Category: Military and Veterans Affairs; Brain Injury
Objective : Examine the contribution of medical comorbidities to rehabilitation outcomes following TBI.
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 predominately severe injury (71%).
Interventions : Not applicable
Main Outcome Measure(s) : Two-Year Post-Injury Outcomes: National Health/Nutrition Survey Medical Comorbidities, Supervision Rating Scale (SRS), FIM-Motor, FIM-Cognitive, Glasgow Outcome Scale- extended (GOS-E).
Results : Using generalized linear regression models and following adjustment for known predictors of rehabilitation outcome, higher comorbidity burden was associated with greater supervision (β = 0.81, pβ = -1.12, p<.01), and lower GOS-E (β = -0.15, p<.01) scores. 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. Sleep apnea (OR = -5.72, 95% CI:-11.25,-1.54) and kidney stones (OR = -10.71, 95% CI:-17.61,-3.73) were associated with lower motor FIM with a non-significant association for chronic pain retained in the model. Chronic pain (OR = -0.57, 95% CI: -1.02,-0.09) and FIM Total (OR = .03, 95% CI: .03,.04) was associated with lower GOS-E scores with a non-significant association for sleep apnea retained in the model. A non-significant association was found for chronic pain and FIM cognitive.
Conclusions : Evidence to support the impact of comorbidity burden on TBI outcome following moderate to severe TBI is sparse. The current study preliminarily highlights the impact of cumulative comorbidity burden and specific medical disorders that can be aggressively addressed in chronic stages of TBI to improve functional outcome.
Risa Nakase-Richardson– Neuropsychologist, Associate Professor, James A. Haley Veterans' Hospital / University of South Florida, Tampa, Florida
Xinyu Tang– Biostatistics Contractor, Tampa VA Research and Education Foundation, Inc, Tampa, Florida
Emily Noyes– Research Assistant, James A Haley VA Hospital, Tampa, Florida
Marc Silva– Neuropsychologist, James A Haley VA Hospital, Tampa, Florida
Leah Drasher-Phillips– Project Manager, James A. Haley VA Medical Center, Tampa, Florida
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
William Walker– Professor, Dept of PM&R, Virginia Commonwealth University, Richmond, Virginia
Flora Hammond– Professor & Chair, Indiana University School of Medicine, Indianapolis, Indiana
Jacob Finn– Clinician Investigator, Minneapolis VA Healthcare System, Minneapolis, Minnesota
Lillian Stevens– Research Psychologist, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
Angelle Sander– Associate Professor, Baylor College of Medicine, Houston, Texas
Deveney Ching– Graduate Research Assistant/Ph.D. Student/WOC Research Assistant, University of South Florida / James A. Haley VA Hospital, Tampa, Florida