共查询到20条相似文献，搜索用时 31 毫秒
1.
Sean M. Phelan Lauren R. Bangerter Greta Friedemann-Sanchez Kandace A. Lackore Megan A. Morris Courtney H. Van Houtven Kathleen F. Carlson Michelle van Ryn Kristin J. Harden Joan M. Griffin 《Archives of physical medicine and rehabilitation》2018,99(11):2222-2229
Objective
To assess the association between perceived stigma and discrimination and caregiver strain, caregiver well-being, and patient community reintegration.Design
A cross-sectional survey study of 564 informal caregivers of U.S. military service veterans of wars in Iraq and Afghanistan who experienced traumatic brain injuries or polytrauma (TBI/PT).Setting
Care settings of community-dwelling former inpatients of U.S. Department of Veterans Affairs Polytrauma Rehabilitation Centers.Participants
Caregivers of former inpatients (N=564), identified through next-of-kin records and subsequent nominations.Interventions
Not applicable.Main Outcome Measures
Caregiver strain, depression, anxiety, loneliness, and self-esteem; as well as care recipient community reintegration, a key aspect of TBI/PT rehabilitation.Results
Family stigma was associated with strain, depression, anxiety, loneliness, lower self-esteem, and less community reintegration. Caregiver stigma-by-association was associated with strain, depression, anxiety, loneliness, and lower self-esteem. Care recipient stigma was associated with caregiver strain, depression, anxiety, loneliness, lower self-esteem, and less community reintegration.Conclusions
Perceived stigma may be a substantial source of stress for caregivers of U.S. military veterans with TBI/PT, and may contribute to poor outcomes for the health of caregivers and for the community reintegration of the veterans for whom they provide care. 相似文献2.
3.
Theresa Louise Bender Pape Bridget Smith Judith Babcock-Parziale Charlesnika T. Evans Amy A. Herrold Kelly Phipps Maieritsch Walter M. High 《Archives of physical medicine and rehabilitation》2018,99(7):1370-1382
Objective
To comprehensively estimate the diagnostic accuracy and reliability of the Department of Veterans Affairs (VA) Traumatic Brain Injury (TBI) Clinical Reminder Screen (TCRS).Design
Cross-sectional, prospective, observational study using the Standards for Reporting of Diagnostic Accuracy criteria.Setting
Three VA Polytrauma Network Sites.Participants
Operation Iraqi Freedom, Operation Enduring Freedom veterans (N=433).Main Outcome Measures
TCRS, Comprehensive TBI Evaluation, Structured TBI Diagnostic Interview, Symptom Attribution and Classification Algorithm, and Clinician-Administered Posttraumatic Stress Disorder (PTSD) Scale.Results
Forty-five percent of veterans screened positive on the TCRS for TBI. For detecting occurrence of historical TBI, the TCRS had a sensitivity of .56 to .74, a specificity of .63 to .93, a positive predictive value (PPV) of 25% to 45%, a negative predictive value (NPV) of 91% to 94%, and a diagnostic odds ratio (DOR) of 4 to 13. For accuracy of attributing active symptoms to the TBI, the TCRS had a sensitivity of .64 to .87, a specificity of .59 to .89, a PPV of 26% to 32%, an NPV of 92% to 95%, and a DOR of 6 to 9. The sensitivity was higher for veterans with PTSD (.80–.86) relative to veterans without PTSD (.57–.82). The specificity, however, was higher among veterans without PTSD (.75–.81) relative to veterans with PTSD (.36–.49). All indices of diagnostic accuracy changed when participants with questionably valid (QV) test profiles were eliminated from analyses.Conclusions
The utility of the TCRS to screen for mild TBI (mTBI) depends on the stringency of the diagnostic reference standard to which it is being compared, the presence/absence of PTSD, and QV test profiles. Further development, validation, and use of reproducible diagnostic algorithms for symptom attribution after possible mTBI would improve diagnostic accuracy. 相似文献4.
