Category: Brain Injury; Military and Veterans Affairs
Objective : Identify associated factors of community reintegration and employment for individuals with traumatic brain injury.
Design : Longitudinal Cohort Study
Setting : A VA Polytrauma Rehabilitation Center
Participants (or Animals, Specimens, Cadavers) : VA TBI Model System participants (N=266) were primarily male (93%), white (73%), with a median age of 31 [IQR 25-50] with predominantly severe TBI (71%).
Interventions : Not applicable
Main Outcome Measure(s) : Two-Year Post-Injury Outcomes: Participation Assessment with Recombined Tools-Objective (PART-O), and Employment Status
Results : Using generalized linear regression models and following adjustment for known predictors of outcome, higher comorbidity burden was associated with lower employment probability (CI: 0.54-0.90) but not PART-O. To examine for the effect of individual comorbid conditions and known predictors of outcome, lasso regression was used for variable selection by shrinking the coefficients of unselected variables to 0. Pre-injury employment (CI:1.2-84) and higher discharge FIM (CI:1.04-1.1) were significantly associated with employment at 2-years with age, race, injury severity, pre-injury mental health, chronic pain, sexual dysfunction, and high cholesterol retained in the model. Younger age (CI: -.02-.00), higher education (.08-.046), being married (CI:.07-.48), and higher discharge FIM (CI:.01-.01) were significantly associated with higher PART-O with chronic pain, sleep apnea, active duty status, and pre-injury mental health treatment retained in the model.
Conclusions : Previous studies have identified many variables associated with reintegration and employment outcomes after traumatic brain injury, such as education level, severity of injury, mental health symptomology, age, and coma duration. This study preliminarily identifies comorbidity burden and specific conditions associated with worse community reintegration. Aggressive management of these comorbidities may help in maximizing TBI outcome among Veterans and Service Members.
Xinyu Tang– Biostatistics Contractor, Tampa VA Research and Education Foundation, Inc, Tampa, Florida
Emily Noyes– Research Assistant, James A Haley VA Hospital, Tampa, Florida
Flora Hammond– Professor & Chair, Indiana University School of Medicine, Indianapolis, Indiana
William Walker– Professor, Dept of PM&R, Virginia Commonwealth University, Richmond, Virginia
Kristen Dams-O'Connor– Associate Professor of Rehabilitation Medicine and Neurology; Director of Brain Injury Research Center, Icahn School of Medicine at Mount Sinai, New York, New York
Angelle Sander– Associate Professor, Baylor College of Medicine, Houston, Texas
Risa Nakase-Richardson– Neuropsychologist, Associate Professor, James A. Haley Veterans' Hospital / University of South Florida, Tampa, Florida
Deveney Ching– Graduate Research Assistant/Ph.D. Student/WOC Research Assistant, University of South Florida / James A. Haley VA Hospital, Tampa, Florida