my life, the way I see things. I
feel more grounded. I’m able to see the lighter side of things. I used
to be a very negative guy.” The category of having new perspec-
tives on life involves primarily cognitive aspects related to finding
meaning in the experience, and coming to understand, accept, or
appreciate aspects of one’s life in new ways.
In the social domain [20–22,28,30–32,34–39,42–51,53,54,56,57,
59,60,62,63,66,68–71,73–75,77–79,83–87,90–94,97,98], two positive
life experiences were evident, having social relationships and being
understood and accepted by others.
Table 3. Participant characteristics in primary research studies (nà71).
Studies
n (%) Articles
Age (years)
All age groups (children/youth-older adults) 2 (3) [20,87]
Children/young adult (<25) 5 (7) [33,44,93,65,92]
Adults and older adults (18á) 13 (18) [29,30,31,38,86,83,54,55,98,23,22,89,70]
Adults (17–65) 47 (66) [32,34–37,39–41,82,96]
a
, [19,21,28,42,43,45–53,56,58,59,61–64,67–69,71–76,80,84,
88,90,91,94]
a
, [77,78,79,81,85]
Older adults (65á) 2 (3) [95,57]
Not reported 3 (4) [97,60,66]
Sex ratio (male:female)
100% male 14 (20) [95,43,88,47,49,50,55,22,63,65,69,71,72,85]
100% female 6 (8) [31,83,53,60,68,81]
Less than 1:1 7 (10) [30,97,93,92,74,78,79]
1:1 to 2:1 12 (17) [96,37,82,42,44,94,51,54,57,98,61,75]
2:1 to 3:1 14 (20) [38–41]
a
, [46,86,20,48,28,23,87,90,91,21,84,70,77]
3:1 to 4:1 10 (14) [32,33,36,52,56,59,62,64,66,89]
Equal to or greater than 4:1 8 (11) [19,29,34,45,58,67,73,76,80]
a
Not reported 1 (1) [35]
Time since TBI
<1-year 9 (12) [20,29,95,97]
a
, [87,90,91]
a
, [19,89,78]
1–5 years 21 (28) [20,32,33,38,44,46,82,86]
a
, [22,48,52,60,61,64,65,90,91,94]
a
, [89,92,77,85]
5–10 years 13 (18) [96,37,47,49,53,58,62,63,84,67,69,74,79]
>10 years 21 (28) [30,31,34,35,42,45,50,51,56,59,98,28,23,21,68,70,71,72,73,75,81]
Not reported/mean not able to be calculated 11 (15) [36,39–41]
a
, [43,54,55,57,66,76,80,83,88,93]
a
TBI severity
All severities 20 (28) [33,34,38,42,44,46,20,83,47,50,94,53,23,87,90,91,66,19,67,89,77]
Mild 8 (11) [30,97,95,43,88,57,62,78]
Mild–moderate 3 (4) [69,76,80,92]
a
Moderate–severe 9 (13) [32,52,56,93,98,28,61,64,79]
Severe 15 (21) [29,39–41]
a
, [45,86,55,59,65,63,70,71,74,72,75,81,85]
Not reported 17 (24) [96,31,35,36,37,82,48,49,51,54,58,60,22,21,84,68,73]
a
Conneeley [39–41] reports on findings from the same study. Soeker et al. [76,80], report on findings from the same study. Fadyl et al. [20] present data from a lon-
gitudinal study and report on data collected approximately 6, 12, and 24 months post-injury. Mealings et al. [90,91] report longitudinal data and data from the
same study. Fadyl et al. [20] and McPherson et al. [87] pertain to the same larger study.
6 E. NALDER ET AL.
Having social relationships was about having other people in
your life who one feels connected to (having social relationships),
having opportunities to engage with others (having social inter-
action), and having people to love and support, and to receive
love and support from (reciprocity). The following quote drawn
from the work of Carlozzi et al. [37,p.s52] illustrates positive expe-
riences of having stronger relationships after the injury: “Your rela-
tionships are more-I want to say meaningful. There’ s more depth to
them”. The category of having social relationships included behav-
ioral aspects, such as having social interaction and having reci-
procity in relationships. It also included cognitive aspects
(accepting or coming to understand) as individuals with TBI dis-
cussed accepting changes in how they get social interaction, and
with their relationships (e.g., letting go of some relationships that
were not helpful in their life).
