Relationship of Preinjury Caregiver and Family Functioning to Community Integration in Adults With Traumatic Brain Injury

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.     

Longitudinal Changes in the Health-Related Quality of Life During the First Year After Traumatic Brain Injury

Lin M-R, Chiu W-T, Chen Y-J, Yu W-Y, Huang S-J, Tsai M-D. Longitudinal changes in the health-related quality of life during the first year after traumatic brain injury.

Objective

To track the health-related quality of life (HRQL) at discharge and at 6 and 12 months after a traumatic brain injury (TBI) and examine factors associated with changes in each HRQL domain.

Design

Longitudinal cohort study.

Setting

Using codes of the International Classification of Diseases, eligible participants who had a newly diagnosed TBI were identified from discharge records of 4 hospitals in northern Taiwan. Information on the HRQL and injury-related characteristics at the initial and 2 follow-up assessments was collected by extracting medical records and conducting telephone interviews.

Participants

Subjects (N=158) participated in the initial assessment, and 147 and 146, respectively, completed the follow-up assessments at 6 and 12 months after injury.

Interventions

Not applicable.

Main Outcome Measure

The brief version of the World Health Organization Quality of Life (WHOQOL-BREF) with 4 domains of physical capacity, psychologic well being, social relationships, and environment.

Results

Scores on all WHOQOL-BREF domains except social relationships greatly improved over the first 6 months and showed continued improvement at 12 months after injury. The domain scores of the WHOQOL-BREF at discharge were significantly associated with the preinjury HRQL level, marital status, alcohol consumption at the time of injury, Glasgow Outcome Scale (GOS) level, cognition, activities of daily living, social support, and depressive status. However, after adjusting for these baseline differences, only the GOS level and depressive status significantly influenced longitudinal changes in the psychologic and social domains over the 12-month period. Changes in the physical and environmental domains were not significantly associated with any characteristics of the study.

Conclusions

During the first year after a TBI, the magnitude of HRQL recovery differed across different HRQL domains. Many factors may have significant associations with the initial domain scores of HRQL after TBI; however, only a few factors can significantly influence longitudinal changes in the HRQL.     

A Preliminary Model for Posttraumatic Brain Injury Depression

Malec JF, Brown AW, Moessner AM, Stump TE, Monahan P. A preliminary model for posttraumatic brain injury depression.

Objective

To develop, based on previous research, and evaluate a model for depression after traumatic brain injury (TBI).

Design

Cross-sectional structural equation modeling (SEM) of data from consecutively recruited patients.

Setting

Acute hospital and inpatient rehabilitation units.

Participants

Adult patients (N=158) after hospital admission for moderate to severe TBI.

Interventions

Not applicable.

Main Outcome Measures

External appraisal of ability in participants was measured by the Mayo-Portland Adaptability Inventory (MPAI-4) Ability Index completed by a TBI clinical nurse specialist. Patient self-appraisal of post-TBI ability and depression were measured by the Awareness Questionnaire and Beck Depression Inventory-II. Functional outcome 1 year after injury was assessed with the MPAI-4 Participation Index.

Results

Successive SEM resulted in a parsimonious model with excellent fit. Consistent with prior research, a moderately strong association between self-appraisal of post-TBI ability and depression was found. Injury severity, as measured by the duration of posttraumatic amnesia (PTA), was not significantly associated with post-TBI depression. The 1-year functional outcome was associated with depression and TBI severity.

Conclusions

The strong association between self-appraisal of post-TBI ability and depression is consistent with the cognitive-behavioral model of depression and recommends consideration and further study of cognitive-behavioral therapy for post-TBI depression. The lack of association between TBI severity and depression may represent the indirect and proxy nature of current measures of TBI severity such as PTA. Emerging neuroimaging techniques (eg, diffusion tensor imaging, magnetic resonance imaging spectroscopy) may provide the more direct measures of disruption of brain function after TBI that are needed to advance this line of research.     

Neuropsychologic and functional outcome after complicated mild traumatic brain injury

Kashluba S, Hanks RA, Casey JE, Millis SR. Neuropsychologic and functional outcome after complicated mild traumatic brain injury.

Objective

To investigate the extent to which neuropsychologic and functional outcome after complicated mild traumatic brain injury (TBI) parallels that of moderate TBI recovery.

