Assessing support needs for people with traumatic brain injury: the Care and Needs Scale (CANS)

After traumatic brain injury (TBI), many individuals have support needs, but the variety, frequency and intensity of such needs vary widely. Currently available scales do not assess all facets of required supports and the eight-category Care and Needs Scale (CANS) was developed in order to capture the range of support needs. The aim of the present study was to examine the sensitivity and validity of the CANS.

Using a sample of 67 people who sustained severe TBI 20-26 years previously, the CANS was compared with the Supervision Rating Scale (SRS), five scales from the Craig Handicap Assessment and Reporting Technique (CHART) and the Sydney Psychosocial Reintegration Scale (SPRS).

The data showed a spread across all CANS categories: 28.4% of participants were fully independent, 46.3% had support needs on less than a daily basis (25.4% intermittently, 13.4% at least weekly and 7.5% every few days) and the remaining 25.4% had needs on a daily basis (ranging from 11.9% for up to 11 hours per day to 4.5% for 24 hours per day). By contrast, the 13-category SRS classified 61.2% in the best category and five categories did not contain any individuals. The CANS showed strong correlation with the SRS (r(s) = 0.75), as well as CHART and SPRS scores (range r(s) = -0.46 to -0.85) and statistically significant differences were found among participant sub-groups. Logistic regression analyses, using variables collected at the time of discharge from rehabilitation, were able to predict independence on the CANS with classification accuracy of 77% and presence of neuropsychological disability was an individual predictor.

These results suggest that the CANS shows promise as a sensitive and valid instrument to measure care and support needs after TBI, particularly in the longer term, and further examination of its psychometric properties is warranted.