Search

The purpose of the current study was to determine perceptions of neuropsychologists (NPs) and speech-language pathologists (SLPs) regarding each other's roles in the rehabilitation setting, and to assess the type and extent of collaborations. Participants were 311 SLPs and 77 NPs working in a rehabilitation setting. Results indicated a great deal of overlap between the roles of SLPs and NPs. While there was much agreement about roles, misperceptions were evident with regard to some of the domains of assessment and treatment. A need for increased collaboration on planning assessments and treatment was evident. The results suggest the need for training of both disciplines in interdisciplinary collaboration and in roles of rehabilitation team members.

Purpose: To describe a cognitive neuroscience model of memory that can be used to guide assessment and promote consistent terminology among members of the rehabilitation team, and to relate the model to frequently used assessment measures. Method: Description of a model of memory, description of how frequently used memory measures relate to the model, and presentation of case studies to exemplify the application of the model to the clinical assessment of memory. Conclusions: Use of a theoretical framework is important for choosing assessment instruments, interpreting the results of test performance, and communicating with patients, their family members, and other members of the interdisciplinary team. Understanding where in the memory process a breakdown occurs can guide treatment recommendations and feedback to patients and family members. (Contains 3 tables and 1 figure.)

To examine the unique contribution of alexithymia at 1 year after traumatic brain injury (TBI) to the prospective prediction of emotional and social health outcomes at 2 years after injury. Multicenter, longitudinal cohort study. Data were collected during year 1 and year 2 postinjury follow-up interviews across 4 TBI Model System centers. Persons with TBI (N=175; 134 men and 41 women) who had English fluency and were capable of providing self-reported data. Not applicable. Primary independent variable was the Toronto Alexithymia Scale-20. Outcome measures included the Interpersonal Reactivity Index, National Institute of Health Toolbox Emotion Battery Anger, Difficulty with Emotion Regulation Scale, Connor-Davidson Resilience Scale, Posttraumatic Stress Disorder Checklist – Civilian, Satisfaction with Life Scale, General Anxiety Disorder-7, Patient Health Questionnaire 9, suicidal ideation, and problematic substance use. Simple adjusted models demonstrated that after controlling for the specific outcome at year 1, Toronto Alexithymia Scale-20 scores significantly predicted year 2 scores for perspective-taking, physical aggression, emotional dysregulation, resilience, anxiety, depression, and suicidal ideation. All of these predictive findings except for physical aggression were maintained in the fully adjusted models that also controlled for age, sex, education level, number of prior TBIs, and motor and cognitive functioning. Compared with those with lower alexithymia scores, persons with TBI who had higher alexithymia scores at 1 year after injury reported poorer emotional health at 2 years after TBI, even after controlling for year 1 outcome scores, sociodemographic characteristics, and injury-related factors. These results support the need to assess for elevated alexithymia and to provide interventions targeting alexithymia early in the TBI recovery process. [ABSTRACT FROM AUTHOR]

Objective: To estimate the prevalence of chronic pain after traumatic brain injury (TBI) and identify characteristics that differ from those without chronic pain. Setting: Community. Participants: A total of 3804 TBI Model Systems (TBIMS) participants who completed the Pain Survey at TBIMS follow-up. Design: A multisite, cross-sectional observational cohort study. Main Outcome Measure(s): Functional outcomes, pain experience, and treatment. Results: 46% reported current chronic pain, 14% reported past (post-injury) chronic pain, and 40% reported no chronic pain. Bivariate differences in sociodemographic and injury characteristics between the 3 pain groups were generally small in effect size, reflecting little clinical difference. However, medium effect sizes were seen for all functional outcomes, such that individuals with current chronic pain had worse functional outcomes compared with individuals in the past pain or no pain groups. Treatment utilization rates were higher for individuals with current chronic pain compared with past pain, with medical treatments being most frequently utilized. Individuals with past pain perceived more improvement with treatment than did those with current chronic pain as represented by a large effect size. Conclusions: Chronic pain affects approximately 60% of those living with TBI. The implications of chronic pain for functional outcomes support inclusion of pain metrics in prognostic models and observational studies in this population. Future research is needed to proactively identify those at risk for the development of chronic pain and determine the efficacy and access to pain treatment. [ABSTRACT FROM AUTHOR]

To investigate catastrophizing and self-efficacy for managing pain among Non-Hispanic Whites, Non-Hispanic Blacks, and Hispanics with chronic pain after traumatic brain injury (TBI), and whether coping interacts with race/ethnicity to predict participation outcomes. Community after discharge from inpatient rehabilitation. 621 individuals with moderate to severe TBI and chronic pain, who completed follow-up as part of a national longitudinal study of TBI and also participated in a collaborative study on chronic pain. Multicenter, cross-sectional, survey study. Catastrophizing subscale from the Coping With Pain Scale; Pain Self-Efficacy Questionnaire; Participation Assessment With Recombined Tools-Objective. After controlling for relevant sociodemographic variables, a significant interaction was observed between race/ethnicity and insurance status, such that Blacks who had public health insurance reported greater catastrophizing in response to pain compared with Whites. Race/ethnicity and self-efficacy for managing pain were unrelated. Greater catastrophizing was associated with lower participation but did not interact with race/ethnicity. Blacks reported lower participation relative to Whites, independent of catastrophizing. Black individuals who have TBI and chronic pain, and who have public insurance, may be vulnerable to difficulties managing pain. They are more likely to cope by catastrophizing, and catastrophizing is related to worse participation outcomes. The results suggest that access to care may affect response to chronic pain after TBI. [ABSTRACT FROM AUTHOR]

To provide reliability and validity data to support the clinical utility of Economic Quality of Life Measure (Econ-QOL) scores in caregivers of civilians and service members/veterans with traumatic brain injury (TBI). Cross-sectional survey study. Three academic medical centers and a Veterans Affairs treatment facility. 376 caregivers of civilians (n=213) and service members/veterans (n=163) with TBI (N=376). N/A. Econ-QOL and several patient-reported outcome measures (Traumatic Brain Injury Caregiver Quality of Life Caregiver-Specific Anxiety and Caregiver Strain, Patient-Reported Outcomes Measurement Information System sleep-related impairment, Neurological Quality of Life Measurement System positive affect and well-being) and measures of financial status (self-reported income). Internal consistency reliability of the Econ-QOL Short Form scores were excellent (all Cronbach's alphas ≥.92). There were no floor or ceiling effects for scores. There was evidence of convergent and discriminant validity, with the Econ-QOL scores having the strongest relationships with self-reported income (convergent validity evidence) and weak relationships with the other measures (discriminant validity evidence). Individuals with scores that were "below or possibly below" the poverty line (according to 2016 federal government poverty level thresholds) reported worse economic quality of life relative to those individuals who were definitely above the poverty line, supporting known-groups validity. This article establishes the clinical utility of scores on the Econ-QOL Short Form in caregivers of persons with TBI and provides evidence that it is valid and appropriate to use such scores not only in a variety of different disability populations (eg, spinal cord injury, stroke) but also in caregivers. [ABSTRACT FROM AUTHOR]

