Advertisement

Unmet Rehabilitation Needs Indirectly Influence Life Satisfaction 5 Years After Traumatic Brain Injury: A Veterans Affairs TBI Model Systems Study

Published:September 16, 2020DOI:https://doi.org/10.1016/j.apmr.2020.08.012

      Highlights

      • Survivors of traumatic brain injury report many unmet rehabilitation needs.
      • Unmet rehabilitation needs indirectly influences chronic-stage life satisfaction.
      • Depression and social/community participation are mediators of life satisfaction.

      Abstract

      Objective

      To describe the association between unmet rehabilitation needs and life satisfaction 5 years after traumatic brain injury (TBI).

      Design

      Prospective observational cohort.

      Setting

      Five Veterans Affairs (VA) Polytrauma Rehabilitation Centers.

      Participants

      VA TBI Model Systems participants (N=301); 95% male; 77% white; average age, 39±14y).

      Interventions

      Not applicable.

      Main Outcome Measures

      Satisfaction With Life Scale (SWLS).

      Results

      Average SWLS score was 22±8. Univariable analyses demonstrated several statistically significant predictors of life satisfaction, including employment status, participation, psychiatric symptom severity, past year mental health treatment, and total number of unmet rehabilitation needs (all P<.05). Multivariable analyses revealed that depression and participation were each associated with life satisfaction. An ad hoc mediation model suggested that unmet rehabilitation needs total was indirectly related to life satisfaction. Total unmet rehabilitation needs ranged from 0-21 (mean, 2.0±3.4). Correlational analyses showed that 14 of the 21 unmet rehabilitation needs were associated with life satisfaction.

      Conclusions

      Findings support the need for rehabilitation engagement in later stages of TBI recovery. Ongoing assessment of and intervention for unmet rehabilitation needs in the chronic phase of recovery have the potential to mitigate decline in life satisfaction.

      Keywords

      List of Abbreviations:

      GAD-7 (Generalized Anxiety Disorder-7), NSI (Neurobehavioral Symptom Inventory), PART-O (Participation Assessment With Recombined Tools-Objective), PCL-C (PTSD Checklist-Civilian version), PHQ-9 (Patient Health Questionnaire-9), PRC (Polytrauma Rehabilitation Center), PTA (posttraumatic amnesia), SWLS (Satisfaction With Life Scale), TBI (traumatic brain injury), TFC (time to follow commands), VA (Veterans Affairs)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Masel B.E.
        • DeWitt D.S.
        Traumatic brain injury disease: long-term consequences of traumatic brain injury.
        in: Levin H.S. Shum D.H.K. Chan R.C.K. Understanding traumatic brain injury: current research and future directions. Oxford University Press, New York2014: 28-56
        • Rutherford G.W.
        • Corrigan J.D.
        Long-term consequences of traumatic brain injury.
        J Head Trauma Rehabil. 2009; 24: 421-423
        • Dikmen S.S.
        • Corrigan J.D.
        • Levin H.S.
        • Machamer J.
        • Stiers W.
        • Weisskopf M.G.
        Cognitive outcome following traumatic brain injury.
        J Head Trauma Rehabil. 2009; 24: 430-438
        • Dikmen S.
        • Machamer J.
        • Fann J.R.
        • Temkin N.R.
        Rates of symptom reporting following traumatic brain injury.
        J Int Neuropsychol Soc. 2010; 16: 401-411
        • Corrigan J.D.
        • Selassie A.W.
        • Orman J.A.L.
        The epidemiology of traumatic brain injury.
        J Head Trauma Rehabil. 2010; 25: 72-80
        • Zaloshnja E.
        • Miller T.
        • Langlois J.A.
        • Selassie A.W.
        Prevalence of long-term disability from traumatic brain injury in the civilian population of the United States, 2005.
        J Head Trauma Rehabil. 2008; 23: 394-400
        • Al-Jarrah M.D.
        • Nazzal M.E.
        • Jamous M.A.
        • Azab M.A.
        • Maayah M.F.
        Association between the functional independence measure and Glasgow Coma Scale regarding the rehabilitation outcomes of traumatic brain injury.
        Neurosciences. 2009; 14: 41-44
        • Huebner R.A.
        • Johnson K.
        • Bennett C.M.
        • Schneck C.
        Community participation and quality of life outcomes after adult traumatic brain injury.
        Am J Occup Ther. 2003; 57: 177-185
        • Sveen U.
        • Røe C.
        • Sigurdardottir S.
        • et al.
        Rehabilitation pathways and functional independence one year after severe traumatic brain injury.
        Eur J Phys Rehab Med. 2016; 52: 650-661
        • Amtmann D.
        • Bocell F.D.
        • Bamer A.
        • et al.
        Psychometric properties of the Satisfaction With Life Scale in people with traumatic brain, spinal cord, or burn injury: a National Institute on Disability, Independent Living, and Rehabilitation Research Model System study.
        Assessment. 2019; 26: 695-705
        • Diener E.
        • Emmons R.
        • Larsen J.
        • Griffin S.
        The Satisfaction With Life Scale.
        J Pers Assess. 1985; 49: 71-75
        • Williamson M.L.
        • Elliott T.R.
        • Berry J.W.
        • Underhill A.T.
        • Stavrinos D.
        • Fine P.R.
        Predictors of health-related quality-of-life following traumatic brain injury.
        Brain Inj. 2013; 27: 992-999
        • Juengst S.B.
        • Adams L.M.
        • Bogner J.A.
        • et al.
        Trajectories of life satisfaction after traumatic brain injury: influence of life roles, age, cognitive disability, and depressive symptoms.
        Rehabil Psychol. 2015; 60: 353-364
        • Anke A.
        • Andelic N.
        • Skandsen T.
        • et al.
        Functional recovery and life satisfaction in the first year after severe traumatic brain injury: a prospective multicenter study of a Norwegian national cohort.
        J Head Trauma Rehabil. 2015; 30: E38-49
        • Arango-Lasprilla J.C.
        • Ketchum J.M.
        • Gary K.
        • et al.
        Race/ethnicity differences in satisfaction with life among persons with traumatic brain injury.
        NeuroRehabilitation. 2009; 24: 5-14
        • Kalpinski R.J.
        • Williamson M.L.
        • Elliott T.R.
        • Berry J.W.
        • Underhill A.T.
        • Fine P.R.
        Modeling the prospective relationships of impairment, injury severity, and participation to quality of life following traumatic brain injury.
        BioMed Res Int. 2013; 2013: 102570
        • Davis L.C.
        • Sherer M.
        • Sander A.M.
        • et al.
