Original research| Volume 102, ISSUE 1, P58-67, January 2021

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

Published:September 16, 2020DOI:


      • 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.



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


      Prospective observational cohort.


      Five Veterans Affairs (VA) Polytrauma Rehabilitation Centers.


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


      Not applicable.

      Main Outcome Measures

      Satisfaction With Life Scale (SWLS).


      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.


      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.


      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)
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