To develop and evaluate the feasibility of a short form of the Behavioral Assessment Screening Tool (BAST mHealth) for high frequency in situ self-reported assessment of neurobehavioral symptoms using mobile health technology for community-dwelling adults with traumatic brain injury (TBI). Prospective, repeated-measures study of mHealth assessment of self-reported neurobehavioral symptoms in adults with and without a lifetime history of TBI over a 2-week period. Community. Community-dwelling adults with (n=52) and without (n=12) a lifetime TBI history consented to the study (N=64). Not applicable. BAST mHealth subscales (2-items each): negative affect, fatigue, executive function, substance abuse, impulsivity; feasibility measured via compliance (assessments assigned/assessments completed) and participant-reported usability. We developed the 10-item BAST mHealth as a screener for high frequency in situ self-reported assessment of neurobehavioral symptoms leveraging mHealth. Compliance for 2 weeks of BAST mHealth supports its feasibility. Fifty-six of 64 participants (87.5%) who completed baseline assessments completed the 2 weeks of daily assessments; all 8 participants who did not complete ecological momentary assessment had a history of TBI. Overall compliance was 81.4% (496 completed of 609 assigned assessments) among all 52 participants with TBI and 96.7% (494 completed of 511 assigned assessments) among the 44 who completed any daily measures, compared with 91.8% (135 completed of 147 assigned assessments) among those with no TBI history. Participants thought the daily surveys were easy to understand and complete and the number of prompts were reasonable. Conducting daily high-frequency in situ self-reported assessment of neurobehavioral symptoms using the BAST mHealth is feasible among individuals with and without a lifetime history of TBI. Developing and evaluating self-reported assessments for community-based assessment is a critical step toward expanding remote clinical monitoring systems to improve post-TBI outcomes. [ABSTRACT FROM AUTHOR]

Objective: To examine the relationship between payer source for acute rehabilitation, residential median household income (MHI), and outcomes at rehabilitation discharge after traumatic brain injury (TBI). Setting: Acute inpatient rehabilitation facilities. Participants: In total, 8558 individuals enrolled in the Traumatic Brain Injury Model Systems (TBIMS) National Database who were admitted to inpatient rehabilitation between 2006 and 2019 and were younger than 64 years. Design: Secondary data analysis from a multicenter longitudinal cohort study. Main Measures: Payer source was divided into 4 categories: uninsured, public insurance, private insurance, and workers' compensation/auto. Relationships between payer source with residential MHI, rehabilitation length of stay (RLOS), and the FIM Instrument at discharge were examined. Covariates included age, injury severity, FIM at admission, and a number of sociodemographic characteristics including minority status, preinjury limitations, education level, and employment status. Results: Individuals with workers' compensation/auto or private insurance had longer RLOS than uninsured individuals or those with public insurance after controlling for demographics and injury characteristics. An adjusted model controlling for demographics and injury characteristics showed a significant main effect of payer source on FIM scores at discharge, with the highest scores noted among those with workers' compensation/auto insurance. The main effect of payer source on FIM at discharge became nonsignificant after RLOS was added to the model as a covariate, suggesting a mediating effect of RLOS. Conclusion: Payer source was associated with preinjury residential MHI and predicted RLOS. While prior studies have demonstrated the effect of payer source on long-term outcomes due to lack of inpatient rehabilitation or quality follow-up care, this study demonstrated that individuals with TBI who are uninsured or have public insurance may be at risk for poorer functional status at the point of rehabilitation discharge than those with private insurance, particularly compared with those with workers' compensation/auto insurance. This effect may be largely driven by having a shorter length of stay in acute rehabilitation. [ABSTRACT FROM AUTHOR]

To examine sex differences in social inferencing deficits after traumatic brain injury (TBI) and to examine the odds of men and women being impaired while controlling for potential confounders. Cross-sectional survey. Two TBI rehabilitation hospitals. One hundred five participants with TBI (60 men, 45 women) and 105 controls without TBI (57 men, 48 women) (N=210). Not applicable. The Awareness of Social Inference Test (TASIT), which includes (1) Emotion Evaluation Test (EET), (2) Social Inference-Minimal (SI-M) test, and (3) Social Inference-Enriched (SI-E) test. Within the control sample, men and women performed similarly on all 3 TASIT subtests. Within the group with TBI, men had significantly lower scores than women on EET (P =.03), SI-M (P =.01), and SI-E (P =.04). Using impairment cutoffs derived from the sample without TBI, we found significantly more men with TBI (30%) were impaired on the EET than women (16.7%); impairment was similar between men and women on SI-M and SI-E. When adjusting for executive functioning and education, the odds of being impaired on the EET did not significantly differ for men and women (odds ratio, 0.47; 95% CI, 0.16-1.40; P =.18). Although more men with TBI have emotion perception deficits than women, the difference appears to be driven by education and executive functioning. Research is needed in larger samples with more definitive norms to better understand social inferencing impairments in men and women with TBI as well as translation to interpersonal behaviors. [ABSTRACT FROM AUTHOR]

Patient report of functioning is one component of the neurocognitive exam following traumatic brain injury, and standardized patient-reported outcomes measures are useful to track outcomes during rehabilitation. The Traumatic Brain Injury Quality of Life measurement system (TBI-QOL) is a TBI-specific extension of the PROMIS and Neuro-QoL measurement systems that includes 20 item banks across physical, emotional, social, and cognitive domains. Previous research has evaluated the responsiveness of the TBI-QOL measures in community-dwelling individuals and found clinically important change over a 6-month assessment interval in a sample of individuals who were on average 5 years post-injury. In the present study, we report on the responsiveness of the TBI-QOL Cognition–General Concerns and Executive Function item bank scores and the Cognitive Health Composite scores in a recently injured sample over a 1-year study period. Data from 128 participants with complicated mild, moderate, or severe TBI within the previous 6 months were evaluated. The majority of the sample was male, white, and non-Hispanic. The participants were 18–92 years of age and were first evaluated from 0 to 5 months post-injury. Eighty participants completed the 1-year follow-up assessment. Results show acceptable standard response mean values (0.47–0.51) for all measures and minimal detectable change values ranging from 8.2 to 8.8 T-score points for Cognition–General Concerns and Executive Functioning measures. Anchor rating analysis revealed that changes in scores on the Executive Function item bank and the Cognitive Health Composite were meaningfully associated with participant-reported changes in the areas of attention, multitasking, and memory. Evaluation of change score differences by a variety of clinical indicators demonstrated a small but significant difference in the three TBI-QOL change scores by TBI injury severity grouping. These results support the responsiveness of the TBI-QOL cognition measures in newly injured individuals and provides information on the minimal important differences for the TBI-QOL cognition measures, which can be used for score interpretation by clinicians and researchers seeking patient-reported outcome measures of self-reported cognitive QOL after TBI. [ABSTRACT FROM AUTHOR]

To investigate depression at 12 months after traumatic brain injury (TBI) in older adults compared with younger adults. Prospective longitudinal cohort study of persons with medically documented mild, moderate, and severe TBI at 12 months postinjury. Eighteen participating Level 1 trauma centers in the United States. Participants with TBI (N=1505) and primary outcome data at 12-month follow-up. Not applicable. Patient Health Questionnaire-9 (PHQ-9). PHQ-9 total scores were significantly lower for older adults (age≥65y; M=3.2) compared with younger adults (age<65y; M=5.0; B =−1.63, P <.001), indicating fewer depressive symptoms in older adults. Age did not interact with education, sex, race/ethnicity, psychiatric history, substance use, or Glasgow Coma Scale severity to affect PHQ-9 scores. Of the 29% of older adults who endorsed symptoms consistent with depression, 14% were classified as minor depression and 15% as major depression. The odds of older adults falling in the major depression vs no depression group were significantly lower (decreased by 56%) compared with younger adults (odds ratio=0.44, P =.001). At 12 months post-TBI, older adults endorse lower depressive symptoms than their younger counterparts and are less likely to experience major depression; however, over one-fourth of older adults endorsed symptoms consistent with depression, warranting evaluation and treatment. [ABSTRACT FROM AUTHOR]