Anthony H. Lequerica Christian Lucca Nancy D. Chiaravalloti Irene Ward John D. Corrigan 《Archives of physical medicine and rehabilitation》2018,99(9):1811-1817
Objective
To test the feasibility and validity of an online version of an established interview designed to determine a lifetime history of traumatic brain injury (TBI).Design
Cross-sectional.Setting
General community.Participants
A volunteer sample of individuals (N= 265) from the general population across the United States.Interventions
Not applicable.Main Outcome Measure(s)
Online version of the Ohio State University Traumatic Brain Injury Identification Method, Rivermead Postconcussion Symptoms Questionnaire (RPQ), Patient-Reported Outcomes Measurement Information System Cognitive Concerns Scale.Results
The measure was completed by 89.4% of the sample with most participants completing the measure in <8 minutes. After controlling for age, sex, psychiatric history, drug or alcohol history, and history of developmental disability, worst TBI severity was significantly associated with scores on the RPQ, F(2,230)=4.56, P=.011, and having a TBI within the past 2 years was associated with higher scores on the cognitive factor subscale of the RPQ, F(1,75)=7.7, P=.007.Conclusions
The online administration of the Ohio State University Traumatic Brain Injury Identification Method appears to be feasible in the general population. Preliminary validity was demonstrated for the indices of worst TBI severity and time since most recent TBI. 相似文献5.
James F. Malec Timothy E. Stump Patrick O. Monahan Jacob Kean Dawn Neumann Flora M. Hammond 《Archives of physical medicine and rehabilitation》2018,99(2):281-288.e2
Objectives
To develop, for versions completed by individuals with traumatic brain injury (TBI) and an observer, a more precise metric for the Neuropsychiatric Inventory (NPI) Irritability and Aggression subscales using all behavioral item ratings for use with individuals with TBI and to address the dimensionality of the represented behavioral domains.Design
Rasch and confirmatory factor analyses of retrospective baseline NPI data from 3 treatment studies.Setting
Postacute rehabilitation clinic.Participants
NPI records (N = 525) consisting of observer ratings (n = 287) and self-ratings (n = 238) by participants with complicated mild, moderate, or severe TBI at least 6 months postinjury.Interventions
Not applicable.Main Outcome Measures
Frequency and severity ratings from NPI Irritability/Lability and Agitation/Aggression subscales.Results
Confirmatory factor analyses of both observer and participant ratings showed good fit for either a 1-factor or a 2-factor solution. Consistent with this, the Rasch model also fit the data well with aggression items indicating the more severe end of the construct and irritability items populating the milder end.Conclusions
Irritability and aggression appear to represent different levels of severity of a single construct. The derived Rasch metric offers a measure of this construct based on responses to all specific items that is appropriate for parametric statistical analysis and may be useful in research and clinical assessments of individuals with TBI. 相似文献6.
Natalie Kreitzer Brad G. Kurowski Tamilyn Bakas 《Archives of physical medicine and rehabilitation》2018,99(11):2342-2354
Objective
To describe and synthesize the literature on adult traumatic brain injury (TBI) family caregiver and dyad intervention. TBI is a common injury that has a significant long-term impact, and is sometimes even characterized as a chronic condition. Informal (ie, unpaid) family caregivers of adults with TBI experience high rates of burnout, depression, fatigue, anxiety, lower subjective well-being, and poorer levels of physical health compared to noncaregivers. This study addresses the critical gap in the understanding of interventions designed to address the impact of TBI on adult patients and their family caregivers.Data Sources
PubMed and MEDLINE.Study Selection
Studies selected for review had to be written in English and be quasi-experimental or experimental in design, report on TBI caregivers, survivors with heavy involvement of caregivers, or caregiver dyads, involve moderate and severe TBI, and describe an intervention implemented during some portion of the TBI care continuum.Data Extraction
The search identified 2171 articles, of which 14 met our criteria for inclusion. Of the identified studies, 10 were randomized clinical trials and 4 were nonrandomized quasi-experimental studies. A secondary search to describe studies that included individuals with other forms of acquired brain injury in addition to TBI resulted in 852 additional titles, of which 5 met our inclusion criteria.Data Synthesis
Interventions that targeted the caregiver primarily were more likely to provide benefit than those that targeted caregiver/survivor dyad or the survivor only. Many of the studies were limited by poor fidelity, low sample sizes, and high risk for bias based on randomization techniques.Conclusions
Future studies of TBI caregivers should enroll a more generalizable number of participants and ensure adequate fidelity to properly compare interventions. 相似文献7.
