Jolie N Haun, Justin McDaniel, Risa Nakase-Richardson, Tali Schneider, Julie McMahon-Grenz, Sharon Barton, Roberto Sandoval, Karen M Skop, Clara Dismuke-Greer, Jerome Sabangan, Kimberly Samson, Daniel W Klyce, Yvonne Friedman, Leah R Gause, Shannon R Miles, Kevin Wells, Mary Jo Pugh
These findings suggest that functional participation may represent an important measure of TBI-related clinical burden that is associated with PTSD symptom trajectories in a TBI rehabilitation program.
OBJECTIVES: To examine how traumatic brain injury (TBI)-related clinical burden (eg, neurobehavioral symptoms, TBI-related lifestyle/participation deficits) is associated with posttraumatic stress disorder (PTSD) symptom trajectories during inpatient rehabilitation.
DESIGN: Cross-sectional and longitudinal cohort study.
SETTING: Veterans Health Administration Intensive Evaluation and Treatment Program for TBI distributed across 5 sites in the United States.
PARTICIPANTS: Participants were male Special Operations Forces with an average age of 42 years (SD, 5.4) and a history of mild to moderate TBI (n=105).
INTERVENTIONS: A longitudinal cohort evaluation was conducted to analyze baseline, discharge, and 6-month follow-up data from Special Operations Forces enrolled in the Veterans Health Administration's Intensive Evaluation and Treatment Program for TBI, which is a variable-length program with interdisciplinary rehabilitation opportunities.
MAIN OUTCOME MEASURES: TBI-related clinical burden was operationalized using neurobehavioral symptom burden and functional participation impairment, and PTSD symptom severity was assessed using the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition. Multivariable linear regression and linear mixed-effects models were used to analyze the data.
RESULTS: Greater neurobehavioral symptom burden (b=1.00; P<.001) and participation-related impairment (b=2.60; P<.001) were independently associated with higher PTSD symptom severity at baseline. Longitudinal analyses indicated that functional participation (b=-0.35; P=.01), but not neurobehavioral symptoms (b=-0.06; P=.14), moderated PTSD symptom trajectories, with greater participation scores predicting steeper reductions in PTSD symptoms over time.
CONCLUSIONS: These findings suggest that functional participation may represent an important measure of TBI-related clinical burden that is associated with PTSD symptom trajectories in a TBI rehabilitation program.