Rehabilitation Needs at 5 Years Post-Traumatic Brain Injury: A VA TBI Model Systems Study

Mahoney, Elaine J.; Silva, Marc A.; Reljic, Tea; Dams-O’Connor, Kristen; Hammond, Flora M.; Monden, Kimberley R.; Chung, Joyce; Dillahunt-Aspillaga, Christina; Nakase‐Richardson, Risa

doi:10.1097/htr.0000000000000629

Cited by 19 publications

(6 citation statements)

References 43 publications

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“…In recent years, data from large-scale prospective studies 5,8,15,16 have enriched understanding of the natural history of TBI. The multicenter Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study revealed that, contrary to popular belief that mild TBI (mTBI) (ie, Glasgow Coma Scale [GCS] score, [13][14][15] is a time-limited condition, the majority of level I trauma center patients with mTBI continue to report symptoms and injury-related problems with daily function at 1 year postinjury. 15,17 Persons with moderate-severe TBI (msTBI) (GCS score, [3][4][5][6][7][8][9][10][11][12] in the TRACK-TBI sample have displayed varied outcomes, often achieving functional independence and returning to work but rarely making a complete recovery.…”

Section: Introductionmentioning

confidence: 99%

“… 7 , 8 , 9 , 10 , 11 Although many persons appear to have an ongoing need for support to overcome and compensate for TBI-related deficits, they rarely receive formal clinical services beyond the first few months postinjury. 12 , 13 , 14 Large-scale prospective studies characterizing the long-term outcomes of TBI may inform initiatives to develop systems of postacute care for TBI that better meet the long-term needs of this population, 14 while promoting clinical research aimed at developing disease-modifying therapies.…”

Section: Introductionmentioning

confidence: 99%

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Functional Recovery, Symptoms, and Quality of Life 1 to 5 Years After Traumatic Brain Injury

et al. 2023

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ImportanceMany level I trauma center patients experience clinical sequelae at 1 year following traumatic brain injury (TBI). Longer-term outcome data are needed to develop better monitoring and rehabilitation services.ObjectiveTo examine functional recovery, TBI-related symptoms, and quality of life from 1 to 5 years postinjury.Design, Setting, and ParticipantsThis cohort study enrolled trauma patients across 18 US level I trauma centers between 2014 and 2018. Eligible participants were enrolled within 24 hours of injury and followed up to 5 years postinjury. Data were analyzed January 2023.ExposuresMild TBI (mTBI), moderate-severe TBI (msTBI), or orthopedic traumatic controls (OTC).Main Outcomes and MeasuresFunctional independence (Glasgow Outcome Scale-Extended [GOSE] score 5 or higher), complete functional recovery (GOSE score, 8), better (ie, lower) TBI-related symptom burden (Rivermead Post Concussion Symptoms Questionnaire score of 15 or lower), and better (ie, higher) health-related quality of life (Quality of Life After Brain Injury Scale-Overall Scale score 52 or higher); mortality was analyzed as a secondary outcome.ResultsA total 1196 patients were included in analysis (mean [SD] age, 40.8 [16.9] years; 781 [65%] male; 158 [13%] Black, 965 [81%] White). mTBI and OTC groups demonstrated stable, high rates of functional independence (98% to 100% across time). While odds of independence were lower among msTBI survivors, the majority were independent at 1 year (72%), and this proportion increased over time (80% at 5 years; group × year, P = .005; independence per year: odds ratio [OR] for msTBI, 1.28; 95% CI, 1.03-1.58; OR for mTBI, 0.81; 95% CI, 0.64-1.03). For other outcomes, group differences at 1 year remained stable over time (group × year, P ≥ .44). Odds of complete functional recovery remained lower for persons with mTBI vs OTC (OR, 0.39; 95% CI, 0.28-0.56) and lower for msTBI vs mTBI (OR, 0.34; 95% CI, 0.24-0.48). Odds of better TBI-related symptom burden and quality of life were similar for both TBI subgroups and lower than OTCs. Mortality between 1 and 5 years was higher for msTBI (5.5%) than mTBI (1.5%) and OTC (0.7%; P = .02).Conclusions and RelevanceIn this cohort study, patients with previous msTBI displayed increased independence over 5 years; msTBI was also associated with increased mortality. These findings, in combination with the persistently elevated rates of unfavorable outcomes in mTBI vs controls imply that more monitoring and rehabilitation are needed for TBI.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Functional Recovery, Symptoms, and Quality of Life 1 to 5 Years After Traumatic Brain Injury