Jennifer H. Marwitz Adam P. Sima Jeffrey S. Kreutzer Laura E. Dreer Thomas F. Bergquist Ross Zafonte Douglas Johnson-Greene Elizabeth R. Felix 《Archives of physical medicine and rehabilitation》2018,99(2):264-271
Objectives
To evaluate (1) the trajectory of resilience during the first year after a moderate-severe traumatic brain injury (TBI); (2) factors associated with resilience at 3, 6, and 12 months postinjury; and (3) changing relationships over time between resilience and other factors.Design
Longitudinal analysis of an observational cohort.Setting
Five inpatient rehabilitation centers.Participants
Patients with TBI (N=195) enrolled in the resilience module of the TBI Model Systems study with data collected at 3-, 6-, and 12-month follow-up.Interventions
Not applicable.Main Outcome Measure
Connor-Davidson Resilience Scale.Results
Initially, resilience levels appeared to be stable during the first year postinjury. Individual growth curve models were used to examine resilience over time in relation to demographic, psychosocial, and injury characteristics. After adjusting for these characteristics, resilience actually declined over time. Higher levels of resilience were related to nonminority status, absence of preinjury substance abuse, lower anxiety and disability level, and greater life satisfaction.Conclusions
Resilience is a construct that is relevant to understanding brain injury outcomes and has potential value in planning clinical interventions. 相似文献8.
Andrea R.S. Huebner Amy Cassedy Tanya M. Brown H. Gerry Taylor Terry Stancin Michael W. Kirkwood Shari L. Wade 《PM & R》2018,10(5):462-471
Background
Mental health problems are common after pediatric traumatic brain injury (TBI). Many patients in need of mental health services do not receive them, but studies have not consistently used prospective and objective methods or followed samples for more than 1 year.Objective
To examine adolescents’ use of mental health services after TBI.Design
Secondary analysis from multicenter prospective randomized controlled trial.Setting
Five level 1 U.S. trauma centers.Participants
Adolescents aged 12-17 years with moderate-to-severe TBI were recruited for a randomized clinical trial (n = 132 at baseline, 124 at 6 months, 113 at 12 months, and 101 at 18 months).Methods
Participants were randomly assigned to counselor-assisted problem-solving or Internet resource comparison. Follow-up assessments were completed at 6, 12, and 18 months after baseline. Generalized estimating equations with a logit link were used to examine use of mental health services. Treatment group and participant impairment were examined as predictors of use.Main Outcome Measurements
Mental health care use was measured with the Service Assessment for Children and Adolescents; daily functioning and clinical outcome with the Child and Adolescent Functional Assessment Scale; behavioral and emotional functioning with the Child Behavior Checklist; and executive dysfunction with the Behavior Rating Inventory of Executive Function.Results
Use of mental health services ranged from 22% to 31% in the 2 years post-TBI. Participants with impairments were about 3 times more likely than those without impairments to receive services (odds ratio 4.61; 95% confidence interval 2.61-8.14; P < .001). However, 50%-68% of patients identified as impaired had unmet mental health care needs.Conclusions
Less than one half of adolescents with behavioral health needs after TBI received mental health services. Future studies are needed to examine barriers associated with seeking services after TBI and psychoeducation as preventive care for this population.Level of Evidence
II 相似文献9.
Lenore A. Hawley Jessica M. Ketchum Clare Morey Kathleen Collins Susan Charlifue 《Archives of physical medicine and rehabilitation》2018,99(8):1584-1590
Objectives
To describe the prevalence of cannabis use in an adult sample with spinal cord injury (SCI) or traumatic brain injury (TBI) in Colorado, and to describe the self-reported reasons and side effects of cannabis use in this sample.Design
Mixed-methods observational study, using focus group data and telephone survey.Setting
Community.Participants
Colorado adults who sustained SCI or moderate to severe TBI and received services through Craig Hospital.Interventions
None.Main Outcome Measures
Survey.Results
Focus group participants identified issues that were then included in the survey development. Seventy percent of the 116 participants surveyed reported cannabis use before their injury (67% SCI, 74% TBI) and 48% reported use after their injury (53% SCI, 45% TBI). Overall, the most common reason for use was recreational (67%), followed by reducing stress/anxiety (62.5%) and improving sleep (59%). Among the respondents with SCI, the most common reasons for use were to reduce spasticity (70%), recreation (63%), and to improve sleep (63%). Among those with TBI, reasons endorsed were recreational (72%), reducing stress/anxiety (62%), and improving sleep (55%). Smoking was the most common method of use.Conclusions
A majority of this sample reported using cannabis before injury, and approximately half reported using cannabis after injury. Both groups reported recreational use, whereas the group with SCI also highly endorsed using cannabis to address chronic medical conditions. Clinicians should be aware of the high prevalence of cannabis use in these populations and the impact such use may have on the individual’s medical management. Further research in this area is needed. 相似文献10.