Being understood and accepted by others was about the feeling
of being supported, having people with whom you can be honest
about aspects of your life, and where things can be left unsaid
(understanding). For instance, Jumisko et al. [56,p.2277] included
the following illustrative quote: “ few friends that I can trust …
they don’t mind if I’m sour or sullen or don’t have strength … they
stay anyhow and say ‘aha it’s that kind of day’ then we will do
something else or do nothing or meet tomorrow, they take it as it is
… you can be as you are, you don’t have to pretend” . Being
accepted refers to experiences of being treated in the same way
as others, being respected, and feeling part of things. The cat-
egory of being understood and accepted included behavioral and
cognitive aspects. For example, being understood or accepted
reflect experiences one has (behavioral), however, feelings and
positive emotions resulting from social relationships and feeling
understood (e.g., feeling cared for and loved, feeling part of
things) reflect affective aspects of these life experiences.
In the doing domain [5,20,22,28, 29,31–35,39–42,45–47,49–52,
54–62,65,67–71,74,76–82,84,86,88,91–94,97,98], three positive life
experiences were evident, being active and productive, having
autonomy and control, and experiencing accomplishment (or achiev-
ing things).
Being active and productive was about having things to do to
occupy one’s time, recognizing that these activities give purpose,
pleasure, and/or direction in life. The category of being active and
productive included behavioral aspects, related to having things
to do, and pursuing goals. It also had affective and cognitive
aspects evident in positive feelings related to engaging in activ-
ities (e.g., satisfaction, pleasure), and accepting new ways of doing
things. The latter is evident in the following quote in an article by
Tasker [79,p.342] “I may not be able to do everything the way I did
before but I can still do many things as long as I approach it in a
slightly different way”.
Having autonomy and control refers to being able to make
decisions and exercise control over one’s life. This category
reflects behavioral aspects of engaging in activities and regaining
a sense of control. The following excerpt from an article by
Roscigno and Van Liew [71,p.5] highlights the importance of mak-
ing decisions about how one lives their life and how this shapes
Table 4. Positive life experiences reflecting indicators of life success.
Life experience Description
Understanding oneself
and one’s life
Having a coherent sense of self
Feeling like a “complete” person
Having a sense of identity
Feeling like one’s “old self”; seeing the TBI as part of who you are.
Understanding one’s identity; understanding your own needs; reconstructing one’s sense of
self; feeling satisfied with a new sense of self; acceptance of a “new me”, including new
roles, strengths and limitations and/or changes to functioning.
Having a sense of self-worth
Having a sense of self-worth/value
Having a positive view of one’s
strength/abilities
Having/regaining a sense of value; feeling good enough/needed; believing in oneself.
Seeing one’s positive attributes, strengths and capacity for resiliency; believing that you are
able to succeed.
Having new perspectives on life
Seeing the meaning in the TBI
experience
Seeing oneself as a better person
Having appreciation/gratitude for
one’s life
Making sense of the TBI experience; connecting the TBI to one’s life story/narrative; seeing
the positive effects of the injury (silver lining).
Feeling that one is a better person now; having an appreciation of the differences among
people.
Having appreciation for what one has in life; having new realizations regarding one’s
appreciation for life; valuing life in a new more meaningful way; feeling at peace; having
a new sense of how to live life and not dwelling on the past.
Social Having social relationships
Having relationships with others
Having social interaction
Having reciprocity in social
relationships
Having relationships with others which may involve forming new relationships and/or
maintaining existing relationships; feeling that the relationships is satisfying, meaningful,
loving, strong.
Having an active social life; accepting changes in social interactions.
Being supported and loved and able to offer support and love others.
Being understood and accepted by
others
Being understood
Being accepted
Being seen as a person
Having people who understand you, understand what you are going through, and who you
can share how you are feeling
Being treated the same as others
Being respected and having status in others’ eyes; feeling included, part of society, important
and accepted as you are.