Design

A longitudinal study comparing neuropsychologic and functional status of persons with complicated mild TBI and moderate TBI at discharge from inpatient rehabilitation and at 1 year postinjury.

Setting

Rehabilitation hospital with a Traumatic Brain Injury Model System.

Participants

Persons with complicated mild TBI (n=102), each with an intracranial brain lesion documented through neuroimaging and a highest Glasgow Coma Scale (GCS) score in the emergency department between 13 and 15, and 127 persons with moderate TBI.

Interventions

Not applicable.

Main Outcome Measures

FIM instrument, Disability Rating Scale, Community Integration Questionnaire, Wechsler Memory Scale logical memory I and II, Rey Auditory Verbal Learning Test, Trail-Making Test, Controlled Oral Word Association Test, Symbol Digit Modalities Test, Wisconsin Card Sorting Test, and block design.

Results

Few differences in neuropsychologic performance existed between the TBI groups. Less severely impaired information processing speed and verbal learning were seen in the complicated mild TBI group at rehabilitation discharge and 1 year postinjury. Despite overall improvement across cognitive domains within the complicated mild TBI group, some degree of impairment remained at 1 year postinjury on those measures that had identified participants as impaired soon after injury. No differences on functional ability measures were found between the TBI groups at either time period postinjury, with both groups exhibiting incomplete recovery of functional status at the 1-year follow-up.

Conclusions

When classifying severity of TBI based on GCS scores, consideration of a moderate injury designation should be given to persons with an intracranial bleed and a GCS score between 13 and 15.     

Sensitivity and Specificity of the Beck Depression Inventory-II in Persons With Traumatic Brain Injury

Homaifar BY, Brenner LA, Gutierrez PM, Harwood JF, Thompson C, Filley CM, Kelly JP, Adler LE. Sensitivity and specificity of the Beck Depression Inventory-II in persons with traumatic brain injury.

Objectives

Our objective was to examine the Beck Depression Inventory-II (BDI-II) in a traumatic brain injury (TBI) sample using a receiver operating characteristic (ROC) curve to determine how well the BDI-II identifies depression. An ROC curve allows for analysis of the sensitivity and specificity of a diagnostic test using various cutoff points to determine the number of true positives, true negatives, false positives, and false negatives.

Design

This was a secondary analysis of data gathered from an observational study. We examined BDI-II scores in a sample of 52 veterans with remote histories of TBI.

Setting

This study was completed at a Veterans Affairs (VA) Medical Center.

Participants

Participants were veterans eligible to receive VA health care services.

Interventions

Not applicable.

Main Outcome Measures

Outcome measures included the BDI-II and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-IV).

Results

We generated an ROC curve to determine how well the BDI-II identifies depression using the SCID-IV as the criterion standard for diagnosing depression, defined here as a diagnosis of major depressive disorder. Results indicated a cutoff score of at least 19 if one has a mild TBI or at least 35 if one has a moderate or severe TBI. These scores maximize sensitivity (87%) and specificity (79%).

Conclusions

Clinicians working with persons with TBI can use the BDI-II to determine whether depressive symptoms warrant further assessment.     

Poor sleep quality and changes in objectively recorded sleep after traumatic brain injury: a preliminary study

Parcell DL, Ponsford JL, Redman JR, Rajaratnam SM. Poor sleep quality and changes in objectively recorded sleep after traumatic brain injury: a preliminary study.

Objectives

To evaluate changes in sleep quality and objectively assessed sleep parameters after traumatic brain injury (TBI) and to investigate the relationship between such changes and mood state and injury characteristics.

Design

Survey and laboratory-based nocturnal polysomnography.

Setting

Sleep laboratory.

Participants

Ten community-based subjects with moderate to very severe TBI and 10 age- and sex-matched controls from the general community.

Interventions

Not applicable.

Main Outcome Measures

Pittsburgh Sleep Quality Index for self-report sleep quality, nocturnal polysomnography for objective sleep recording, and Hospital Anxiety and Depression Scales.

Results

Compared with controls, TBI patients reported significantly poorer sleep quality and higher levels of anxiety and depression. Objective sleep recording showed that TBI patients showed an increase in deep (slow wave) sleep, a reduction in rapid eye movement sleep, and more frequent nighttime awakenings. No significant relationship was observed between these changes in sleep and injury severity or time since injury. Anxiety and depression covaried with the observed changes in sleep.