Maya N. Hatch Jason Raad Katie Suda Kevin T. Stroupe Alice J. Hon Bridget M. Smith 《Archives of physical medicine and rehabilitation》2018,99(6):1099-1107
Objective
To examine the different sources of medications, the most common drug classes filled, and the characteristics associated with Medicare Part D pharmacy use in veterans with spinal cord injury/disorder (SCI/D).Design
Retrospective, cross-sectional, observational study.Setting
Outpatient clinics and pharmacies.Participants
Veterans (N=13,442) with SCI/D using Medicare or Veteran Affairs pharmacy benefits.Interventions
Not applicable.Main Outcome Measures
Characteristics and top 10 most common drug classes were examined in veterans who (1) used VA pharmacies only; (2) used both VA and Medicare Part D pharmacies; or (3) used Part D pharmacies only. Chi-square tests and multinomial logistic regression analyses were used to determine associations between various patient variables and source of medications. Patient level frequencies were used to determine the most common drug classes.Results
A total of 13,442 veterans with SCI/D were analyzed in this study: 11,788 (87.7%) used VA pharmacies only, 1281 (9.5%) used both VA and Part D pharmacies, and 373 (2.8%) used Part D pharmacies only. Veterans older than 50 years were more likely to use Part D pharmacies, whereas those with traumatic injury, or secondary conditions, were less associated with the use of Part D pharmacies. Opioids were the most frequently filled drug class across all groups. Other frequently used drug classes included skeletal muscle relaxants, gastric medications, antidepressants (other category), anticonvulsants, and antilipemics.Conclusions
Approximately 12% of veterans with SCI/D are receiving medication outside the VA system. Polypharmacy in this population of veterans is relatively high, emphasizing the importance of health information exchange between systems for improved care for this medically complex population. 相似文献11.
Cynthia Harrison-Felix Jody K. Newman Lenore Hawley Clare Morey Jessica M. Ketchum William C. Walker Kathleen R. Bell Scott R. Millis Cynthia Braden James Malec Flora M. Hammond C.B. Eagye Laura Howe 《Archives of physical medicine and rehabilitation》2018,99(11):2131-2142
Objective
To evaluate the effectiveness of a replicable group treatment program for improving social competence after traumatic brain injury (TBI).Design
Multicenter randomized controlled trial comparing 2 methods of conducting a social competency skills program, an interactive group format versus a classroom lecture.Setting
Community and veteran rehabilitation centers.Participants
Civilian, military, and veteran adults with TBI and social competence difficulties (N=179), at least 6 months postinjury.Interventions
The experimental intervention consisted of 13 weekly group interactive sessions (1.5h) with structured and facilitated group interactions to improve social competence, and the control consisted of 13 traditional classroom sessions using the same curriculum with brief supplemental individual sessions but without structured group interaction.Main Outcome Measures
Profile of Pragmatic Impairment in Communication (PPIC), an objective behavioral rating of social communication impairments after TBI. LaTrobe Communication Questionnaire (LCQ), Goal Attainment Scale (GAS), Satisfaction with Life Scale, Posttraumatic Stress Disorder Checklist-C (PCL) civilian version, Brief Symptom Inventory 18 (BSI-18), Scale of Perceived Social Self-Efficacy (PSSE).Results
Social competence goals (GAS) were achieved and maintained for most participants regardless of treatment method. Significant improvements in the primary outcome (PPIC) and 2 of the secondary outcomes (LCQ and BSI) were seen immediately posttreatment and at 3 months posttreatment in the alternative treatment arm only; however, these improvements were not significantly different between the group interactive structured treatment and alternative treatment arms. Similar trends were observed for PSSE and PCL-C.Conclusions
Social competence skills improved for persons with TBI in both treatment conditions. The group interactive format was not found to be a superior method of treatment delivery in this study. 相似文献12.