et al. 2023

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“…1,2 Reductions in health-related quality of life (HRQOL) and participation are commonly reported. [3][4][5] Despite extensive knowledge about common TBI-related sequelae, research has consistently documented worldwide unmet needs for health care services in the chronic phase of TBI, 6,7 even in affluent countries with universal health care services. 8 There are few methodologically rigorous studies that document treatment options in the chronic phase of TBI.…”

Section: Introductionmentioning

confidence: 99%

Effect of an Individually Tailored and Home-Based Intervention in the Chronic Phase of Traumatic Brain Injury

et al. 2023

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ImportanceTraumatic brain injury (TBI) can cause long-lasting and heterogeneous difficulties that require an individually tailored approach to rehabilitation. However, high-quality studies of treatment options in the chronic phase of TBI are lacking.ObjectiveTo evaluate the effect of a home-based, individualized, and goal-oriented rehabilitation intervention in the chronic phase of TBI.Design, Setting, and ParticipantsThis study was an intention-to-treat parallel-group assessor-blinded randomized clinical trial with 1:1 randomization to an intervention or control group. Participants included adults in southeastern Norway who had sustained a TBI more than 2 years earlier, lived at home, and had ongoing TBI-related difficulties. A population-based sample of 555 individuals were invited, and 120 were included. Participants were assessed at baseline, 4 months, and 12 months after inclusion. Specialized rehabilitation therapists provided the intervention in patients’ homes or via video conference and telephone. Data collection was conducted between June 5, 2018, and December 14, 2021.InterventionsThe intervention group received an 8-session individually tailored and goal-oriented rehabilitation program over 4 months. The control group received usual care in their municipality.Main Outcomes and MeasuresPreestablished primary outcomes were disease-specific health-related quality of life (HRQOL; measured by the Quality of Life After Brain Injury [QOLIBRI] overall scale) and social participation (measured by the Participation Assessment With Recombined Tools–Objective [PART-O] social subscale). Preestablished secondary outcomes included generic HRQOL (measured by the EuroQol 5-dimension 5-level [EQ-5D-5L] questionnaire), difficulty with TBI-related problem management (target outcomes; mean severity calculated across 3 main self-identified problem areas that were individually measured using a 4-point Likert scale), TBI symptoms (measured by the Rivermead Post Concussion Symptoms Questionnaire [RPQ]), psychological distress (depression and anxiety; measured by the Patient Health Questionnaire 9-item scale and the Generalized Anxiety Disorder 7-item scale [GAD-7], respectively), and functional competency (measured by the Patient Competency Rating Scale).ResultsAmong 120 participants in the chronic phase of TBI, the median (IQR) age was 47.5 (31.0-55.8) years, and the median (IQR) time since injury was 4 (3-6) years; 85 (70.8%) were male. A total of 60 participants were randomized to the intervention group, and 60 were randomized to the control group. Between baseline and 12 months, no significant between-group effects were found for the primary outcomes of disease-specific HRQOL (QOLIBRI overall scale score: 2.82; 97.5% CI, −3.23 to 8.88; P = .30) or social participation (PART-O social subscale score: 0.12; 97.5% CI, −0.14 to 0.38; P = .29). At 12 months, the intervention group (n = 57) had significantly higher generic HRQOL (EQ-5D-5L score: 0.05; 95% CI, 0.002-0.10; P = .04) and fewer symptoms of TBI (RPQ total score: −3.54; 95% CI, −6.94 to −0.14; P = .04) and anxiety (GAD-7 score: −1.39; 95% CI, −2.60 to −0.19; P = .02) compared with the control group (n = 55). At 4 months only, the intervention group (n = 59) had significantly less difficulty managing TBI-related problems (target outcomes mean severity score: −0.46, 95% CI, −0.76 to −0.15; P = .003) compared with the control group (n = 59). No adverse events were reported.Conclusions and RelevanceIn this study, no significant results were observed for the primary outcomes of disease-specific HRQOL or social participation. However, the intervention group reported improvements in secondary outcomes (generic HRQOL and symptoms of TBI and anxiety) that were maintained at 12-month follow-up. These findings suggest that rehabilitation interventions could help patients even in the chronic phase of TBI.Trial RegistrationClinicalTrials.gov Identifier: NCT03545594