Conclusions

The findings contribute to the growing body of evidence that sleep is involved in the physiologic processes underlying neural recovery. The association between anxiety and depression and the observed changes in sleep in TBI patients warrants further examination to determine whether a causative relationship exists.     

Do secondary conditions explain the relationship between depression and health care cost in women with physical disabilities?

Morgan RO, Byrne MM, Hughes RB, Petersen NJ, Taylor HB, Robinson-Whelen S, Hasche JC, Nosek MA. Do secondary conditions explain the relationship between depression and health care cost in women with physical disabilities?

Objective

To examine the influence of depression on health care utilization and costs among women with disabilities and to determine whether the severity of other secondary health conditions affects this association.

Design

A time series of 7 interviews over a 1-year period.

Setting

Large, southern metropolitan area.

Participants

Community-dwelling women (N=349) with a self-identified diagnosis of a physical disability.

Interventions

Not applicable.

Main Outcome Measures

Primary disability, secondary health conditions (Health Conditions Checklist), depressive symptoms (Beck Depression Inventory-Second Edition), and health care utilization (based on the Health and Social Service Utilization Questionnaire and the Stanford Health Assessment Questionnaire). We estimated health care costs using standardized criteria and published average costs.

Results

Outpatient and emergency department health care utilization and overall costs were higher in women with depressive symptoms and increased with the frequency and severity of the symptoms. Depressive symptoms were highly correlated with the severity of secondary health conditions. Adjusting for demographics and primary disability, both the presence and severity of depressive symptoms were associated with significantly higher health care costs. However, secondary health condition severity explained the association between depressive symptoms and cost; it also substantially increased the variance in cost that was explained by the multivariate models.

Conclusions

Secondary health conditions are significantly associated with depressive symptoms and higher health care costs, with secondary health conditions accounting for the association between depressive symptoms and costs. This association suggests that effective management of secondary health conditions may help reduce both depressive symptomatology and health care costs.     

The reliability and validity of the brief symptom inventory-18 in persons with traumatic brain injury

Meachen S-J, Hanks RA, Millis SR, Rapport LJ. The reliability and validity of the Brief Symptom Inventory−18 in persons with traumatic brain injury.

Objective

To investigate the psychometric properties of the Brief Symptom Inventory−18 (BSI-18) among persons with traumatic brain injury (TBI).

Design

Inception cohort design with cross-sectional follow-up of 6 months to 15 years.

Setting

Rehabilitation hospital.

Participants

Adults (N=257) with moderate to severe TBI (81 inpatients and 176 follow-up participants, analyzed separately).

Interventions

Not applicable.

Main Outcome Measures

The BSI-18 is a brief screen of psychologic distress with a Global Severity Index (GSI), and 3 clinical subscales: somatization, anxiety, and depression.

Results

Internal consistency of the GSI was high in both follow-up participants (α=.91) and inpatients (α=.84), whereas estimates for the somatization, anxiety, and depression subscales were more variable (α range, .61-.84). As would be expected for a measure of affective state, retest reliability estimates were only moderate. The BSI-18 GSI correlated with multiple measures of psychosocial adjustment. After accounting for demographics, injury severity, inpatient functional status, years since injury, and various psychosocial factors, the BSI-18 showed incremental validity in predicting concurrent functional, psychosocial, and psychologic status.

Conclusions

The BSI-18 GSI had excellent reliability and validity among inpatients and follow-up participants. Modest reliability estimates may place an upper bound on the validity of the BSI-18 clinical subscales in inpatient TBI populations.     

Family Functioning Is Associated With Depressive Symptoms in Caregivers of Acute Stroke Survivors

Epstein-Lubow GP, Beevers CG, Bishop DS, Miller IW. Family functioning is associated with depressive symptoms in caregivers of acute stroke survivors.

Objective

To determine whether family functioning is uniquely associated with caregiver depressive symptoms in the immediate aftermath of stroke.

Design

Cross-sectional data from the baseline assessment of an intervention study for stroke survivors and their families.

Setting

Neurology inpatient service of a large urban hospital.