To understand the factor structure of health-related quality of life specific to caregivers of people living with traumatic brain injury (TBI). Prospective, cross-sectional data collection. Three TBI Model Systems rehabilitation hospitals, an academic medical center, and a military medical treatment facility. Caregivers (N=558) of people who have sustained a TBI (344 caregivers of civilians and 214 caregivers of service members or veterans; 85% women; 58% spouses; mean age, 46.12±14.07y) who have provided care for an average of 5.82±5.40 years. Not applicable. The Traumatic Brain Injury Caregiver Quality of Life (TBI-CareQOL) measurement system including 10 Patient-Reported Outcomes Measurement Information System item banks (anger, anxiety, depression, social isolation, sleep disturbance, fatigue, ability to participate in social roles and activities, satisfaction with social roles and activities, emotional support, informational support) and 5 TBI-CareQOL banks (feelings of loss–self, feelings of loss–person with TBI, feeling trapped, caregiver-specific anxiety, caregiver strain). Confirmatory factor analysis model fit indices were compared for 14 empirically derived and 5 theoretically derived models. Confirmatory factor analysis results indicated that the best model fit was for a 6-factor model with dimensions that included mental health, social support, social participation, social isolation, physical health, and caregiver emotion. Results indicated that a 6-factor model provided the best model fit for health-related quality of life in caregivers of individuals with TBI. These results have utility for both research and clinical applications. Establishing the TBI-CareQOL's factor structure provides preliminary evidence of the measurement system's construct validity, helps inform the selection of measures for specific research or clinical interventions, and informs the development of composite scores. [ABSTRACT FROM AUTHOR]

To develop a pain interference item bank, computer adaptive test (CAT), and short form for use by individuals with traumatic brain injury (TBI). Cross-sectional survey study. Five TBI Model Systems rehabilitation hospitals. Individuals with TBI (N=590). Not applicable. Traumatic Brain Injury–Quality of Life (TBI-QOL) Pain Interference item bank. Confirmatory factor analysis provided evidence of a single underlying trait (χ2 [740]=3254.030; P <.001; Comparative Fix Index=0.988; Tucker-Lewis Index=0.980; Root Mean Square Error of Approximation=0.076) and a graded response model (GRM) supported item fit of 40 Pain Interference items. Items did not exhibit differential item functioning or local item dependence. GRM calibration data were used to inform the selection of a 10-item static short form and to program a TBI-QOL Pain Interference CAT. Comparative analyses indicated excellent comparability and reliability across test administration formats. The 40-item TBI-QOL Pain Interference item bank demonstrated strong psychometric properties. End users can administer this measure as either a 10-item short form or CAT. [ABSTRACT FROM AUTHOR]

To develop traumatic brain injury (TBI)-optimized versions of the Quality of Life in Neurological Disorders (Neuro-QoL) Ability to Participate in Social Roles and Activities and Satisfaction with Social Roles and Activities item banks, evaluate the psychometric properties of the item banks developed for adults with TBI, develop short form and computer adaptive test (CAT) versions, and report information to facilitate research and clinical applications. We used a mixed methods design to develop and evaluate Ability to Participate in Social Roles and Activities and Satisfaction with Social Roles and Activities items. Focus groups defined the constructs, cognitive interviews guided item revisions, and confirmatory factor analysis and item response theory methods helped calibrate item banks and evaluate differential item functioning related to demographic and injury characteristics. Five TBI Model Systems centers in the United States. Community-dwelling adults with TBI (N=556). None. Traumatic Brain Injury–Quality of Life (TBI-QOL) Ability to Participate in Social Roles and Activities and TBI-QOL Satisfaction with Social Roles and Activities item banks. Forty-five Ability to Participate in Social Roles and Activities and 41 Satisfaction with Social Roles and Activities items demonstrated good psychometric properties. Although some of the items are new, most were drawn from analogous banks in the Neuro-QoL measurement system. Consequently, the 2 TBI-QOL item banks were linked to the Neuro-QoL metric, and scores are comparable with the general population. All CAT and short forms correlated highly (>0.90) with the full item banks and demonstrate comparable construct coverage and measurement error. The TBI-QOL Ability to Participate in Social Roles and Activities and TBI-QOL Satisfaction with Social Roles and Activities item banks are TBI-optimized versions of the Neuro-QoL Ability to Participate in Social Roles and Activities and Satisfaction with Social Roles and Activities item banks and demonstrate excellent measurement properties in individuals with TBI. These measures, particularly in CAT or short form format, are suitable for efficient and precise measurement of social outcomes in clinical and research applications. [ABSTRACT FROM AUTHOR]

To develop an item response theory (IRT)-calibrated, patient-reported outcome measure of subjective independence for individuals with traumatic brain injury (TBI). Large-scale item calibration field testing; confirmatory factor analysis (CFA) and graded response model IRT analyses. Five TBI Model System centers across the United States. Adults with complicated mild, moderate, or severe TBI (N=556). Traumatic Brain Injury–Quality of Life (TBI-QOL) Independence item bank and the TBI-QOL Asking for Help scale. A total of 556 individuals completed 44 items in the Independence item pool. Initial factor analyses indicated that items related to the idea of "asking for help" were measuring a different construct from other items in the pool. These 9 items were set aside. Twenty-two other items were removed because of bimodal distributions and/or low item-total correlations. CFA supported unidimensionality of the remaining Independence items. Graded response model IRT analysis was used to estimate slopes and thresholds for the final 13 Independence items. An 8-item fixed-length short form was also developed. The 9 Asking for Help items were analyzed separately. One misfitting item was deleted, and the final 8 items became a fixed-length IRT-calibrated scale. Reliability was high for both measures. The IRT-calibrated TBI-QOL Independence item bank and short form and TBI-QOL Asking for Help scale may be used to measure important issues for individuals with TBI in research and clinical applications. [ABSTRACT FROM AUTHOR]

Abstract Objective To develop a new patient-reported outcome measure that captures feelings of being trapped that are commonly experienced by caregivers of individuals with traumatic brain injury (TBI). Design Cross-sectional. Setting Three TBI Model Systems rehabilitation hospitals, an academic medical center, and a military medical treatment facility. Participants Caregivers (N=560) of civilians with TBI (n=344) and caregivers of service members/veterans with TBI (n=216). Interventions Not applicable. Outcome Measures Traumatic Brain Injury Caregiver Quality of Life (TBI-CareQOL) Feeling Trapped item bank. Results From an initial item pool of 28 items, exploratory and confirmatory factor analyses supported the retention of 16 items. After graded response model (GRM) and differential item functioning analyses were conducted, 15 items were retained in the final measure. GRM calibration data, along with clinical expert input, were used to choose a 6-item, static short form (SF), and the calibration data were used for programming of the TBI-CareQOL Feeling Trapped computer adaptive test (CAT). CAT simulation analyses produced an r =0.99 correlation between CAT scores and the full item bank. Three-week short-form test-retest reliability was very good (r =0.84). Conclusions The new TBI-CareQOL Feeling Trapped item bank was developed to provide a sensitive and efficient examination of the effect that feelings of being trapped, due to the caregiver role, have on health-related quality of life for caregivers of individuals with TBI. Both the CAT and corresponding 6-item SF demonstrate excellent psychometric properties. Future work is needed to establish the responsiveness of this measure to clinical interventions for these caregivers. Highlights • Caregivers of persons with traumatic brain injury often feel trapped. • The Traumatic Brain Injury Caregiver Quality of Life Feeling Trapped item bank was developed to assess quality of life in caregivers. • This new measure addresses an important caregiver emotional concern. [ABSTRACT FROM AUTHOR]

Abstract Objective To examine group differences among caregivers of service members or veterans (SMVs) and civilians with traumatic brain injury (TBI). Design An observational research study examining the group differences between caregivers of SMVs and civilians with TBI. The data presented was collected as part of a larger study that calibrated and validated the Traumatic Brain Injury-Care Quality of Life (TBI-CareQOL) item banks. Setting Participants in this multicenter study completed an online survey via a study-specific website. Surveys were completed at the study site, at home, or via phone interview. Civilian caregivers were recruited from 4 rehabilitation hospitals and caregivers of SMVs were recruited through community outreach and collaboration with the Hearts of Valor. Participants Participants (N=473) consisted of 344 caregivers of civilians with TBI and 129 caregivers of SMVs with TBI. Interventions Not applicable. Main Outcome Measures Zarit Burden Interview Scale, TBI-CareQOL, and Mayo Portland Adaptability Inventory, 4th revision (MPAI-4). Results Of the independent variables included in the logistic regression model that classified military-affiliated vs civilian caregivers, 5 were statistically significant: age, spousal status, time since injury, MPAI-4 Adjustment, and TBI-CareQOL Feeling Trapped. Conclusions The results indicate that caregivers of SMVs were more likely to report worse emotional and social adjustment among the individuals with TBI and caregivers of SMVs were more likely to report greater levels of feeling trapped by their caregiving duties. [ABSTRACT FROM AUTHOR]