Robert C. Lynall J. Troy Blackburn Kevin M. Guskiewicz Stephen W. Marshall Prudence Plummer Jason P. Mihalik 《Archives of physical medicine and rehabilitation》2018,99(5):880-886
Objective
To compare movement reaction time and joint kinematics between athletes with recent concussion and matched control recreational athletes during 3 functional tasks.Design
Cross-sectional.Setting
Laboratory.Participants
College-aged recreational athletes (N=30) comprising 2 groups (15 participants each): (1) recent concussion group (median time since concussion, 126d; range, 28–432d) and (2) age- and sex-matched control group with no recent concussions.Interventions
We investigated movement reaction time and joint kinematics during 3 tasks: (1) jump landing, (2) anticipated cut, and (3) unanticipated cut.Main Outcome Measures
Reaction time and reaction time cost (jump landing reaction time–cut reaction time/jump landing reaction time×100%), along with trunk, hip, and knee joint angles in the sagittal and frontal planes at initial ground contact.Results
There were no reaction time between-group differences, but the control group displayed improved reaction time cost (10.7%) during anticipated cutting compared with the concussed group (0.8%; P=.030). The control group displayed less trunk flexion than the concussed group during the nondominant anticipated cut (5.1° difference; P=.022). There were no other kinematic between-group differences (P≥.079).Conclusions
We observed subtle reaction time and kinematic differences between individuals with recent concussion and those without concussion more than a month after return to activity after concussion. The clinical interpretation of these findings remains unclear, but may have future implications for postconcussion management and rehabilitation. 相似文献13.
Alex W.K. Wong Stephen C.L. Lau Mandy W.M. Fong David Cella Jin-Shei Lai Allen W. Heinemann 《Archives of physical medicine and rehabilitation》2018,99(9):1763-1775
Objective
To determine the extent to which the content of the Quality of Life in Neurological Disorders (Neuro-QoL) covers the International Classification of Functioning, Disability and Health (ICF) Core Sets for multiple sclerosis (MS), stroke, spinal cord injury (SCI), and traumatic brain injury (TBI) using summary linkage indicators.Design
Content analysis by linking content of the Neuro-QoL to corresponding ICF codes of each Core Set for MS, stroke, SCI, and TBI.Setting
Three academic centers.Participants
None.Interventions
None.Main Outcome Measures
Four summary linkage indicators proposed by MacDermid et al were estimated to compare the content coverage between Neuro-QoL and the ICF codes of Core Sets for MS, stroke, MS, and TBI.Results
Neuro-QoL represented 20% to 30% Core Set codes for different conditions in which more codes in Core Sets for MS (29%), stroke (28%), and TBI (28%) were covered than those for SCI in the long-term (20%) and early postacute (19%) contexts. Neuro-QoL represented nearly half of the unique Activity and Participation codes (43%–49%) and less than one third of the unique Body Function codes (12%?32%). It represented fewer Environmental Factors codes (2%?6%) and no Body Structures codes. Absolute linkage indicators found that at least 60% of Neuro-QoL items were linked to Core Set codes (63%?95%), but many items covered the same codes as revealed by unique linkage indicators (7%?13%), suggesting high concept redundancy among items.Conclusions
The Neuro-QoL links more closely to ICF Core Sets for stroke, MS, and TBI than to those for SCI, and primarily covers activity and participation ICF domains. Other instruments are needed to address concepts not measured by the Neuro-QoL when a comprehensive health assessment is needed. 相似文献14.
Colin M. Bosma Nashwa Mansoor Chiara S. Haller 《Archives of physical medicine and rehabilitation》2018,99(8):1576-1583
Objective
To investigate the relation between posttraumatic stress (PTS) symptom severity and health-related quality of life (HRQoL) after severe traumatic brain injury (TBI).Design
Longitudinal prospective multicenter, cohort study on severe TBI in Switzerland (2007–2011).Setting
Hospital, rehabilitation unit, and/or patient’s living facility.Participants
Patients with severe TBI (N=109) were included in the analyses. Injury severity was determined using the Abbreviated Injury Score of the head region after clinical assessment and initial computed tomography scan.Interventions
Not applicable.Main Outcome Measures
HRQoL (Medical Outcomes Study 12-Item Short-Form Health Survey Physical and Mental Component Summaries) and self-reported emotional, cognitive, and interpersonal functioning (Patient Competency Rating Scale for Neurorehabilitation).Results
Multilevel models for patients >50 and ≤50 years of age revealed significant negative associations between PTS symptom severity and interpersonal functioning (P<.001 and P=.002), respectively. Among patients ≤50 years of age, PTS symptom severity was significantly associated with total functioning (P=.001) and emotional functioning (P<.001). Among all patients, PTS symptom severity was significantly associated with cognitive functioning (P<.001) and mental HRQoL (P=.01).Conclusions
Findings indicate that PTS symptoms after severe TBI are negatively associated with HRQoL and emotional, cognitive, and interpersonal functioning. 相似文献15.