Participants

Stroke survivors (n=192), each with a primary caregiver. The mean age of stroke survivors was 66 years, and most, 57%, were men (n=110). The mean age of caregivers was 57 years, and 73% (n=140) of the caregivers were women. Eighty-five percent of caregivers were white.

Interventions

Not applicable.

Main Outcome Measures

Measures were chosen to assess caregivers' depressive symptoms (Centers for Epidemiologic Studies Depression Scale), family functioning (Family Assessment Device), and additional factors such as health status (Medical Outcomes Study 36-Item Short-Form Health Survey) and stroke survivors' cognitive abilities (modified Mini-Mental State Examination) and functional impairments (FIM and Frenchay Activities Index).

Results

Depressive symptoms were mild to moderate in 14% and severe in 27% of caregivers. Family functioning was assessed as unhealthy in 34% of caregiver-patient dyads. In statistical regression models, caregiver depression was associated with patients' sex, caregivers' general health, and family functioning.

Conclusions

Forty-one percent of caregivers experienced prominent depressive symptoms after their family member's stroke. Higher depression severity in caregivers was associated with caring for a man, and having worse health and poor family functioning. After stroke, the assessment of caregivers' health and family functioning may help determine which caregivers are most at risk for a depressive syndrome.     

Pain, depression, and fatigue as a symptom cluster in advanced cancer

Context

Pain, depression, and fatigue are common symptoms in cancer populations. They often coexist and have been suggested as a specific symptom cluster. Systemic inflammation (SI) may be a possible common mechanism.

Objective

This study examined whether pain, depression, and fatigue exist as a symptom cluster in advanced cancer patients with cachexia and might be related to the presence of SI.

Methods

Secondary data analysis was undertaken of two clinical trials in patients with cancer cachexia (n = 654). Pain, depression, and fatigue were assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30. Plasma C-reactive protein (CRP) was measured as a marker of SI in a subgroup (n = 436). Multivariate analysis and a series of regression analyses were undertaken relating pain, depression, fatigue, and CRP.

Results

Pain, depression, and fatigue clustered, with between two and four times as many patients having all three symptoms as would be expected if the symptoms only coexist by chance (P < 0.001). CRP was not related to the symptom cluster. There was a strong relationship between the pattern of symptoms and physical functioning (P < 0.001).

Conclusion

Pain, depression, and fatigue is an identifiable symptom cluster in a cohort of cachexic cancer patients and is associated with reduced physical functioning.     

Fatigue in patients with chronic heart failure — A burden associated with emotional and symptom distress

Background

The relationship between experience of fatigue and emotional and symptom distress in chronic heart failure (CHF) needs to be thoroughly explored, because fatigue has major impact on daily activities in life.

Aims

The purpose was to examine the association between fatigue, as a multidimensional experience and anxiety, depression and symptom distress, and to explore the relationships between individual symptoms and the dimensions of fatigue in patients with CHF.

Methods

A consecutive sample of 112 patients with exacerbation of symptoms of CHF answered the Multidimensional Fatigue Inventory (MFI-20), the Hospital Depression and Anxiety (HAD) Scale and the Symptom Distress Scale (SDS).

Results

Anxiety was associated with mental fatigue, whereas depression was associated with reduction of activity, low motivation and decreased functioning. Physical fatigue was affected by symptom distress, with women reporting more distress than men. With exception of breathlessness, poor agreement was found between fatigue and the most intensive reported symptoms.

Conclusions

The relationship between emotional distress and the experience of fatigue in patients with CHF may have a devastating affect on the patient's ability to cope and manage daily activities, including self-care and adherence to recommended treatment.     

Differential Performance of SF-36 Items in Healthy Adults With and Without Functional Limitations

Horner-Johnson W, Krahn GL, Suzuki R, Peterson JJ, Roid G, Hall T, the RRTC Expert Panel on Health Measurement. Differential performance of SF-36 items in healthy adults with and without functional limitations.

Objective

To determine whether Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) items show differential item functioning among healthy adults with various types of functional limitations as compared with a healthy sample with no identified limitations.

Design

Survey responses were analyzed by using partial correlations.

Setting

General community.

Participants

Participants (N=206) included (1) adults with spinal cord injury (SCI), (2) adults who were deaf or hard of hearing, (3) adults who were legally blind, (4) adults with psychiatric or emotional conditions, and (5) adults with no reported functional limitations. Participants were screened to ensure the absence of substantial health problems.