Abstract Objective To investigate the association of the sociocultural variables race/ethnicity, education, and poverty level to caregivers' positive and negative appraisals following traumatic brain injury. Design Survey. Setting Community. Participants Caregivers (N=344; 216 white; 69 black; 39 Hispanic) of persons with complicated mild to severe TBI at least 1-year postinjury. Intervention Not applicable. Main Outcome Measures Modified Caregiver Appraisal Scale (M-CAS); Zarit Burden Interview (ZBI). Results Black caregivers reported lower levels of perceived burden on both the M-CAS and the ZBI. Black and Hispanic caregivers reported more traditional caregiver ideology (caregiving as a responsibility) than did whites. Greater poverty was associated with higher burden on the M-CAS, lower caregiver satisfaction, and less mastery. Higher education was associated with higher burden on the ZBI and with lower caregiver mastery. Conclusions Treatment professionals should be culturally sensitive to the different perspectives that caregivers may have based on sociocultural factors. Sociocultural factors should be considered in research investigating caregiver outcomes, including appraisals. [ABSTRACT FROM AUTHOR]

Abstract Objective To develop a new measurement system, the Traumatic Brain Injury Caregiver Quality of Life (TBI-CareQOL), that can evaluate both general and caregiving-specific aspects of health-related quality of life (HRQOL) in caregivers of persons with traumatic brain injury (TBI). Design New item pools were developed and refined using literature reviews, qualitative data from focus groups, and cognitive debriefing with caregivers of civilians and service members/veterans with TBI, as well as expert review, reading level assessment, and translatability review; existing item banks and new item pools were assessed using an online data capture system. Exploratory and confirmatory factor analysis, item response theory, and differential item functioning analyses were utilized to develop new caregiver-specific item banks. Known-groups validity was examined using a series of independent samples t tests comparing caregivers of low-functioning vs high-functioning persons with TBI for each of the new measures, as well as for 10 existing Patient-Reported Outcomes Measurement Information System (PROMIS) measures. Setting Three TBI Model Systems rehabilitation hospitals, an academic medical center, and a military medical treatment facility. Participants Caregivers (N=560) of civilians (n=344) or service members/veterans with TBI (n=216). Interventions Not applicable. Main Outcome Measures The TBI-CareQOL measurement system (including 5 new measures and 10 existing PROMIS measures). Results Exploratory and confirmatory factor analysis, item response theory, and differential item functioning analyses supported the development of 5 new item banks for Feelings of Loss-Self, Feelings of Loss-Person with TBI, Caregiver-Specific Anxiety, Feeling Trapped, and Caregiver Strain. In support of validity, individuals who were caring for low-functioning persons with TBI had significantly worse HRQOL than caregivers that were caring for high-functioning persons with TBI for both the new caregiver-specific HRQOL measures, and for the 10 existing PROMIS measures. Conclusions The TBI-CareQOL includes both validated PROMIS measures and newly developed caregiver-specific measures. Together, these generic and specific measures provide a comprehensive assessment of HRQOL for caregivers of civilians and service members/veterans with TBI. Highlights • The TBI-CareQOL measurement system includes new and existing self-report measures. • Measures were developed specific to caring for someone with traumatic brain injury. • Generic measures also evaluate important quality of life constructs for caregivers. [ABSTRACT FROM AUTHOR]

Abstract Objectives To establish the reliability and validity of the newly developed TBI-CareQOL patient-reported outcome (PRO) measures in caregivers of civilians and service members/veterans (SMVs) with traumatic brain injury (TBI) so that they can be used with confidence in clinical research and practice. Design Computer-based surveys delivered through an on-line data capture platform. Setting Three TBI Model Systems rehabilitation hospitals, an academic medical center, and a military medical treatment facility. Participants Caregivers (N=560) of individuals with TBI; this included 2 different study samples: 344 caregivers of civilians with TBI and 216 caregivers of SMVs with TBI. Intervention Not Applicable. Main Outcome Measures Five Traumatic Brain Injury Caregiver Quality of Life (TBI-CareQOL) item banks. Results Reliabilities for the TBI-CareQOL measures were excellent (all Cronbach's α >.88); 3-week test-retest reliability ranged from.75 to.90 across the 2 samples. Convergent validity was supported by moderate to high associations among the TBI-CareQOL measures and moderate correlations between the TBI-CareQOL measures and other measures of health-related quality of life (HRQOL) and caregiver burden. Discriminant validity was supported by low correlations between the TBI-CareQOL measures and less-related constructs (eg, caregiver satisfaction). Known-groups validity was supported: caregivers of individuals that were low functioning had worse HRQOL than caregivers of high-functioning individuals. Conclusions Results provide psychometric support for the new TBI-CareQOL item banks. As such, these measures fill a significant gap in the caregiver literature where sensitive PRO measures that capture changes in HRQOL are needed to detect improvements for interventions designed to assist family caregivers. [ABSTRACT FROM AUTHOR]

Abstract Objective To develop a new measure of caregiver strain for use in caregivers of individuals with traumatic brain injury (TBI), Traumatic Brain Injury Caregiver Quality of Life (TBI-CareQOL) Caregiver Strain. Design Qualitative data, literature reviews, and cross-sectional survey study. Setting Three TBI Model Systems rehabilitation hospitals, an academic medical center, and a military medical treatment facility. Participants Caregivers (N=560) of civilians (n=344) or service members/veterans (SMVs) with TBI (n=216). Interventions Not applicable. Main Outcome Measure TBI-CareQOL Caregiver Strain Item Bank. Results Exploratory and confirmatory factor analyses, a graded response model (GRM) and differential item functioning supported the retention of 33 items in the final measure. GRM calibration data was used to inform the selection of a 6-item static short form, and to program the TBI-CareQOL Caregiver Strain computer-adaptive test (CAT). CAT simulation analyses indicated a 0.97 correlation between the CAT scores and the full item-bank. Three-week test-retest reliability was strong (r =0.83). Conclusions The new TBI-CareQOL Caregiver Strain CAT and corresponding 6-item short form were developed using established rigorous measurement development standards; this is the first self-reported measure developed to evaluate caregiver strain in caregivers of individuals with TBI. Highlights • The Traumatic Brain Injury Caregiver Quality of Life (TBI-CareQOL) measurement system includes new and existing self-report measures. • Measures were developed specific to caring for someone with traumatic brain injury. • Generic measures also evaluate important quality of life constructs for caregivers. [ABSTRACT FROM AUTHOR]

Abstract Objective To design a new measure of caregiver-specific anxiety for use in caregivers of individuals with traumatic brain injury (TBI), the Traumatic Brain Injury Caregiver Quality of Life (TBI-CareQOL) Caregiver-Specific Anxiety item bank. Design Cross-sectional survey study. Setting Three TBI Model Systems rehabilitation hospitals, an academic medical center, and a military medical treatment facility. Participants Three hundred forty-four caregivers of civilians with TBI and 216 caregivers of service members/veterans with TBI (N=560). Interventions Not applicable. Main Outcome Measures TBI-CareQOL Caregiver-Specific Anxiety item bank. Results The retention of 40 Caregiver-Specific Anxiety items was supported by exploratory and confirmatory factor analyses. Graded response model (GRM) and differential item functioning analyses supported the retention of 33 items in the final measure. Expert review and GRM calibration data was used to select a 6-item static short form, and GRM calibration data was used to program the TBI-CareQOL Caregiver-Specific Anxiety computer adaptive test (CAT). Conclusions Established, rigorous measurement development standards were used to develop the new TBI-CareQOL Caregiver-Specific Anxiety CAT and corresponding 6-item short form. This measure is the first patient-reported outcome measure designed to assess caregiver-specific anxiety in caregivers of individuals with TBI. The measure exhibits strong psychometric properties. Highlights • Caregivers of persons with traumatic brain injury often have heightened anxiety. • A new self-report measure of caregiver-specific anxiety was developed. • This new measure can help identify caregivers with significant anxiety. [ABSTRACT FROM AUTHOR]