Background
Depression and traumatic brain injury (TBI) substantially contribute to the U.S. health care burden. Depression is a known risk factor for prolonged recovery after TBI. However, the effect of depression treatment on health care utilization has yet to be studied.Objective
To examine whether an association exists between pharmacologic treatment of depression at the time of mild or concussive TBI and the number of subsequent clinician visits for persistent injury-related symptoms.Design
Retrospective medical record review.Setting
Tertiary care medical center.Participants
A total of 120 patients (mean age 45.6 years) with a history of depression who subsequently experienced a mild or concussive TBI were included.Methods
Individuals were identified with co-occurring diagnoses of depression and mild or concussive TBI by retrospective electronic medical record review. The diagnosis of depression must have preceded the diagnosis of TBI.Main Outcome
The number of clinician visits for postinjury symptoms were counted at 3, 6, and 12 months postinjury.Results
Clinician visits for persistent injury-related symptoms were significantly fewer at all 3 time points for the group treated for depression at time of injury.Conclusions
Depressed individuals who were pharmacologically treated for depression at the time of TBI had significantly fewer clinician visits for persistent postinjury symptoms than those not pharmacologically treated for depression at the time of injury. Routine depression screening in patients with a high risk for TBI may identify a mood disorder that could contribute to persistent symptoms if left untreated, with its effective management potentially reducing health-related costs.Level of Evidence
III 相似文献16.
Investigating the Variability in Mild Traumatic Brain Injury Definitions: A Prospective Cohort Study
Louise M. Crowe Stephen Hearps Vicki Anderson Meredith L. Borland Natalie Phillips Amit Kochar Sarah Dalton John A. Cheek Yuri Gilhotra Jeremy Furyk Jocelyn Neutze Mark D. Lyttle Silvia Bressan Susan Donath Charlotte Molesworth Ed Oakley Stuart R. Dalziel Franz E. Babl 《Archives of physical medicine and rehabilitation》2018,99(7):1360-1369
Objective
To prospectively compare the proportion of traumatic brain injuries (TBIs) that would be classified as mild by applying different published definitions of mild TBI to a large prospectively collected dataset, and to examine the variability in the proportions included by various definitions.Design
Prospective observational study.Setting
Hospital emergency departments.Participants
Children (N=11,907) aged 3 to 16 years (mean age, 8.2±3.9y). Of the participants, 3868 (32.5%) were girls, and 7374 (61.9%) of the TBIs were the result of a fall. Median Glasgow Coma Scale score was 15.Main Outcome Measures
We applied 17 different definitions of mild TBI, identified through a published systematic review, to children aged 3 to 16 years. Adjustments and clarifications were made to some definitions. The number and percentage identified for each definition is presented.Results
Adjustments had to be made to the 17 definitions to apply to the dataset: none in 7, minor to substantial in 10. The percentage classified as mild TBI across definitions varied from 7.1% (n=841) to 98.7% (n=11,756) and varied by age group.Conclusions
When applying the 17 definitions of mild TBI to a large prospective multicenter dataset of TBI, there was wide variability in the number of cases classified. Clinicians and researchers need to be aware of this variability when examining literature concerning children with mild TBI. 相似文献17.
Karen H. Seal Daniel Bertenthal Deborah E. Barnes Amy L. Byers Carolyn J. Gibson Tessa L. Rife Kristine Yaffe 《The journal of pain》2018,19(8):931-941
Clinical practice guidelines admonish against prescribing opioids for individuals with chronic pain and traumatic brain injury (TBI) because of increased risk for adverse outcomes, yet no studies have described opioid prescribing patterns in these higher-risk patients. Between October 2007 and March 2015, 53,124 Iraq and Afghanistan veterans with chronic pain not prescribed opioids in the previous year were followed for 1 year after completing a Comprehensive TBI Evaluation within the Department of Veterans Affairs health care facilities. Veterans reporting the most severe TBI sequelae (eg, loss of consciousness?>30 minutes) were significantly more likely to receive short-term and long-term opioid therapy than those with less severe or no TBI sequelae (P values?<?.001). In analyses adjusted for sociodemographic characteristics, military service, pain disability, and previous nonopioid treatment modalities, veterans with moderate to severe TBI had a significantly increased risk of receiving opioid therapy. Veterans with moderate to severe TBI and comorbid post-traumatic stress disorder and depression had an even greater risk of initiating long-term opioid therapy in the year after the Comprehensive TBI Evaluation (adjusted relative risk?=?3.57 [95% confidence interval?=?2.85–4.47]). Higher-risk patients with chronic pain and TBI with mental health comorbidities may benefit from improved access to behavioral health and nonpharmacological therapies for chronic pain.
