Journal of Head Trauma Rehabilitation最新文献

{"title":"Resilience and Quality of Life in Mild Traumatic Brain Injury: Serial Mediating Role of Sleep Quality and Depression.","authors":"Ya-Wen Hsiao, Hsiang-Yun Lan, Ching-Yuan Ma, Dueng-Yuan Hueng, Yun-Cune Chang, Hui-Hsun Chiang","doi":"10.1097/HTR.0000000000001177","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001177","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the influence of resilience on quality of life (QoL) in patients with mild traumatic brain injury (mTBI), and to evaluate the mediating roles of sleep quality and depression in the relationship. Setting: Emergency and neurosurgical outpatient departments in regional medical center in northern Taiwan.</p><p><strong>Participants: </strong>A total of 310 adults patients diagnosed with mTBI were recruited between 3 and 12 months postinjury.</p><p><strong>Design: </strong>A cross-sectional observational study using self-report measures and serial-mediation analysis.</p><p><strong>Main measures: </strong>Participants completed the Resilience Scale for Adults, Pittsburgh Sleep Quality Index, Beck Depression Inventory-II, and the WHO Quality of Life-BREF. Data were analyzed using PROCESS Model 6 with 5000 bootstrap resamples.</p><p><strong>Results: </strong>Resilience was associated with improved QoL, both directly and indirectly through sleep quality and depression. In particular, resilience predicted higher sleep quality and fewer depressive symptoms. Poor sleep quality was associated with greater depressive symptoms, which in turn predicted lower QoL. All direct and indirect pathways in the serial mediation model were significant (P < 0.001), and the model explained 54% of the variance in QoL.</p><p><strong>Conclusion: </strong>Our findings suggest that resilience influences QoL through sleep quality and depression. Enhancing resilience and sleep quality may reduce depressive symptoms and improve overall well-being in patients recovering from mTBI.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148257484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Multifactor Prediction Model of Recovery of Consciousness in Patients With Unresponsive Wakefulness Syndrome: A Multicenter, Retrospective Study.","authors":"Zi Yu, Wenqian Lin, Zuojun Cao, Yuanyuan Chu, Longwen He, Nianze Chen, Junwei Lv, Yiqi Tang, Xiangtong Ji, Xinwei Tang, Fengzhi Liu, Ying Chen, Ruiping Hu, Junfa Wu, Yi Wu, Hongyu Xie","doi":"10.1097/HTR.0000000000001186","DOIUrl":"10.1097/HTR.0000000000001186","url":null,"abstract":"<p><strong>Aims: </strong>This multicenter retrospective cohort study aimed to develop 3 predictive models to estimate consciousness status 3 months after admission. These models were designed to serve as complementary prognostic tools for patients diagnosed with unresponsive wakefulness syndrome (UWS) using the Coma Recovery Scale-Revised (CRS-R).</p><p><strong>Methods: </strong>We retrospectively collected data from 154 patients with UWS across 2 clinical centers, encompassing demographic, clinical, and laboratory biomarkers. Variable selection was performed using adaptive least absolute shrinkage and selection operator (LASSO) and ridge regression. The final predictive models were constructed using binary logistic regression, while additional machine-learning algorithms (Random Forest, SVM, and XGBoost) were applied for comparative evaluations of predictive performance.</p><p><strong>Results: </strong>Of the patients studied, 88 (57%) regained responsiveness within 3 months, while 66 (43%) remained in UWS. Model UWS-base, incorporating clinical factors such as traumatic brain injury (TBI), hypoxic encephalopathy, hydrocephalus, and diffuse injury, demonstrated utility for outpatient preliminary screening. Model UWS-plus achieved superior accuracy (AUC = 0.84) by integrating key biomarkers, including fT3, albumin score, lymphocyte count, and alkaline phosphatase. Model UWS-lite, retaining only lymphocyte count alongside clinical variables, maintained robustness in resource-limited settings (AUC = 0.83). Notably, these biomarkers emerged as factors potentially associated with recovery, generating hypotheses for future interventional studies.