Doing [19,20,28,29,31–35,
39–42,45–47,49–51,
54,56–62,65,67–71,
74,76–80]
Being active and productive
Having productive activities
Having a job
Having goals
Engaging in leisure activities
Doing things that occupy one’s time and provide a sense of purpose; having things to do;
feeling satisfied with one’s productivity; learning to do daily activities in different ways.
Returning to work or school, engaging in volunteer activities; having a job.
Engaging in activities that allow one to pursue their goals; setting new goals.
Engaging in activities for pleasure.
Having autonomy and control Having autonomy, privacy, control over one’s life and being able to make one’s own
decisions.
Feeling independent, capable of doing things for oneself and of making one’s own decisions.
Experiencing accomplishment
Having a sense of challenge
Receiving acknowledgement from
others
Achieving milestones
Having something to work toward; finding ways to work around constraints; making a
contribution.
Having others recognize one’s capabilities, strengths, and achievements.
Achieving milestones (e.g., getting a job, living independently, getting married).
Hope Having hope in life Having hope, plans, a belief in the future; feeling some certainty and optimism about the
future; feeling involved in a life of purpose and potential for achievement.
INDICATORS OF LIFE SUCCESS FOLLOWING BRAIN INJURY 7
engagement in activity: “He liked to be social and had tried many
different social avenues over the last 18 years to keep his social life
active. He finished 2 years of college after his injury, insisted on liv-
ing independently, and worked to support himself despite his
limitations.”
Experiencing accomplishments relates to experiences of being
challenged, having successes recognized by others, and making a
contribution. Sometimes the success was expressed as finding
ways around obstacles to meeting a goal [19,29,32,37,61], and
other times it related to giving back to others or to society
[28,33,34,61,62]. Accomplishments were in some cases judged
using information from the social environment, either acknow-
ledgement from others [39,47], or social norms reflecting import-
ant milestones (e.g., supporting oneself, having a family, getting
married) [19,29,51]. The category of experiencing accomplish-
ments included behavioral aspects (e.g., having something to
work toward and finding ways around constraints), and affective
aspects reflected in positive feelings related to perceived
successes.
In the hope domain [19–21,28,29,32–34,38,49,53,56–58,61,65,67,
72,76–83,85–87,89–91,94], the key experiences related to having
hope in life, envisioning and feeling optimistic about the future,
and believing that one is living a life that has purpose. This cat-
egory has cognitive aspects reflected in how one thinks about the
future (belief in future potential, optimism about the future) and
behavioral aspects (making plans and having experiences that
make one feel that life is purposeful). The following quote in a
study by Carulli et al. [82,p.33] illustrates experiences that give a
sense of purpose and meaning and contribute to feeling hopeful
about the future: “ What I want my future to be like is helping
others who are less fortunate than me. There are people in my com-
munity that look to me as, not a mentor, but a role model, I think,
because of what I have been through. They see me going to school
and finding success and being out there and not limiting my future
because I have a TBI … so I’m pretty hopeful about my future, I
have made quite a few connections in my sphere of people that I
want to be with, other faith-based people, and people who have a
real desire to help others”.
A transactional framework of positive life experiences is pre-
sented in Figure 3. The framework emerged from the analysis and
helps to: (1) illustrate the interconnections between experiences
in each life domain (understanding, doing, social, and hope) and
(2) capture the factors influencing positive life experiences. The
framework is transactional, recognizing different ways that individ-
uals are both shaping and shaped by the contexts where experi-
ences take place, and framed according to a life course
perspective. The bottom arrow in Figure 3 denotes that these
experiences occur at a particular point in time in individual’s lives,
are shaped by past experiences, and influence future choices and
opportunities.
Figure 3. Transactional framework of positive life experiences.