Abstract Objective To develop new patient-reported outcome (PRO) measures to better understand feelings of loss in caregivers of individuals with traumatic brain injury (TBI). Design Cross-sectional survey study. Setting Three TBI Model Systems rehabilitation hospitals, an academic medical center, and a military medical treatment facility. Participants Caregivers (N=560) of civilians with TBI (n=344) or service members/veterans (SMVs) with TBI (n=216). Interventions Not applicable. Main Outcome Measures Traumatic Brain Injury Caregiver Quality of Life (TBI-CareQOL) Feelings of Loss-Self and TBI-CareQOL Feelings of Loss-Person with Traumatic Brain Injury item banks. Results While the initial exploratory and confirmatory factor analyses of the feelings of loss item pool (98 items) potentially supported a unidimensional set of items, further analysis indicated 2 different factors: Feelings of Loss-Self (43 items) and Feelings of Loss-Person with TBI (20 items). For Feelings of Loss-Self, an additional 13 items were deleted due to item-response theory-based item misfit; the remaining 30 items had good overall model fit (comparative fit index [CFI]=0.96, Tucker-Lewis index [TLI]=.96, root mean squared error of approximation [RMSEA]=.10). For Feelings of Loss-Other, 1 additional item was deleted due to an associated high correlated error modification index value; the final 19 items evidenced good overall model fit (CFI=0.97, TLI=.97, RMSEA=.095). The final item banks were developed to be administered as either a Computer Adaptive Test (CAT) or a short-form (SF). Clinical experts approved the content of the 6-item SFs of the 2 measures (3-week test-retest was r =.87 for Feelings of Loss-Self and r =.85 for Feelings of Loss-Person with TBI). Conclusions The findings from this study resulted in the development of 2 new PROs to assess feelings of loss in caregivers of individuals with TBI; TBI-CareQOL Feelings of Loss-Self and TBI-CareQOL Feelings of Loss-Person with TBI. Good psychometric properties were established and an SF was developed for ease of use in clinical situations. Additional research is needed to determine concurrent and predictive validity of these measures in the psychological treatment of those caring for persons with TBI. Highlights • Feelings of loss are common in caregivers of persons with traumatic brain injury. • Two new self-report measures of caregiver feelings of loss were developed. • These self-report measures can help identify feelings of entrapment in caregivers. [ABSTRACT FROM AUTHOR]

Abstract Objective To provide important reliability and validity data to support the use of the Patient-Reported Outcomes Measurement Information System (PROMIS) mental health measures in caregivers of civilians or service members/veterans (SMVs) with traumatic brain injury (TBI). Design Patient-reported outcome surveys administered through an electronic data collection platform. Setting Three TBI model systems rehabilitation hospitals, an academic medical center, and a military medical treatment facility. Participants Caregivers (N=560) of individuals with a documented TBI (344 civilians and 216 military). Intervention Not applicable. Main Outcome Measures PROMIS anxiety, depression, and anger item banks. Results Internal consistency for all the PROMIS Mental Health item banks was very good (all α>.86) and 3-week test-retest reliability was good to adequate (ranged from.65 to.85). Convergent validity and discriminant validity of the PROMIS measures were also supported. Caregivers of individuals who were low functioning had worse emotional health-related quality of life (HRQOL) (as measured by the 3 PROMIS measures) than caregivers of high-functioning individuals, supporting known groups validity. Finally, levels of distress, as measured by the PROMIS measures, were elevated for those caring for low-functioning individuals in both samples (rates ranged from 26.2% to 43.6% for caregivers of low-functioning individuals). Conclusions Results support the reliability and validity of the PROMIS anxiety, depression, and anger item banks in caregivers of civilians and SMVs with TBI. Ultimately, these measures can be used to provide a standardized assessment of HRQOL because it relates to mental health in these caregivers. [ABSTRACT FROM AUTHOR]

Objective: To characterize supervision levels across residential settings at 1 year post-TBI and explore predictors of supervision in a Veteran and Service-member population. Setting: Five VA Polytrauma Rehabilitation Centers. Participants: A total of 302 individuals enrolled in the VA TBI Model Systems (TBIMS) research program. Design: Prospective, longitudinal, multisite. Main Measures: Primary residence and supervision levels measured via scores on the Supervision Rating Scale. For predictive modeling, scores were dichotomized into 2 groups: those that were fully independent/living alone or required only some supervision during the day (independent group, n = 195) and those that required overnight supervision, full-time indirect supervision, and full-time direct supervision (dependent group, n = 107). Results: Thirty-five percent were receiving supervision at 1 year post-TBI across residential settings and 28% were living in alternative settings. Multivariate modeling indicated that older age and longer posttraumatic amnesia (PTA) were predictive of having a need for supervision at 1 year postinjury. Conclusions: Supervision needs are long-term features of moderate and severe TBI. Results of this study lend support to the shift toward conceptualizing TBI as a chronic disease. [ABSTRACT FROM AUTHOR]

Objective To evaluate the effectiveness of an educational intervention designed to reduce traumatic brain injury (TBI)–related misconceptions among blacks and Latinos with complicated mild to severe TBI. Design Randomized controlled trial with masked 1-month follow-up. Setting Community. Participants Persons (N=52) with complicated mild to severe TBI (mean best day 1 Glasgow Coma Scale score, 11.27±3.89) were randomly recruited from 141 eligible participants (mean age, 37.71±13.88y; age range, 19–66y; mean months postinjury, 24.69±11.50); 25 participants (48.1%) of participants were black and 27 (51.9%) were Hispanic/Latino. Of the Hispanic/Latino participants, 18 (66.7%) were non-U.S. born and 12 (44.4%) spoke Spanish as their primary language. Twenty-seven individuals were randomized to the educational intervention group and 25 were randomized to the wait-list control group. Interventions Single-session educational intervention with written materials provided in English or Spanish. Main Outcome Measures Forty-item Common Misconceptions about Traumatic Brain Injury Questionnaire administered at baseline and 1-month follow-up. Results After controlling for ethnic and language differences, a significant between-group main effect ( P =.010) and a significant time-group interaction for the Common Misconceptions about Traumatic Brain Injury Questionnaire were noted (Wilks Λ =.89; F 1,46 =6.00; P =.02). The intervention group showed a decrease in TBI misconception percentages, whereas the wait-list control group maintained similar percentages. At 1-month follow-up, the wait-list control group reported more misconceptions than did the intervention group ( P =.019). Conclusions An educational intervention developed to address the recovery process, common symptoms, and ways to handle the symptoms provides promise as a tool to decrease TBI misconceptions among persons from ethnically and educationally diverse backgrounds. The effects of therapist characteristics and the client-therapist relation on outcomes should be further explored. [ABSTRACT FROM AUTHOR]