Interventions

Not applicable.

Main Outcome Measure

SF-36.

Results

Partial correlations showed a significant negative correlation, indicating differential item functioning (ie, apparent bias) for people with SCI on all 10 SF-36 Physical Functioning items. For people who were blind, 5 items showed a significant negative correlation. Two items had significant negative correlations for the deaf/hard-of-hearing group. One item showed significant negative performance for people with mental health conditions.

Conclusions

Our data indicated a possibility for measurement bias caused by the blending of health and function concepts in the SF-36.     

Outcome following a physiotherapist-led intervention for chronic low back pain: the important role of cognitive processes

Objectives

To examine whether patients with chronic low back pain exhibit changes in cognitive factors following Interactive Behavioural Modification Therapy (IBMT), delivered by physiotherapists; and to examine the association between pre- to post-treatment changes in cognitive factors (cognitive processes) and pre- to post-treatment changes in pain, disability and depression.

Design

Observational before-after study.

Setting

Outpatient physiotherapy department.

Participants

One hundred and thirty-seven patients with chronic low back pain.

Interventions

IBMT: ‘Work Back to Life’ rehabilitation programme.

Main outcome measures

Pre- to post-treatment changes in pain, disability and a range of cognitive factors.

Results

Patients demonstrated significant favourable changes for a range of cognitive factors. Furthermore, pre- to post-treatment changes in these cognitive factors explained an additional 22%, 17% and 15% of the variance in changes in pain, disability and depression, respectively, after controlling for other important factors.

Conclusions

Changes that emerge in cognitive factors are strongly related to treatment outcome within a physiotherapy treatment context. Specifically, reductions in fear of movement and catastrophising, and increases in functional self-efficacy appear to be particularly important. Modifying these cognitive factors should be seen as a priority when treating patients with chronic low back pain.     

Posttraumatic Stress Disorder and Spinal Cord Injury

Krause JS, Saunders LL, Newman S. Posttraumatic stress disorder and spinal cord injury.

Objectives

To identify the prevalence of posttraumatic stress disorder (PTSD) after spinal cord injury (SCI) in a sample averaging over 2 decades postinjury at assessment. Related objectives are to confirm the factor structure, compare subscales with those reported in a nonclinical sample, and identify the relationship of PTSD with depression.

Design

Survey.

Setting

A medical university in the Southeastern United States.

Participants

Participants were initially identified through specialty hospitals in the Midwest and Southeastern United States. A cohort of adults (N=927) with traumatic SCI of at least 1 year duration at enrollment in 2002 to 2003 and a minimum of 7 years at the time of assessment completed the study materials.

Interventions

Not applicable.

Main Outcomes Measures

PTSD was measured by the Purdue Posttraumatic Stress Disorder Scale-Revised, and depression was measured by the Patient Health Questionnaire 9-item.

Results

PTSD was reported by less than 10% of the participants. Item endorsement decreased as a function of years postinjury, primarily because of low rates of endorsement among those 21 or more years postinjury. Confirmatory factor analysis did not result in an acceptable fit for subscales, item sets, or factors previously reported in the literature. Participants scored higher than a nonclinical sample (reported in the literature) on the arousal and avoidance subscales but lower on the re-experiencing subscale. Item endorsements were lower for the first set of items that relate directly to the SCI itself, with the highest item endorsement for “have difficulty remembering important aspects of event.” PTSD rarely occurred in the absence of a depressive disorder.

Conclusions

PTSD does not appear to be highly prevalent in long-term SCI survivors, and endorsement of items related to re-experiencing and even recalling the injury are rare. Because SCI often is accompanied by mild traumatic brain injury, difficulty recalling the event may have an organic rather than psychologic component.     

A Generalizability Study of the Instrumental Activities of Daily Living Profile

Bottari C, Dassa C, Rainville C, Dutil É. A generalizability study of the Instrumental Activities of Daily Living Profile.

Objective

To establish generalizability estimates of the Instrumental Activities of Daily Living (IADL) Profile when administered to persons with a moderate or severe traumatic brain injury (TBI) within their home and community environment.

Design

Generalizability theory was used to estimate generalizability and dependability coefficients as well as the relative contribution of identified sources of measurement error to total measurement error. Decision studies were used to enable the investigators to determine the optimal measurement design.