8 E. NALDER ET AL.
Experiences within each domain were closely connected. For
example, experiences related to social relationships and inter-
action (e.g., being accepted by others and being seen as a per-
son) and engaging in meaningful activities (e.g., experiencing
accomplishment, being active and productive) were linked to self-
identity (understanding) [48,49,58]. The following quote in a paper
by MacQueen et al. [22,p.307] links engagement in activities to a
masculine identity: “I still do eh, you know I still do the blokey
things, you know, go down the pub, meet friends, I don’t drink
much now ’cause I have to be careful with the brain injury and
alcohol and stuff so you know I still do that, go to the football” .
Social relationships motivated engagement in activity (doing) and
being active and productive provided opportunities for social
interaction (social). The following quote from an article by Libin
et al. shows the links between social relationships and being
active and productive [62,p.134] “I think it was more of a getting
back into the photography. I joined a photojournalism group …
and I met other decent photographers. I notice that this area is very
cliquey, so I met some really good female photographers who are
not only good in photography, but they’re actually good friends.”
Having new perspectives on life (understanding domain) contrib-
uted toward hope for the future, as evident in the following
quote in a study by Sabat et al. [72,p.22] “I have two choices: I can
either be happy and accept what is happening and look forward to
the future, or be sad and regret what is done”.
The positive experiences in each domain reflect both indicators
of success and processes contributing to how individuals respond
to challenging experiences in their life. For instance, in some cases,
a loss of productive activities (doing) was re-framed when individu-
als appreciated that it gave them more time to spend with close
others (social) [32,55], or opportunities to pursue new interests or
other activities that provide pleasure or a sense of purpose (doing
and hope) [19,21,34]. Alternatively, experiences of being treated as
different to others, or not respected (social), in some cases caused
individuals to seek a sense of control in their participation (doing)
[19,29], or to “let go” of some relationships and focus on relation-
ships with others who understand them (social) [32,43].
Discussion
Resiliency is an emerging area of study in TBI, explaining how
individuals adapt to life adversities [5]. The purpose of this review
was to synthesize qualitative literature in TBI and identify indica-
tors of life success from the perspective of individuals living with
TBI. A two-stage screening process identified 76 articles meeting
the criteria for inclusion. Positive life experiences were organized
into four domains: (1) an understanding domain reflecting experi-
ences of having a coherent sense of self, a sense of self-worth,
and forming new perspectives on life; (2) a social domain reflect-
ing experiences of having social relationships and interaction, and
feeling accepted/understood; (3) a doing domain reflecting expe-
riences of having things to do, a sense of control, and experienc-
ing accomplishment; and (4) a hope domain comprising
experiences of having hope and perceiving one is living a mean-
ingful and purposeful life. The studies included people living with
TBI (mild to severe), of all age ranges (children to older adults).
The primary objective was to identify indicators of life success
from the perspective of individuals living with TBI. Findings
reflected life experiences within understanding, doing, social, and
hope domains. This organization aligns with other literature on
how individuals experience meaning in life. For example,
Maslow’s hierarchy of human needs discusses the needs for affili-
ation, achievement, and self-actualization [100] which
conceptually are similar to the experiences falling within the social,
doing, and understanding domains, respectively. Additionally, litera-
ture on quality of life discusses domains of being (understanding),
belonging (connection to other people and places), and becoming
(engaging in activities that will allow one to meet their goals)
[101]. Our findings therefore support other literature describing dif-
ferent ways through which individuals experience meaning in life.
The four domains of life experiences (understanding, doing,
social, and hope) also align with research on resiliency. For
example, Masten’s seminal work discussed basic adaptational proc-
esses underpinning resiliency, including connection to others,
motivation to engage in the environment, and cognitive processes
which may influence understanding/meaning of experiences [102].
In disability research on resiliency, King et al. [7] identified that indi-
viduals acquired new life directions, through interactions with
others and their sense of belonging (social), taking part in mean-
ingful activities (doing), and acquiring an understanding of them-
selves and the world (understanding). Hope has been described as
a resiliency-related adaptive self-capacity relevant to rehabilitation
[4]. Taken together, resiliency literature and the findings in this
scoping review, suggest that resiliency following TBI may involve
multiple processes involving social interaction and relationships to
feel connected, accepted or understood, doing (or engagement in
activities providing a sense of control, purpose, or accomplish-
ment), meaning-making to develop understanding of oneself and
of life, and having experiences that provide a sense of hope.
