International Journal for Quality in Health Care, 2021, 33(1), 1–7 doi: 10.1093/intqhc/mzab044 Advance Access Publication Date: 8 March 2021 Original Research Article Original Research Article Feasibility of modifying the hospital environment to reduce the length of amnesia after traumatic brain injury: a pilot randomized controlled trial NATASHA A. LANNIN 1,2 , CLAIRE GALEA 3 , MEGAN COULTER 2 , RUSSELL GRUEN 4 , LAURA JOLLIFFE 1,2 , TAMARA OWNSWORTH 5 , JULIA SCHMIDT 6 , and CAROLYN UNSWORTH 1,7 1 Department of Neuroscience, Monash University, Melbourne, VIC, Australia, 2 Occupational Therapy Department, Alfred Health, Melbourne, VIC, Australia, 3 Melanoma Institute Australia, Sydney, NSW, Australia, 4 College of Health and Medicine, Australian National University, Canberra, ACT, Australia, 5 Menzies Health Institute Queensland, Griffith University, Mount Gravatt, QLD, Australia, 6 University of British Columbia, Vancouver, BC, Canada, and 7 Federation University, Mount Helen, VIC, Australia Address reprint requests to: Natasha Lannin, Department of Neuroscience, Monash University, Melbourne, VIC 3800, Australia. Tel: +613 9903 0304; E-mail: Natasha.Lannin@monash.edu Received 20 September 2020; Editorial Decision 24 February 2021; Revised 21 December 2020; Accepted 8 March 2021 Abstract Background: Reorientation programmes have been an important component of neurotrauma reha- bilitation for adults who suffer from post-traumatic amnesia (PTA) after traumatic brain injury (TBI); however, research testing the efficacy of acute programmes is limited. Objective: This study aimed to determine if it is feasible to provide a standardized environmental reorientation programme to adults suffering from PTA after TBI in an acute care hospital setting, and whether it is likely to be beneficial. Methods: We conducted a randomized controlled trial with concealed allocation and intention-to- treat analysis. A total of 40 participants suffering from PTA after TBI were included. The control group received usual care; the experimental group received usual care plus a standardized ori- entation programme inclusive of environmental cues. The primary outcome measure was time to emergence from PTA measured by the Westmead PTA Scale, assessed daily from hospital admission or on regaining consciousness. Results: Adherence to the orientation programme was high, and there were no study-related adverse responses to the environmental orientation programme. Although there were no statis- tically significant between-group differences in time to emergence, the median time to emergence was shorter for those who received the standardized reorientation programme (9.0 (6.4–11.6) versus 13.0 (4.5–21.5) days). Multivariate analysis showed that the Glasgow Coma Scale (GCS) at scene (P = 0.041) and GCS at arrival at hospital (P = 0.0001) were significant factors contributing to the longer length of PTA. Conclusion: Providing an orientation programme in acute care is feasible for adults suffering from PTA after TBI. A future efficacy trial would require 216 participants to detect a between-group difference of 5 days with an alpha of 0.05 and a power of 80%. © The Author(s) 2021. Published by Oxford University Press on behalf of International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 1 Downloaded from https://academic.oup.com/intqhc/article/33/1/mzab044/6162463 by guest on 04 January 2023