Category: Brain Injury; Military and Veterans Affairs; Cross-Cutting
To investigate the prevalence of unmet rehabilitation needs of patients who are five years post traumatic brain injury (TBI) and to describe differences between those with mild versus moderate to severe injury.
Prospective observational cohort study.
Five Veterans Affairs (VA) Polytrauma Rehabilitation Centers (PRC).
Participants (or Animals, Specimens, Cadavers) :
VA TBIMS participants (N= 369 ; 95% male, 64% Caucasian, with predominately Moderate/Severe injury [66%]) with a five-year post-TBI follow up.
Main Outcome Measure(s) :
Rehabilitation Needs Survey: a 21-item survey that assesses cognitive, emotional, social, and functional needs.
Among all participants, 28% indicated that they had between 1 and 5 unmet needs, 15% reported between 6 and 10, and 10% reported more than 10. The most commonly endorsed unmet needs included "Improving Memory" (32.2%), "Controlling Physical Symptoms" (27.1%), and "Managing Emotions" (23.0%). Subgroup analyses revealed those who sustained Moderate/Severe TBI (M=3.8, SD=5.0) reported more unmet needs than those with Mild TBI (M=2.3, SD=3.5, p=.007). The two most frequently reported unmet needs were the same for both groups: "Improving Memory" (Mild: 29.2%, Moderate/Severe: 32.9%) and "Controlling Physical Symptoms" (Mild: 28.1%, Moderate/Severe: 27.1%). These subgroups differed most in their report of unmet needs in the areas of "Engaging in Recreation", "Solving Problems", "Getting Around the Community", "Improving Job Skills", and "Accessing Psychological Support". For these areas, individuals with Moderate/Severe were more likely to report an unmet need (all p<.05).
Conclusions : Recent studies highlight the evolution of TBI in chronic stages, and these findings support the need for specific rehabilitation services at five years post-TBI. Individuals with moderate-to-severe TBI have a greater number of unmet needs, particularly in the areas of community reintegration and accessing psychological services.
Elaine Mahoney– Neuropsychology Postdoctoral Resident, James A. Haley Veterans Hospital, Tampa, Florida
Marc Silva– Neuropsychologist, James A Haley VA Hospital, 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
Joyce Chung– Program Analyst, VA Palo Alto, Palo Alto, California
Joseph Giacino– Director, Rehabilitation Neuropsychology, Spaulding Rehabilitation Hospital/Harvard Medical School, Charlestown, Massachusetts
Flora Hammond– Professor & Chair, Indiana University School of Medicine, Indianapolis, Indiana
Ambuj Kumar– Associate Professor, Director, USF Health Morsani College of Medicine, Pinellas Park, Florida
Tea Reljic– Statistical Data Analyst, University of South Florida, Tampa, Florida
Risa Nakase-Richardson– Neuropsychologist, Professor, James A. Haley Veterans Hospital / University of South Florida, Tampa, Florida
Christina Dillahunt-Aspillaga– Associate Professor; Research Affiliate, USF - RMHC, Veterans Affairs, James A. Haley Hospital Rehabilitation Outcomes Research Center, Tampa, Florida
Kimberley Monden– Principal Investigator, Craig Hospital, Denver, Colorado