The life experiences outlined in Table 4 and Figure 3 are both
processes and outcomes. They reflect processes in that they
explain how individuals negotiate life challenges related to the
TBI experience, and outcomes in that they are indicators of what
it means to do well in life at a particular moment in time from
the perspective of individuals living with TBI. These experiences
align with literature on life goals [103] and on interventions that
encourage living according to one’s values [104], which posit that
individuals views of themselves, and their aspirations/hopes for
the future change in response to life experiences. Understanding
indicators of success in life is an important first step in directing
rehabilitation and support services to enable individuals with TBI
to achieve what they want in life.
Other resiliency research in the context of TBI has used life sat-
isfaction, perceived wellbeing, psychological distress, and partici-
pation [17,105,106] as indicators of successful adaptation. The
current scoping review supports recent calls for studying resili-
ency in a multidimensional way [107], and suggests the need to
think of resiliency-related outcomes holistically, going beyond the
absence of distress and including other indicators of life success.
Honan et al. [10] through stakeholder consultation identified pri-
ority areas for psychosocial research, including activities and par-
ticipation, social support and relationships, and sense of self,
which is supported by the findings in the current review. A pro-
cess-model of resiliency specific to TBI proposed three inter-
related resiliency-related outcomes [5], reengaging in activities,
adapting participation and reconstructing identity. The positive
life experiences identified in this scoping review extend this
model and provide more nuanced indicators of successful adapta-
tion. For example, re-engaging in activity could be expanded to
include having things to do, accepting changes in how one car-
ries out these activities, having a sense of autonomy, and having
accomplishments. Similarly, in the understanding domain, it is not
only about reconstructing self-identity but about having a sense
of self-worth and developing new perspectives on life [5].
The findings also align with themes in Levack et al. [18] quali-
tative meta-synthesis highlighting the contextualized nature of
INDICATORS OF LIFE SUCCESS FOLLOWING BRAIN INJURY 9
resiliency. Disconnect with pre-injury self, mind/body disconnect,
social disconnect, and emotional distress, demonstrate the signifi-
cant experience of loss following TBI [18]. Some of the positive
experiences revealed in this review reflect the opposite of these
difficult experiences. For example, having a coherent sense of self
relates to the adversity of experiencing a disconnect with pre-
injury self, and the positive experiences of having social
relationships and being accepted relate to the adversity of social
disconnect [18]. This supports the contextualized nature of resili-
ency, where outcomes relate to the nature of the adversity and
how it is experienced and interpreted by individuals with TBI [5].
A secondary objective was to describe the nature of the quali-
tative research. A range of study designs were reported (e.g.,
grounded theory, phenomenology), and some studies referenced
epistemological beliefs or conceptual paradigms guiding their
work, of which interpretive approaches were most common. This
suggests that in general researchers and participants were under-
taking a process of interpreting, seeking understanding of experi-
ences and individualized meanings, recognizing this is
contextualized and constructed through the research process
[108]. It is apparent that there are few critical studies which may
be useful to problematize the discourses and power relations that
may be operating and influencing what success in life means, and
who can/can’t experience these successes [109]. Only three stud-
ies used narrative methods [52,79,81] which may be useful in
future resiliency research to understand the meanings embedded
in how individuals story their experiences [110].
Most included studies generated data through verbal methods
(interviews). As some have suggested that interviews can be chal-
lenging for individuals with cognitive and communication difficulties
[111] it may be useful to explore other methods in future research.
Visual or arts-based methods are an alternative approach to generat-
ing data, have been reported to promote deeper reflection on
issues, elicit meanings, and stories [112,113], and by not solely rely-
ing on verbal discussion, may help to mitigate challenges to gener-
ating data with individuals who have cognitive or communication
difficulties [111]. Including multiple perspectives (e.g., those of indi-
viduals with TBI and caregivers) may also be important to give a
more holistic perspective on life outcomes and experiences.