BACKGROUND: Persons with moderate to severe TBI are at increased risk for unintentional injury or harm in the home and community; however, there is currently no standard measure of safety risk they face now and in the future. OBJECTIVE: To develop comprehensive and content valid scales and item pools for assessing safety and risk for persons with moderate to severe traumatic brain injuries. METHOD: Qualitative psychometric methods for developing scales and items were used including literature review, item development and revision, focus groups with interdisciplinary rehabilitation staff (n = 26) for rating content validity, and cognitive interviewing of TBI family members (n = 9) for assuring item clarity. RESULTS: The Safety Assessment Measure is comprised of 6 primary scales - Cognitive Capacity, Visuomotor Capacity, Wheelchair Use, Risk Perception, Self-Regulation, and Compliance Failures with Safety Recommendations - in which family caregivers or clinicians rate the risk for unintentional injury or harm in adults who have sustained moderate or severe TBI. The scale item pools encompass a broad spectrum of everyday activities that pose risk in the home and community and were rated as having excellent levels of content validity. CONCLUSIONS: The Safety Assessment Measure scales and items cover a broad range of instrumental activities of daily living that can increase the risk of unintentional injuries or harm. Empirical evidence suggests that the Safety Assessment Measure items have excellent content validity. Future research should use modern psychometric methods to examine each scale unidimensionality, model fit, and precision. [ABSTRACT FROM AUTHOR]

Objective To investigate sexual functioning and its predictors in spouses/partners of persons with traumatic brain injury (TBI). Design Inception cohort survey. Setting Community. Participants Persons (N=70) with complicated mild to severe TBI admitted to 1 of 6 participating TBI Model Systems inpatient rehabilitation units and their spouses/partners who were both living in the community and assessed 1 year after injury. Interventions Not applicable. Main Outcome Measures Derogatis Interview for Sexual Functioning Self-Report; Global Sexual Satisfaction Index. Results Twenty percent of spouses/partners of persons with TBI reported sexual dysfunction, and 44% reported dissatisfaction with sexual functioning. Sixty-two percent of spouses/partners reported a decrease in sexual activity during the year postinjury, 34% reported a decrease in sexual drive or desire, and 34% indicated that sexuality was less important in comparison to preinjury. The sexual functioning of spouses/partners of persons with TBI was highly associated with the sexual functioning of the person with TBI. Age of spouses/partners and sexual functioning in persons with the TBI were significant predictors of spouses'/partners' sexual functioning, even after controlling for sex of partners and the physical, cognitive, participation, and sexual functioning of the persons with injury. Conclusions Greater sexual dysfunction in spouses/partners was associated with older age and with poorer sexual functioning in the person with injury. Rehabilitation professionals should provide education on the potential impact of TBI on sexual functioning for both persons with TBI and their spouses/partners, and integrate the assessment of sexual functioning into their clinical assessment, making appropriate referrals for therapy. [ABSTRACT FROM AUTHOR]

Objective: To examine the effect of primary language on admission and discharge FIM™ communication ratings in a sample of individuals with moderate-to-severe traumatic brain injury (TBI). Design and methods: Secondary data analysis of rehabilitation admission and discharge FIM™ communication ratings of 2795 individuals hospitalized at a Traumatic Brain Injury Model Systems (TBIMS) centre between 2007–2012. Results: Individuals who spoke no English were rated worse on functional communication outcomes at inpatient rehabilitation discharge relative to individuals whose primary language was English. Conclusions: These findings may reflect systematic bias in FIM™ communication ratings of non-English-speaking individuals with TBI and/or TBI-induced communication difficulties in non-English-speaking individuals. Clinical and research implications are discussed. [ABSTRACT FROM AUTHOR]

Objective To determine the accuracy of self-reported length of coma and posttraumatic amnesia (PTA) in persons with medically verified traumatic brain injury (TBI) and to investigate factors that affect self-report of length of coma and PTA duration. Design Prospective cohort study. Setting Specialized rehabilitation center with inpatient and outpatient programs. Participants Persons (N=242) with medically verified TBI who were identified from a registry of persons who had previously participated in TBI-related research. Intervention Not applicable. Main Outcome Measures Self-reported length of coma and self-reported PTA duration. Results Review of medical records revealed that the mean medically documented length of coma and PTA duration was 6.9±12 and 19.2±22 days, respectively, and the mean self-reported length of coma and PTA duration was 16.7±22 and 106±194 days, respectively. The average discrepancy between self-report and medical record for length of coma and PTA duration was 8.2±21 and 64±176 days, respectively. Multivariable regression models revealed that time since injury, performance on cognitive tests, and medical record values were associated with self-reported values for both length of coma and PTA duration. Conclusions In this investigation, persons with medically verified TBI showed poor accuracy in their self-report of length of coma and PTA duration. Discrepancies were large enough to affect injury severity classification. Caution should be exercised when considering self-report of length of coma and PTA duration. [ABSTRACT FROM AUTHOR]

Objectives To identify aspects of health-related quality of life (HRQOL) that are relevant to caregivers of individuals with traumatic brain injury (TBI) and to propose an integrated conceptual framework based on this information. Design Nine focus groups with caregivers of individuals with moderate-to-severe TBI were qualitatively analyzed to ascertain the effect that caring for an individual with a TBI has on caregiver HRQOL. Setting University hospitals and rehabilitation treatment centers. Participants Caregivers (N=55) of individuals with moderate-to-severe TBI. Interventions Not applicable. Main Outcome Measures Not applicable. Results Qualitative analysis indicated that caregivers were most concerned about their social health (42% of comments). Other important issues were emotional health (34%), physical health (11%), cognitive health (3%), and feelings of loss (9%; feelings of loss related to changes in the future/potential of the care recipient or related to the caregiver). Areas of concern that were discussed that were specific to the caregiver and not fully evaluated by existing patient-reported outcomes (PROs) included feelings of loss, anxiety related to the caregiver role (reinjury concerns, worry about leaving the person alone, etc), and caregiver strain (burden, stress, feeling overwhelmed, etc). Conclusions Although existing PROs capture relevant aspects of HRQOL for caregivers, there are HRQOL domains that are not addressed. A validated and sensitive HRQOL tool for caregivers of individuals with TBI will facilitate initiatives to improve outcomes in this underserved group. [ABSTRACT FROM AUTHOR]

Objective: To identify preinjury coping profiles among adults with uncomplicated mild traumatic brain injury (mTBI) and complicated mTBI and to determine whether preinjury coping profiles contribute to the prediction of emotional functioning and quality of life (QOL) 3 months post-mTBI. Participants: One hundred eighty-seven persons with medically documented mTBI (uncomplicated mTBI, n = 89; complicated mTBI, n = 98) were recruited from the emergency center of a level I trauma center and followed in community 3 months post-mTBI. Measures: The Ways of Coping Questionnaire was administered within 2 weeks of injury. Cluster analysis was used to group participants on basis of their preinjury use of problem-focused and avoidant coping strategies. The Brief Symptom Inventory and the 36-item Short-Form Health Survey were administered 3 months postinjury. Results: Cluster analysis distinguished 3 distinct preinjury coping profiles that were differentially associated with outcomes. Participants who used avoidant coping showed the worse emotional functioning and QOL outcomes, although this cluster also reported high usage of problem-focused strategies. Preinjury coping profiles explained a significant proportion of the variance in depression, anxiety, and mental health QOL at 3 months postinjury beyond that accounted for by demographic characteristics and mTBI severity. Conclusions: Cluster analysis holds practical value in illustrating the pattern of coping strategies used by person with uncomplicated and complicated mTBI. It appears worthwhile to address coping in future trials of interventions that are aimed at improving emotional functioning after mTBI. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To conduct a systematic review of the prognostic value of self-reported traits/problems/strengths and environmental barriers/facilitators for participation outcomes in persons with traumatic brain injury (TBI). Data Sources: Articles published through August 15, 2013, obtained by conducting electronic searches of PubMed, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature databases and a review of reference lists of reviewed articles. Study Selection: Reviewed articles were written in English and presented findings on adult humans with TBI, participation outcomes, and ≥1 self-reported trait/problem/strength (eg, depression, pain, coping style) and/or ≥1 environment barrier/facilitator (eg, social support, family functioning, access to services). Data Extraction: Each of the 996 abstracts was examined by 2 reviewers, and those failing to meet all inclusion criteria were excluded. Data were extracted from the 63 retained articles by 2 independent reviewers, who met to resolve any differences in study quality rating or evidence recorded. Study quality was determined using American Academy of Neurology (AAN) criteria. Data Synthesis: Conclusions regarding prognostic importance of self-report and environmental barrier/facilitator variables were made using AAN criteria. Conclusions regarding barrier/facilitator variables indicated that access to transportation, access to services, and participation in social interaction were possibly predictive of employment outcome, whereas living arrangements and social support were possibly not predictive of employment outcome. Conclusions regarding self-report variables indicated that the number of postconcussive symptoms, fatigue, and physical competence were probably predictive of employment and need for supervision, whereas self-efficacy was probably not predictive of employment. Subjective well-being, pain, and social interaction were possibly predictive of employment, whereas coping style was possibly not predictive. Conclusions: Although additional investigation is needed, self-report variables are likely to make important contributions to predicting participation outcomes. Future research should be guided by coherent conceptual models and use a consistent set of assessment instruments to facilitate comparisons between studies. [Copyright &y& Elsevier]