        Preinjury predictors of life satisfaction at 1 year after traumatic brain injury.
        Arch Phys Med Rehabil. 2012; 93: 1324-1330
        • Gause L.
        • Finn A.
        • Lamberty G.
        • et al.
        Predictors of satisfaction with life in veterans after traumatic brain injury: a VA TBI Model Systems study.
        J Head Trauma Rehabil. 2017; 32: 255-263
        • Saban K.L.
        • Smith B.M.
        • Collins E.G.
        • Pape T.L.B.
        Sex differences in perceived life satisfaction and functional status one year after severe traumatic brain injury.
        J Womens Health (Larchmt). 2011; 20: 179-186
        • Corrigan J.D.
        • Whiteneck G.
        • Mellick D.
        Perceived needs following traumatic brain injury.
        J Head Trauma Rehabil. 2004; 19: 205-216
        • Heinemann A.W.
        • Sokol K.
        • Garvin L.
        • Bode R.K.
        Measuring unmet needs and services among persons with traumatic brain injury.
        Arch Phys Med Rehabil. 2002; 83: 1052-1059
        • Pickelsimer E.E.
        • Selassie A.W.
        • Sample P.L.
        • Heinemann A.W.
        • Gu J.K.
        • Veldheer L.C.
        Unmet service needs of persons with traumatic brain injury.
        J Head Trauma Rehabil. 2007; 22: 1-13
        • Whiteneck G.G.
        • Eagye C.B.
        • Cuthbert J.P.
        • et al.
        One to five year outcomes after moderate-to-severe traumatic brain injury requiring inpatient rehabilitation.
        Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Atlanta, GA2018
        • Lamberty G.J.
        • Nakase-Richardson R.
        • Farrell-Carnahan L.
        • et al.
        Development of a traumatic brain injury model system within the Department of Veterans Affairs Polytrauma System of Care.
        J Head Trauma Rehabil. 2014; 29: E1-7
        • Corrigan J.D.
        • Bogner J.
        • Mellick D.
        • et al.
        Prior history of traumatic brain injury among persons in the Traumatic Brain Injury Model Systems National Database.
        Arch Phys Med Rehabil. 2013; 94: 1940-1950
        • Horn S.D.
        • Corrigan J.D.
        • Bogner J.
        • et al.
        Traumatic brain injury-practice based evidence study: design and patients, centers, treatments, and outcomes.
        Arch Phys Med Rehabil. 2015; 96 (e15): S178-S196
        • Granger C.V.
        • Hamilton B.B.
        • Keith R.A.
        • Zielesny M.
        • Sherwin F.S.
        Advances in functional assessment for medical rehabilitation.
        Top Geriatr Rehabil. 1986; 1: 59-74
        • Dodds T.A.
        • Martin D.P.
        • Stolov W.C.
        • Deyo R.A.
        A validation of the functional independence measurement and its performance among rehabilitation inpatients.
        Arch Phys Med Rehabil. 1993; 74: 531-536
        • Spitzer R.L.
        • Kroenke K.
        • Williams J.B.
        • Löwe B.
        A brief measure for assessing generalized anxiety disorder: the GAD-7.
        Arch Intern Med. 2006; 166: 1092-1097
        • Kroenke K.
        • Spitzer R.L.
        • Williams J.B.
        • Monahan P.O.
        • Lowe B.
        Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection.
        Ann Intern Med. 2007; 146: 317-325
        • Löwe B.
        • Decker O.
        • Müller S.
        • et al.
        Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population.
        Med Care. 2008; 46: 266-274
        • Cicerone K.D.
        • Kalmar K.
        Persistent postconcussion syndrome: the structure of subjective complaints after mild traumatic brain injury.
        J Head Trauma Rehabil. 1995; 10: 1-17
        • King P.R.
        • Donnelly K.T.
        • Donnelly J.P.
        • et al.
        Psychometric study of the neurobehavioral symptom inventory.
        J Rehabil Res Dev. 2012; 49: 879-888
        • Vanderploeg R.D.
        • Silva M.A.
        • Soble J.R.
        • et al.
        The structure of postconcussion symptoms on the Neurobehavioral Symptom Inventory: a comparison of alternative models.
        J Head Trauma Rehabil. 2015; 30: 1-11
        • Whiteneck G.G.
        • Dijkers M.P.
        • Heinemann A.W.
        • et al.
        Development of the participation assessment with recombined tools-objective for use after traumatic brain injury.
        Arch Phys Med Rehabil. 2011; 92: 542-551
        • Bogner J.A.
        • Whiteneck G.G.
        • Corrigan J.D.
        • Lai J.S.
        • Dijkers M.P.
        • Heinemann A.W.
        Comparison of scoring methods for the participation assessment with recombined tools-objective.
