Modeling of Community Integration Trajectories in the First Five Years after Traumatic Brain Injury

Abstract

The aims of this study were to assess the trajectories of community integration in individuals with traumatic brain injury (TBI) through one, two, and five years post-injury and to examine whether those trajectories could be predicted by demographic and injury characteristics. A longitudinal cohort study was conducted with 105 individuals with moderate-to-severe TBI admitted to a trauma referral center in 2005-2007. Demographics and injury-related factors were extracted from medical records. At the one-, two- and five-year follow-ups, community integration was measured by the Community Integration Questionnaire (CIQ). A hierarchical linear model (HLM) examined whether longitudinal trajectories of community integration could be predicted by: time, sex, age, relationship status, education, employment status, occupation, acute Glasgow Coma Scale score, cause of injury, days in post-traumatic amnesia (PTA), computed tomography Marshall Score, and Injury Severity Score. CIQ scores improved across the three time-points (p<0.001). Additionally, higher trajectories of community integration were predicted by being single at the time of injury (p<.001), higher level of education (p=0.006), employment (p<0.001), and a shorter length of PTA (p<0.001). In a follow-up HLM with interaction terms, time*PTA was statistically significant (p<0.001), suggesting that participants with longer PTA increased in community integration more rapidly than those with shorter PTA. The longitudinal course of community integration described in this study may help rehabilitation professionals to plan more extensive follow-ups and targeted rehabilitation programs in the early stage of recovery for patients with specific demographic and injury characteristics.

Disability and quality of life 20 years after traumatic brain injury

“…Age and gender had no impact on community reintegration. However, injury severity influenced community integration, in line with previous studies (Andelic et al., ; Sandhaug, Andelic, Langhammer, & Mygland, ; Winkler, Unsworth, & Sloan, ). The results also showed significant improvements in the community integration from 10 to 20 years both in between and within TBI severity groups.…”

“…A large proportion of patients with moderate and severe traumatic brain injury (TBI) sustain long‐term physical, cognitive, and emotional impairments that have a deep impact on their functioning, reintegration to society and health‐related quality of life (HRQL; Andelic et al., ; Forslund, Roe, Sigurdardottir, & Andelic, ; Hammond et al., ; Jacobsson, Westerberg, Soderberg, & Lexell, ; Ponsford, Draper, & Schonberger, ; Schulz‐Heik et al., ; Sigurdardottir, Andelic, Roe, & Schanke, ; Wilson et al., ). TBI outcomes up to 10 years postinjury have been documented in several studies (Andelic et al., , ; Dahm & Ponsford, ; Jourdan et al., ). The findings suggest that patients with moderate and severe TBI experience persisting functional limitations and decreased employment rates (Andelic et al., ; Forslund et al., ; Ponsford et al., ), reduced physical and mental health and elevated probabilities of social isolation (Andelic et al., ; Hawthorne, Gruen, & Kaye, ).…”

Sex & gender considerations in concussion research

“…The severity of insomnia was found to be a main factor independently associated with community integration [ 34 ], perceived disability severity [ 33 ], more severe fatigue and diminished alertness [ 36 ]. Consistent with previous research [ 39 ], we observed a trend toward better community integration in females compared with males, with scores 15.56 ± 6.01 versus 13.96 ± 4.67, respectively, when utilizing the community integration questionnaire, although our results did not reach the level of statistical significance [ 35 ]. Likewise, the frequency of marked/extreme global disability in females was lower than in males (36 vs 65%, respectively) when utilizing the Sheehan disability scale [ 34 ].…”

Traumatic Brain Injury Rehabilitation in Hong Kong: A Review of Practice and Research

“…They also experience difficulties in the psychosocial domain—often as a result of a combination of injury-related, psychological, and social factors [ 21 , 22 ], which predisposes them to a range of psychosocial and emotional problems [ 5 ]. Taken together, these consequences also hinder their reintegration into the community [ 23 ]. Fortunately, some of these consequences are at least amenable to rehabilitation.…”