Objective: To investigate longitudinal changes in sexual functioning during the first year following moderate to severe traumatic brain injury (TBI). Design: Prospective cohort study. Setting: Community. Participants: 182 persons (53 women and 129 men) with moderate to severe TBI who were admitted to 1 of 6 participating TBI Model System centers and followed in the community at 6 and 12 months after injury. Main Measures: Derogatis Interview for Sexual Functioning-Self-Report (DISF-SR); Global Sexual Satisfaction Index (GSSI). Results: Mean T-scores on the DISF-SR Arousal subscale demonstrated marginal improvement over time, with a 2.59-point increase (P = .05) from 6 to 12 months after injury. There were no significant differences over this 6-month period on the remaining DISF-SR subscales, including sexual cognition/fantasy, sexual behavior/experience, and orgasm. There was no significant change in satisfaction with sexual functioning on the GSSI from 6 months (72% satisfied) to 12 months (71% satisfied). Conclusions and Implications: Sexual function and satisfaction appears to be stable in those with moderate to severe TBI from 6 to 12 months after injury, with the exception of minimal improvement in arousal. These findings, to our knowledge, reflect the first evidence regarding prospective changes in sexual functioning in this population. Future research can go far to assist clinicians in treatment planning and managing patient expectations of recovery of sexual functioning after TBI. [ABSTRACT FROM AUTHOR]

Abstract: Davis LC, Sherer M, Sander AM, Bogner JA, Corrigan JD, Dijkers MP, Hanks RA, Bergquist TF, Seel RT. Preinjury predictors of life satisfaction at 1 year after traumatic brain injury. Objective: To investigate the predictive value of preinjury factors for satisfaction with life (SWL) at 1-year posttraumatic brain injury (TBI). Design: Secondary analysis of prospective, longitudinal registry using data collected during inpatient rehabilitation and at 1-year post-TBI. Setting: Fifteen specialized brain injury units providing acute rehabilitation care as part of the Traumatic Brain Injury Model Systems (TBIMS) program. Participants: Community-dwelling persons (N=444) with moderate to severe TBI aged 16 to 64 years enrolled in the TBIMS program between October 2007 and October 2008 with 1-year follow-up data. Interventions: Not applicable. Main Outcome Measure: Satisfaction With Life Scale (SWLS). Results: Hierarchical stepwise linear regression revealed that injury-related and demographic variables did not contribute significantly to the explained variance in SWLS scores. In contrast, the preinjury functioning (education, productivity/employment) and preinjury condition (psychiatric and substance use problems, severe sensory dysfunction, learning problems, prior TBI) blocks each contributed significantly to the explained variance in SWLS scores. Preinjury functioning accounted for 2.9% of the variance and preinjury conditions for 3.8%. Conclusions: Although their contributions are small, preinjury functioning and preinjury conditions are important to consider in the prediction of SWL post-TBI. Educational level and history of psychiatric and other premorbid difficulties are particularly important for clinicians to consider when implementing or developing interventions for persons with moderate to severe TBI. [Copyright &y& Elsevier]

Abstract: Sander AM, Maestas KL, Pappadis MR, Sherer M, Hammond FM, Hanks R, and the NIDRR Traumatic Brain Injury Model Systems Module Project on Sexuality After TBI. Sexual functioning 1 year after traumatic brain injury: findings from a prospective Traumatic Brain Injury Model Systems collaborative study. Objective: To investigate the incidence and types of sexual difficulties in men and women with traumatic brain injury (TBI) 1 year after injury, as well as their comfort level in discussing problems with health care professionals. Design: Prospective cohort study. Setting: Community. Participants: Persons with TBI (N=223; 165 men and 58 women) who had been treated at 1 of 6 participating TBI Model Systems inpatient rehabilitation units and were living in the community. Interventions: None. Main Outcome Measures: Derogatis Interview for Sexual Functioning-self-report (DISF-SR); Global Sexual Satisfaction Index (GSSI); structured interview regarding changes in sexual functioning; and comfort level discussing sexuality with health care professionals. Results: Women with TBI scored significantly below the normative sample for all subscales of the DISF-SR, including sexual cognition/fantasy, arousal, sexual behavior/experience, and orgasm. Men scored significantly below the normative sample on all scales except arousal. Women reported greater dysfunction than men for sexual cognition/fantasy and arousal. Twenty-nine percent of participants reported dissatisfaction with sexual functioning on the GSSI, with a greater percentage of men reporting dissatisfaction. Sixty-eight percent of participants indicated that they would spontaneously raise issues of sexual difficulties with health care professionals, while the remainder would either bring it up only if directly asked or would not discuss it at all. Conclusions: Sexual difficulties were present in a substantial portion of community-dwelling people with TBI at 1 year after injury. Educational interventions to increase awareness among people with TBI and rehabilitation professionals are warranted, as well as interventions to improve sexual functioning. [Copyright &y& Elsevier]

Background:Earlier models of disability emphasized the impact of only injury-related factors impeding community integration. However, recent models incorporate the significance of physical and social environment on community integration. This study aimed to identify perceived environmental barriers that impact community integration among an ethnically diverse sample of persons with traumatic brain injury (TBI).Material/ Methods:A total of 167 patients with medically documented TBI, consecutively admitted to the Neurosurgery Service at a Level I trauma center, participated in this study. Participants completed assessments in their homes at least 6 months post injury. Environmental barriers were assessed using the Craig Hospital Inventory of Environmental Factors-Short Form (CHIEFSF). Community integration was evaluated using the Community Integration Measure (CIM) and the Craig Handicap Assessment and Reporting Technique - Short Form (CHART-SF). Results:After accounting for injury severity, race and pre-injury productivity, MANCOVA results indicated that service/assistance barriers was significantly associated with decreased community integration. Trends were found for physical/structural and attitudinal/support barriers. Multiple regression analyses revealed that physical/structural barriers were associated with decreased independent participation, belonging, and occupation/productivity outcomes. Service/assistance barriers were associated with both decreased independent participation and mobility. Attitudinal/support barriers were associated with increased community mobility. Conclusions:Certain environmental barriers perceived by persons with TBI may negatively impact their reintegration to the community post injury. Identifying such barriers may help develop programs or policies to reduce barriers, while facilitating improved access to health care and other services after injury. [ABSTRACT FROM AUTHOR]