In terms of the countries, the research predominantly occurred
within North America or Commonwealth countries (e.g., UK,
Canada, Australia, New Zealand, and South Arica). Future research
should explore how individuals perceive their adaptation to life after
TBI in other countries (e.g., in Asian or South American regions per-
haps) and explicitly consider differences in cultural and religious
beliefs, and values, that might shape the meanings attached to life
experiences and indicators of life success [6]. Equally important is to
consider other factors that might influence experiences after TBI
such as gender or age. Most studies included participants covering
a broad age range (youth and young adults – older adults) and it
may be worthwhile to continue to explore whether the experiences,
processes of adaptation, and indicators of life success following TBI
are similar/different depending on life stage.
Implications for research and practice
This review synthesizes findings from qualitative literature in TBI
and describes positive experiences to track in TBI research and
program evaluation as they reflect indicators of life success identi-
fied by individuals with TBI. The framework of positive life experi-
ences (Figure 3) may be applied and evaluated in future research,
particularly where the emphasis is on capturing experiences import-
ant to individuals themselves. Future research could explore what
outcome measures exist that would assess the life experiences
identified in this review. As the life experiences reflected what
individuals have, felt, or accepted, it will be important to explore
to what extent measures include items that capture behavioral,
affective, and cognitive aspects of resiliency [5]. Longitudinal work
is also needed to study resiliency and adaptation over time and
to describe the processes and factors operating to bring about
positive life experiences which would serve to test and evaluate
the framework presented in Figure 3.
The findings also have implications for rehabilitation interven-
tion. A recent review identified several examples of resiliency-
enhancing interventions that have been studied with individuals
with TBI [114]. The interventions incorporated psychoeducation,
skills training, and cognitive-behavioral approaches [114]. Based
on the findings of this scoping review, we believe that ecological
interventions that provide opportunities for engaging in activities
in real-world contexts is important, so that individuals can have
experiences that will influence their adaptation. For example,
coaching interventions that adopt a collaborative, strength-based,
participation-oriented approach, have been shown in other con-
texts (e.g., pediatric rehabilitation) to contribute to empowered
mindsets and resiliency-related outcomes [115] and may hold
promise for individuals with TBI. Participation in narrative
approaches has been found to enable personal growth part of
building a strengths-based identity [116]. Additionally, recent trials
have indicated that Acceptance and Commitment Therapy may
reduce psychological distress for individuals with TBI [117,118].
This approach focuses on enabling individuals to live in ways that
are meaningful and aligned with their values [104,118]. The
emphasis on working collaboratively, and on engaging in
activities aligned with one’s values, may serve to influence resili-
ency-related outcomes. Future research is warranted, to evaluate
resiliency enhancing interventions, and to consider how different
services or interventions provide opportunities for individuals to
have positive experiences identified in this review.
Limitations
Some limitations to this review must be acknowledged. As articles
not published in English, or in a peer-reviewed source were
excluded, the review may have missed some relevant qualitative
studies and thus may not have captured all evidence on indicators
of life success from the perspectives of individuals with TBI.
Additionally, the review excluded data from service providers, and
family caregivers, and future research should also explore their per-
spectives regarding the indicators of life success following TBI that
may be targeted in service delivery. This review had a large number
of people involved in screening articles for inclusion which may
introduce more sources of bias and a greater possibility of error.
This risk was mitigated by the fact that two reviewers screened each
article, and a third person (the first author) was engaged if discrep-
ancies arose. Additionally, two people completed all data extraction.
In conclusion, this scoping review determined and described
positive experiences that reflect indicators of life success from the
perspective of individuals with TBI, including understanding having a
coherent sense of self, a sense of self-worth, and developing new
more adaptive perspectives on one’s life; social relationships, interac-
tions, and feeling accepted and understood by others; doing or
engaging in productive activities, and experiencing a sense of con-
trol and accomplishment; and lastly hope. A transactional framework
of life experiences, developed from the retrieved literature, can be
applied to inform our understanding of how individuals negotiate
adversity through experiences that promote understanding of
10 E. NALDER ET AL.
oneself and the world, social relationships, engagement in activity
and hope. These experiences can serve as a basis for future research
into resiliency. Understanding how to create opportunities for these
experiences to occur will help to shape service delivery in ways that
foster resiliency processes and may assist individuals with TBI to live
life in a way that is meaningful to them.