        Arch Phys Med Rehabil. 2011; 92: 552-563
        • Weathers F.W.
        • Huska J.A.
        • Keane T.M.
        PCL-C for DSM-IV.
        National Center for PTSD – Behavioral Science Division, Boston1991
        • Vasterling J.J.
        • Brailey K.
        • Proctor S.P.
        • Kane R.
        • Heeren T.
        • Franz M.
        Neuropsychological outcomes of mild traumatic brain injury, post-traumatic stress disorder and depression in Iraq-deployed US Army soldiers.
        Brit J Psychiatry. 2012; 201: 186-192
        • McDonald S.
        • Calhoun P.
        The diagnostic accuracy of the PTSD Checklist: a critical review.
        Clin Psychol Rev. 2010; 30: 976-987
        • Kroenke K.
        • Spitzer R.L.
        The PHQ-9: a new depression diagnostic and severity measure.
        Psychiatr Ann. 2002; 32: 509-515
        • Kroenke K.
        • Spitzer R.
        • Williams J.
        The PHQ-9: validity of a brief depression severity measure.
        J General Intern Med. 2001; 16: 606-613
        • Fann J.R.
        • Bombardier C.H.
        • Dikmen S.
        • et al.
        Validity of the Patient Health Questionnaire-9 in assessing depression following traumatic brain injury.
        J Head Trauma Rehabil. 2005; 20: 501-511
        • Centers for Disease Control and Prevention
        Behavioral Risk Factor Surveillance System (BRFSS) users guide.
        Department of Health and Human Services, Atlanta1998
        • Nakase-Richardson R.
        • Haskin A.H.
        • Lynn C.
        • et al.
        Development of the TBI Rehabilitation Needs Survey for veterans and service members in post-acute stages of TBI [abstract].
        Arch Phys Med Rehabil. 2016; 97: e127-e128
        • Royer A.C.
        • Silva M.A.
        • Finn J.
        • Cotner B.
        • Nakase-Richardson R.
        Rehabilitation needs in veterans and service members 1-year after traumatic brain injury [abstract].
        Arch Phys Med Rehabil. 2018; 99: e174
        • Teasdale G.
        • Maas A.
        • Lecky F.
        • Manley G.
        • Stocchetti N.
        • Murray G.
        The Glasgow Coma Scale at 40 years: standing the test of time.
        Lancet Neurol. 2014; 13: 844-854
        • Nakase-Richardson R.
        • Sherer M.
        • Seel R.T.
        • et al.
        Utility of post-traumatic amnesia in predicting 1-year productivity following traumatic brain injury: comparison of the Russell and Mississippi PTA classification intervals.
        J Neurol Neurosurg Psychiatry. 2011; 82: 494-499
        • Baron R.M.
        • Kenny D.A.
        The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations.
        J Pers Soc Psychol. 1986; 51: 1173-1182
        • Hayes A.F.
        Introduction to mediation, moderation, and conditional process analysis. A regression-based approach.
        Guilford Press, New York2013
        • Preacher K.J.
        • Kelley K.
        Effect size measures for mediation models: quantitative strategies for communicating indirect effects.
        Psychol Methods. 2011; 16: 93-115
        • Kumar R.G.
        • Ketchum J.M.
        • Corrigan J.D.
        • et al.
        The longitudinal effects of comorbid health burden on functional outcomes for adults with moderate to severe traumatic brain injury.
        J Head Trauma Rehabil. 2020; 35: E372-E381
        • Hammond F.M.
        • Corrigan J.D.
        • Ketchum J.M.
        • et al.
        Prevalence of medical and psychiatric comorbidities following traumatic brain injury.
        J Head Trauma Rehabil. 2019; 34: E1-10
        • Department of Veterans Affairs
        Polytrauma/TBI system of care.
        (Available at:)
        • Resnik L.
        • Braford D.W.
        • Glynn S.M.
        • Jette A.M.
        • Johnson C.
        • Hernandez S.W.
        Issues in defining and measuring veteran community reintegration: proceedings of the Working Group on Community Reintegration, VA Rehabilitation Outcomes Conference, Miami, Florida.
        J Rehabil Res Dev. 2012; 49: 87-100
      1. Dillahunt-Aspillaga C, et al. Using coalition building as a tool to implement resource facilitation for veterans with traumatic brain injury: implications for rehabilitation counselors. J Rehabil; in press.

        • United States Library of Congress. S
        2372 - VA MISSION Act of 2018.
        (Available at:)
        • Nakase-Richardson
        • Stevens L.F.
        • Tang X.
        • et al.
        Comparison of the VA and NIDILRR TBI Model System cohorts.
        J Head Trauma Rehabil. 2017; 32: 221-233