Abstract: Sander AM, Maestas KL, Sherer M, Malec JF, Nakase-Richardson R. Relationship of caregiver and family functioning to participation outcomes after postacute rehabilitation for traumatic brain injury: a multicenter investigation. Objective: To investigate the contribution of caregiver emotional functioning and family functioning to participation outcomes after postacute rehabilitation for traumatic brain injury (TBI). Design: Prospective cohort study. Setting: Three postacute comprehensive-integrated postacute rehabilitation programs associated with National Institute on Disability and Rehabilitation Research–funded TBI Model Systems Centers. Participants: Persons with medically documented TBI (N=136; 57% with severe TBI, 12% moderate, 31% mild), primarily men and 69% white. Interventions: Not applicable. Main Outcome Measures: Community Integration Questionnaire and Craig Handicap Assessment and Reporting Technique (CHART). Results: After accounting for age, education, sex, and race/ethnicity, there was a significant interaction between caregiver emotional functioning and time since injury for CHART Occupation and Social Integration Scale scores. Better emotional functioning in caregivers was associated with greater occupation and social integration outcomes for persons who entered the postacute rehabilitation program within 6 months of injury, but not for those >6 months postinjury. There was no relationship of family functioning to participation outcomes, and no interaction between family functioning and time since injury. Conclusions: Caregiver distress should be accounted for in studies investigating the effectiveness of postacute rehabilitation after TBI. Screening of caregivers early during postacute rehabilitation can target those who need assistance to improve their support of the person with TBI. [Copyright &y& Elsevier]

Sady MD, Sander AM, Clark AN, Sherer M, Nakase-Richardson R, Malec JF. Relationship of preinjury caregiver and family functioning to community integration in adults with traumatic brain injury. Objective: To investigate the relationship of preinjury caregiver and family functioning to community integration outcomes in persons with traumatic brain injury (TBI). Design: Inception cohort. Setting: Three TBI Model Systems inpatient rehabilitation facilities. Participants: Persons with TBI (N=141) and their caregivers admitted to inpatient rehabilitation and followed up at 1 to 2 years after injury. Interventions: Not applicable. Main Outcome Measures: Community Integration Questionnaire and the Social and Occupation scales of the Craig Handicap Assessment and Reporting Technique. Results: There were significant interactions of several preinjury caregiver and family variables with injury severity. For persons with complicated mild/moderate injury, better family functioning was associated with greater home integration, and less caregiver distress was associated with better social integration. For persons with severe injuries, greater caregiver perceived social support was associated with better outcomes in productivity and social integration. Conclusions: Preinjury caregiver and family characteristics interact with injury severity to affect outcomes in persons with injury. Research on outcomes should include measures of caregiver and family functioning. Early interventions targeted toward decreasing caregiver distress, increasing support, and improving family functioning may have a positive impact on later outcomes. [Copyright &y& Elsevier]

Neuropsychologists are increasingly asked to provide recommendations regarding functional abilities based on test results, particularly within the rehabilitation setting. Yet, the empirical basis for making such recommendations is limited. The current study examines relationships between executive functioning and social communication measures and concurrently measured occupational and social integration outcomes. Participants were 121 individuals with traumatic brain injury (TBI) recruited from participants in a longitudinal study of outcome following TBI who had all received comprehensive brain injury rehabilitation. As part of a larger study designed to evaluate social communication abilities following TBI, participants completed measures of executive functioning, affect perception, perceived communication ability, and functional outcome. After adjusting for age, education, and performance on executive functioning measures, social communication performance accounted for a unique 5.6% of the variance in occupational outcomes and 7.9% of variance in social integration outcomes. Executive functioning performance accounted for a unique 13.3% of the variance in occupational functioning and 16.0% of explained variance in social integration. These results provide evidence of the value of executive functioning and social communication measures in the prediction of functional outcomes. Additionally, such results provide preliminary support for the addition of social communication measures to assessment of TBI in neuropsychological practice. [ABSTRACT FROM AUTHOR]

Abstract: High WM Jr, Roebuck-Spencer T, Sander AM, Struchen MA, Sherer M. Early versus later admission to postacute rehabilitation: impact on functional outcome after traumatic brain injury. Objective: To examine the impact of participation in a postacute community reentry program on functional outcome after traumatic brain injury (TBI). Design: Cohort, nonrandomized, intervention study. Pretest-posttest, follow-up design. Setting: Nonprofit outpatient community reentry program affiliated with an inpatient rehabilitation hospital. Participants: Three groups of persons with moderate to severe TBI differing in length of time between injury and admission. The first group entered postacute rehabilitation within 6 months of injury (n=115); the second group, between 6 and 12 months (n=23); and the third group, greater than 12 months (n=29). Interventions: Persons with TBI participated in a postacute community reentry program (average, 4.3mo) that emphasized (1) teaching compensatory strategies to address residual cognitive deficits; (2) arranging environmental supports to maximize functioning; (3) counseling and education to address personal and family adjustment and to improve accurate self-awareness; and (4) transition from simulated activities in the clinic to productive activities in the community. Main Outcome Measures: Disability Rating Scale, Supervision Rating Scale, and the Community Integration Questionnaire. Results: All groups showed improvements between admission and discharge on measures of overall disability, independence, home competency, and productivity, and these gains were maintained at follow-up. For the group beginning postacute rehabilitation the earliest (<6mo postinjury) independence continued to improve after discharge. Community integration total score and home competency also continued to improve even after discharge. Conclusions: The results point toward the effectiveness of postacute rehabilitation in improving functional outcome after TBI even for persons who have reached stable neurologic recovery at 12 or more months postinjury. [Copyright &y& Elsevier]

Primary objective: To investigate the relationship of family functioning to patients' progress in a post-acute TBI rehabilitation programme. Research design: Cohort study investigating predictors of change from admission to follow-up. Methods and procedures: Caregivers of 37 persons with severe TBI consecutively admitted to a residential post-acute rehabilitation facility completed the Family Assessment Device (FAD) within a few weeks of admission. The Disability Rating Scale (DRS) was completed upon admission and ∼1 month after discharge. FAD scores were used to predict DRS change scores after controlling for injury severity, admit FAD scores, and time from admission to follow-up. Main outcomes and results: Persons with unhealthy family functioning showed less improvement on DRS total, level of functioning (LOF), and employability (EMP) scores. Conclusions: The results emphasize that family functioning is an important variable to include in future models predicting rehabilitation outcome, and the importance of family intervention as part of the rehabilitation process. [ABSTRACT FROM AUTHOR]

Abstract: The ultimate goal of rehabilitation research is to improve the lives of people with disabilities; yet, little research is implemented into clinical practice. The objectives of the current article are to serve as a guide for rehabilitation researchers regarding factors that contribute to translation of the evidence base in clinical practice, to highlight some common problems encountered by clinicians when trying to implement evidence-based treatments, and to provide tips that researchers can use to enhance the likelihood of their research products being used in clinical practice. The impact of clinician and environmental factors on use of evidence-based medicine are reviewed. Practical issues encountered by clinicians when attempting to translate evidence-based findings into practice are highlighted by discussing 2 areas of research: compensatory strategies for memory impairment after brain injury and use of electrical stimulation for weakness and paralysis in persons with spinal cord injury. The article closes with a series of tips to assist researchers in translating findings to clinicians. [Copyright &y& Elsevier]

Supplemental digital content is available in the text. Objective: The aim of the study was to investigate sex differences and the impact of social living situation on individual functional independence measure outcomes after stroke rehabilitation. Design: A retrospective observational study using Medicare fee-for-service beneficiaries (N = 125,548) who were discharged from inpatient rehabilitation facilities in 2013 and 2014 after a stroke. Discharge individual functional independence measure score, dichotomized as ≥5 and <5, was the primary outcome measure. A two-step generalized linear mixed model was used to measure the effect of sex on each functional independence measure item while controlling for many clinical and sociodemographic covariates. Results: After adjusting for sociodemographic and clinical factors, females had higher odds of reaching a supervision level for 14 of 18 functional independence measure items. Males had higher odds of reaching a supervision level on 2 of 18 functional independence measure items. Individuals who lived alone before their stroke had higher odds of reaching a supervision level than individuals who lived with a caregiver or with family for all functional independence measure items. Conclusions: When sociodemographic and clinical factors are controlled, females are more likely to discharge from inpatient rehabilitation at a supervision level or better for most functional independence measure items. Individuals who live alone before their stroke have higher odds of discharging at a supervision level or better. [ABSTRACT FROM AUTHOR]