Acknowledgements
We gratefully acknowledge members of the TBI-Resiliency
Collective who provided feedback on the review findings and
implications for research and service delivery.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Funding
This work was supported by a Partnership Development Grant
from the Canadian Social Sciences and Humanities Research
Council. Dr. Nalder holds the Canada Research Chair (Tier 2) in
Resiliency and Rehabilitation funded by the Canadian Institutes of
Health Research, and a March of Dimes Canada, Paul J.J. Martin
Early Career Professorship. Dr. King holds a Canada Research Chair
(Tier 1) in Optimal Care for Children with Disabilities funded by
the Canadian Institutes of Health Research.
ORCID
Emily Nalder http://orcid.org/0000-0001-9612-9420
Gillian King http://orcid.org/0000-0001-7199-1217
Anne W. Hunt http://orcid.org/0000-0002-1933-6503
Laura R. Hartman http://orcid.org/0000-0001-7246-7863
Erica Lenton http://orcid.org/0000-0001-9392-2669
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Appendix A. Example search strategy
Medline
Ovid MEDLINE: Epub Ahead of Print, In-Process & Other Non-
Indexed Citations, Ovid MEDLINE
V
R
Daily and Ovid MEDLINE
V
R
<1946–Present>
# Searches Results
1 Craniocerebral Trauma/ 21 594
2 brain injuries/ or brain hemorrhage, traumatic/ or cerebral hemorrhage, traumatic/ or brain injuries, traumatic/ or brain injury, chronic/ or
Brain Contusion/
53 253
3 Head Injuries, Penetrating/ or Head Injuries, Closed/ 3812
4 Glasgow Outcome Scale/ or Glasgow Coma Scale/ 9747
5 (glasgow adj3 (scale⇤or measure⇤or instrument⇤)).tw,kf. 10 305
6 (rancho los amigos or ((rancho or amigos) adj4 (scale⇤or instrument⇤or measure⇤))).tw,kf. 184
7 ((head or crani⇤or capitis or brain⇤or cerebr⇤or cerebel⇤or neuro⇤or forebrain⇤or skull⇤or hemispher⇤or intra-cran⇤or inter-cran⇤)
adj3 (injur⇤or trauma⇤or damag⇤or wound⇤or fractur⇤or contusion⇤)).tw,kf
174 089
8 tbi.tw,kf. 19 630
9 or/1-8 [⇤⇤TBI] 204 382
10 exp qualitative research/ 35 928
11 grounded theory/ 654
12 focus groups/ or narration/ 30 705
13 (qualitativ⇤or interpretative⇤or interpretive⇤or Delphi or themes or focus group⇤or ethnograph⇤or fieldwork or field work or
hermeneutic⇤).tw,kf.
288 451
14 interview⇤.mp. 333 513
15 (grounded⇤adj4 theor⇤).tw,kf. 10 492
16 (phenomenolog⇤or autoethnograph⇤or auto-ethnograph⇤or critical⇤social⇤).tw,kf. 22 857
17 ((document⇤or script⇤or transcript⇤or thematic⇤or critical or discourse⇤) adj2 (analy⇤or interpret⇤)).tw,kf. 62 644
18 (diary or diaries or narrative⇤or narration or journal?ing).tw,kf. 49 244
19 (experience⇤adj7 (child⇤or elderly or adult⇤or teen⇤or youth⇤or adolescent⇤or survivor⇤or patient⇤or individual⇤or
participant⇤)).tw,kf.
247 081
20 (mixed method⇤or multi method⇤or multimethod⇤or mixedmethod⇤).tw,kf. 15 170
21 or/10-20 [⇤⇤Qualitative] 861101
22 9 and 21 [⇤⇤TBI and Qualitative] 7903
14 E. NALDER ET AL.