Setting

The IADL Profile was administered in subjects' homes and community environments.

Participants

Convenience sample of adults with a moderate or severe TBI (N=30, aged 16-65y).

Interventions

Not applicable.

Main Outcome Measures

IADL Profile scores include 6 factor scores (going to the grocery store/shopping for groceries, having a meal with guests/cleaning up, putting on outdoor clothing, obtaining information, making a budget, and preparing a hot meal) and 1 total score.

Results

The greatest sources of measurement error were the subject-item interactions (3-random-facet design) and the subject-rater interactions (2-random-facet design). One hundred percent of generalizability coefficients of factor scores indicated acceptable to excellent reliability. Indices of dependability confirmed that 1 evaluator could reliably score the tool on a single occasion after having received a 3-day training workshop.

Conclusions

The IADL Profile administered to persons with a moderate or severe TBI provides occupational therapists with a reliable set of measures of IADL independence capable of both capturing and analyzing the complex interactions between personal and environmental factors.     

Aging With Traumatic Brain Injury: Cross-Sectional Follow-Up of People Receiving Inpatient Rehabilitation Over More Than 3 Decades

Sendroy-Terrill M, Whiteneck GG, Brooks CA. Aging with traumatic brain injury: cross-sectional follow-up of people receiving inpatient rehabilitation over more than 3 decades.

Objective

To investigate aging with traumatic brain injury (TBI) by determining if long-term outcomes after TBI are predicted by years postinjury and age at injury after controlling for the severity of the injury and sex.

Design

Cross-sectional follow-up telephone survey.

Setting

Community residents who had received initial treatment in a comprehensive inpatient rehabilitation hospital.

Participants

Survivors of TBI (N=243) stratified by years postinjury (in seven 5-year cohorts ranging from 1 to over 30 years postinjury) and by age at injury (in 2 cohorts of people injured before or after age 30).

Interventions

None.

Main Outcome Measures

Measures of postconcussive symptoms, major secondary conditions including fatigue (Modified Fatigue Impact Scale), physical and cognitive activity limitations (FIM, Alertness Behavior Subscale of the Sickness Impact Profile, Medical Outcomes Study 12-Item Health Status Survey Short Form), societal participation restrictions (Craig Handicap Assessment and Reporting Technique), environmental barriers (Craig Hospital Inventory of Environmental Factors), and perceived quality of life (Satisfaction with Life Scale).

Results

Most problems identified by the outcome measures were reported by one fourth to one half of the study participants. Increasing decades postinjury predicted declines in physical and cognitive functioning, declines in societal participation, and increases in contractures. Increasing age at injury predicted declines in functional independence, increases in fatigue, declines in societal participation, and declines in perceived environmental barriers.

Conclusions

This investigation has increased our understanding of the aging process after TBI by demonstrating that both components of aging (years postinjury and age at injury) are predictive of several outcomes after TBI.     

Impact of Traumatic Brain Injury on Participation in Leisure Activities

Wise EK, Mathews-Dalton C, Dikmen S, Temkin N, Machamer J, Bell K, Powell JM. Impact of traumatic brain injury on participation in leisure activities.

Objective

To determine how participation in leisure activities for people with traumatic brain injury (TBI) changes from before injury to 1 year after injury.

Design

Prospective evaluation of leisure participation at 1 year after TBI.

Setting

Level I trauma center.

Participants

Rehabilitation inpatients (mean age, 35.3 years; 77% male; 77% white) with moderate to severe TBI (N=160).

Interventions

Not applicable.

Main Outcome Measure

Functional Status Examination.

Results

At 1 year after injury, 81% had not returned to preinjury levels of leisure participation. Activities most frequently discontinued included partying, drug and alcohol use, and various sports. The activity most often reported as new after injury was watching television. Of the small fraction who returned to preinjury levels, 70% did so within 4 months of injury. Sixty percent of those who did not return to preinjury levels were moderately to severely bothered by the changes.

Conclusions

At 1 year after injury, many TBI survivors engage in a reduced number of leisure activities, which are more sedentary and less social, with a substantial fraction dissatisfied with these changes. While discontinuing some activities may be viewed as a positive change, there are few new ones to replace them.