</p><p><strong>Conclusion: </strong>We propose a biomarker-integrated model that complements the prognosis of UWS. Our findings also encourage a more holistic approach to clinical practice, wherein hydrocephalus management and systemic biomarkers may be considered alongside traditional scales to inform prognosis and guide therapeutic decisions.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148258383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rasch Analysis of the 7-Item Fatigue Severity Scale (FSS-7) in Traumatic Brain Injury.","authors":"Frederik Have Dornonville de la Cour, Tine Nielsen, Martin Matre, Nada Andelic, Marianne Løvstad, Daniel Løke","doi":"10.1097/HTR.0000000000001189","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001189","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate validity, reliability, and targeting of the Norwegian 7-item Fatigue Severity Scale (FSS-7) in adults with moderate-to-severe traumatic brain injury (TBI).</p><p><strong>Setting: </strong>Inpatient and outpatient acute care and postacute rehabilitation facilities.</p><p><strong>Participants: </strong>Ninety-four patients with intracranial injury, 20% women, with a mean age of 45.8 years (SD = 13.6), provided 185 complete FSS-7 responses at 6 months (n = 94) and 12 months (n = 91) post-TBI.</p><p><strong>Design: </strong>Secondary analysis of data from a longitudinal observational study using the Rasch model and graphical log-linear Rasch models (GLLRM).</p><p><strong>Main measures: </strong>The FSS-7 is a self-report fatigue measure derived from the original FSS by omitting items 1 and 2. Differential item functioning (DIF) was examined for sex, age, education, and sleep disturbances (Epworth sleepiness scale and insomnia severity index).</p><p><strong>Results: </strong>The FSS-7 did not fit the Rasch model due to poor fit of item 4 and local dependence between items 5 and 6. A 6-item version (FSS-6), excluding item 4, provided good fit to a GLLRM accounting for the local dependence between items 5 and 6. No DIF or item parameter drift over time was detected. The FSS-6 demonstrated excellent reliability (r = 0.936), while targeting was less than optimal, as on average, only 57% of the maximum obtainable test information was reached.</p><p><strong>Conclusions: </strong>The FSS-6, excluding item 4, provides a valid measure of fatigue with excellent reliability for adults at 6 and 12 months post-TBI. The total raw score is invariant across sex, age, educational level, and sleep disturbances with no item parameter drift from 6 to 12 months postinjury. The FSS-6 may be useful for screening and monitoring fatigue in TBI rehabilitation and research, although a reassessment of targeting is recommended for future research on a larger and broader sample of patients.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148258494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Verbal Memory in Traumatic Brain Injury: Associations With Age, Post-traumatic Stress Disorder, and Antidepressant Use.","authors":"Katherine L Barlis, Michael D Horner, Jacobo Mintzer, Sudie E Back, Andrew Lawson, Jory Crull, Kristine Yaffe, John Absher, Olga Brawman-Mintzer, Jane E Joseph","doi":"10.1097/HTR.0000000000001179","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001179","url":null,"abstract":"<p><strong>Objective: </strong>Episodic memory is one of the cognitive domains most affected after a traumatic brain injury (TBI), and memory decline is a hallmark of both normal aging and Alzheimer disease (AD). Although TBI is reported to accelerate age-related cognitive decline and brain atrophy, it is unclear how this trajectory is shaped by frequent co-occurring factors such as post-traumatic stress disorder (PTSD) and psychotropic medication use. This study tested whether age-related decline in delayed verbal memory is more pronounced among adults with a history of TBI than those without TBI. Analyses also explored PTSD status and use of selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors (SSRIs/SNRIs) as independent moderators of verbal memory performance.</p><p><strong>Setting: </strong>VA Medical Center and surrounding community.</p><p><strong>Participants: </strong>Sixty-two Veterans and civilians, ages 30-65, were enrolled. Participants who performed below established cutoffs on performance validity testing were excluded. Analyses (n = 56) included 28 adults with a history of TBI (82% mild, 18% moderate) and 28 demographically matched controls without TBI.