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“…This healthcare quality chasm poses an even wider disparity for those following TBI, where navigation and engagement in healthcare services can be complicated by cognitive challenges 8,9. Indeed, healthcare access barriers are associated with report of greater unmet rehabilitation needs specifically in those with TBI in the years that follow injury 12…”

mentioning

confidence: 99%

“…8,9 Indeed, healthcare access barriers are associated with report of greater unmet rehabilitation needs specifically in those with TBI in the years that follow injury. 12 Initiatives to address chronic pain are a national priority. [13][14][15] As clinical care teams have attempted to respond to chronic pain, the opioid crisis in the United States has led to national legislative priorities in advancing evidence-based treatment and prevention measures to reduce the rate of opioids and addiction.…”

mentioning

confidence: 99%

Stakeholder Engagement to Identify Implementation Strategies to Overcome Barriers to Delivering Chronic Pain Treatments: A NIDILRR and VA TBI Model Systems Collaborative Project

Haun,

Nakase-Richardson,

Cotner

et al. 2024

Journal of Head Trauma Rehabilitation

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Objective: The purpose of this article is to illustrate the process of stakeholder-engaged intervention mapping approach to identify implementation strategies to overcome data-driven prioritized barriers to receiving chronic pain services for persons with traumatic brain injury (TBI). Setting: Community. Participants: Healthcare providers (n = 63) with 2 or more years' experience treating persons with TBI, interviewed between October 2020 and November 2021 provided data for identification of barriers. TBI, chronic pain, and qualitative research subject matter experts (SMEs) participated in the mapping approach. Design: Participatory-based research design, using descriptive and intervention mapping approaches. Results: Four barriers to accessing chronic pain treatment by persons with TBI which emerged from provider interviews were prioritized for intervention mapping: cognitive deficits of patients (67%); patient comorbidities (63%); mental health and/or substance abuse issues (59%); and patient participation (62%). SMEs used prioritized barriers to develop 4 primary objectives and implementation strategies designed to: (1) engage consumers to validate and identify strategies; (2) tailor pain treatment and delivery to overcome barriers; (3) develop and disseminate guidelines and best practices when delivering care to persons with TBI to support spread; and (4) increase awareness, skills, and readiness of workforce to deliver pain treatment to persons with TBI. SMEs used an evidence-based approach to develop a mapping matrix of the prioritized barriers, implementation objectives, and aligned implementation strategies to impact change. Conclusion: Implementation science is needed to facilitate knowledge translation into practice for this complex population to overcome barriers to care. Implementation strategies to address barriers to accessing chronic pain care for individuals with TBI were chosen through a participatory approach to engaging SMEs to support these rehabilitation implementation efforts. Future work includes gathering input from individuals with TBI and chronic pain and to move the intervention (implementation) mapping matrix forward to inform future implementation research, policy, and practice.

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Rehabilitation Needs at 5 Years Post-Traumatic Brain Injury: A VA TBI Model Systems Study

Cited by 19 publications

References 43 publications

Functional Recovery, Symptoms, and Quality of Life 1 to 5 Years After Traumatic Brain Injury

Functional Recovery, Symptoms, and Quality of Life 1 to 5 Years After Traumatic Brain Injury

Effect of an Individually Tailored and Home-Based Intervention in the Chronic Phase of Traumatic Brain Injury

Stakeholder Engagement to Identify Implementation Strategies to Overcome Barriers to Delivering Chronic Pain Treatments: A NIDILRR and VA TBI Model Systems Collaborative Project

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