Perspective
Paradoxically, veterans with greater TBI severity and comorbid mental health burden are more likely to be prescribed opioids for chronic pain. More vulnerable veterans may benefit from improved access to behavioral health and nonpharmacological modalities for chronic pain, because of the health and safety risks of opioids. 相似文献18.
Shane N. Sweet Emilie Michalovic Amy E. Latimer-Cheung Michelle Fortier Luc Noreau Walter Zelaya Kathleen A. Martin Ginis 《Archives of physical medicine and rehabilitation》2018,99(3):468-476.e12
Objectives
To investigate the role of spinal cord injury (SCI) peer mentorship on quality of life (QoL)/participation, and test a self-determination theory model that explains the role of SCI peer mentorship on these outcomes.Design
A static group comparison design.Setting
Community.Participants
A convenience sample of mentees (individuals receiving peer mentorship) (n=68) and nonmentees (n=63) who had an SCI, were older than 18 years, and spoke either English or French.Interventions
Mentees: at least 4 peer mentorship sessions over the past 5 years; nonpeer mentees: 0 or 1 brief introductory session.Main Outcome Measures
QoL (ie, life satisfaction and positive and negative affect), participation (eg, autonomous indoor; family role), and the psychological needs of autonomy, competence, and relatedness.Results
No group differences were found, but years since injury was a moderator indicating that, generally, peer mentees living with SCI for longer (～30y) appear to benefit more from peer mentorship interactions compared with nonmentees and mentees living with SCI for approximately 6 years. Competence and relatedness mediated the peer mentorship–outcome relationship for QoL and some participation variables, indicating that peer mentorship predicted competence and relatedness, which in turn were related to the outcomes.Conclusions
Satisfaction of competence and relatedness needs requires greater attention in SCI peer mentorship. Years since injury modified the relationship between peer mentorship and outcomes, which provided new insights on the role of SCI peer mentorship. Further studies are needed to determine SCI peer mentorship–specific outcomes that are important across the years-since-injury spectrum. 相似文献19.
Sarah Gunn Gerald H. Burgess John Maltby 《Archives of physical medicine and rehabilitation》2018,99(9):1805-1810
Objective
To explore the factor structure of the UK Functional Independence Measure and Functional Assessment Measure (FIM+FAM) among focal and diffuse acquired brain injury patients.Design
Criterion standard.Setting
A National Health Service acute acquired brain injury inpatient rehabilitation hospital.Participants
Referred sample of adults (N=447) admitted for inpatient treatment following an acquired brain injury significant enough to justify intensive inpatient neurorehabilitationIntervention
Not applicable.Outcome Measure
Functional Independence Measure and Functional Assessment Measure.Results
Exploratory factor analysis suggested a 2-factor structure to FIM+FAM scores, among both focal-proximate and diffuse-proximate acquired brain injury aetiologies. Confirmatory factor analysis suggested a 3-factor bifactor structure presented the best fit of the FIM+FAM score data across both aetiologies. However, across both analyses, a convergence was found towards a general factor, demonstrated by high correlations between factors in the exploratory factor analysis, and by a general factor explaining the majority of the variance in scores on confirmatory factor analysis.Conclusions
Our findings suggested that although factors describing specific functional domains can be derived from FIM+FAM item scores, there is a convergence towards a single factor describing overall functioning. This single factor informs the specific group factors (eg, motor, psychosocial, and communication function) after brain injury. Further research into the comparative value of the general and group factors as evaluative/prognostic measures is indicated. 相似文献20.
Donna L. Murdaugh Kim E. Ono Andrew Reisner Thomas G. Burns 《Archives of physical medicine and rehabilitation》2018,99(5):960-966