</p><p><strong>Main measures: </strong>Delayed recall on a standardized verbal memory task was the primary outcome measure. Analyses tested for main effects of TBI status, age, and their interaction, as well as interactions with the moderator variables (PTSD status and SSRI/SNRI use).</p><p><strong>Design: </strong>Observational, cross-sectional design.</p><p><strong>Results: </strong>Participants with a TBI history did not significantly differ from those without TBI in verbal memory performance. There was a trend toward poorer memory performance with age among participants with a TBI history not taking SSRIs/SNRIs, while participants with PTSD and TBI taking SSRIs/SNRIs demonstrated better performance with age.</p><p><strong>Conclusion: </strong>The findings underscore the importance of considering psychiatric comorbidities and medication use when examining cognition and aging effects in individuals with TBI. Larger, longitudinal studies are warranted to clarify how traumatic stress and psychotropic medications may mediate cognitive aging trajectories after TBI.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148211278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Feasibility and Efficacy of a Virtual, Symptom-Guided Aerobic Exercise Intervention to Improve Cognition in Mild Traumatic Brain Injury: A Single-Blind Pilot Randomized Control Trial With an Active Comparator Group.","authors":"Emma M Tinney, Mark C Nwakamma, Goretti España-Irla, Lauren Kong, Colette Chen, Jeremy Hwang, Amanda O'Brien, Madeleine L Perko, Ryan Luke Sodemann, Jacqueline Caefer, Julia Manczurowsky, Charles H Hillman, Alexandra M Stillman, Timothy P Morris","doi":"10.1097/HTR.0000000000001188","DOIUrl":"10.1097/HTR.0000000000001188","url":null,"abstract":"<p><strong>Background: </strong>Mild traumatic brain injury (mTBI) affects millions worldwide, with cognitive impairment substantially affecting daily functioning. Despite this burden, evidence-based nonpharmaceutical interventions remain lacking in clinical practice. Emerging evidence suggests aerobic exercise may improve post-mTBI cognition; however, the methodological limitations, particularly inadequate control groups, prevent definitive conclusions.</p><p><strong>Objective: </strong>This pilot randomized controlled trial examined the feasibility and preliminary efficacy of a 12-week virtual exercise intervention for community-dwelling adults aged 18-55 years with mTBI within 1 year of injury.</p><p><strong>Methods: </strong>Thirty-seven participants were randomized to either symptom-guided aerobic exercise or active balance control; both delivered virtually 3 times weekly for 30 minutes over 12 weeks. Primary outcomes assessed feasibility metrics; secondary outcomes examined cognitive function including Trail Making Test (TMT) Part A and Part B.</p><p><strong>Results: </strong>Of enrolled participants, 75% completed the intervention with 94.2% session adherence and zero adverse events, demonstrating excellent feasibility and safety. The aerobic group demonstrated greater improvements in executive function compared with balance controls, with large effect sizes for TMT B-A difference scores in both postintervention comparisons (Hedges' g = 1.20, 95% CI [0.00-2.41]) and Group × Time interactions (Hedges' g = 1.38, 95% CI [0.27-2.49]). In addition, the aerobic group self-reported fewer sleep disturbances postintervention (g = 1.65, 95% CI [0.22-3.09]).</p><p><strong>Conclusion: </strong>These findings establish that virtual, supervised, symptom-guided exercise interventions are feasible and safe for mTBI populations, with preliminary evidence suggesting aerobic exercise specifically benefits cognitive flexibility and sleep quality after mTBI. A fully powered randomized controlled trial is warranted to confirm these effects.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148205254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Depression Symptoms and Suicidal Ideation Trajectories Among Asian Americans and Pacific Islanders Over the 10 years After TBI: A Model Systems Study.","authors":"Bani Malhotra, Juan Carlos Arango-Lasprilla, Stephanie Agtarap, Daniel W Klyce, Amy J Starosta, Olivia Chapman, Joyce S Chung, Umesh M Venkatesan, Mia E Dini, Bridget Xia, Paul B Perrin","doi":"10.1097/HTR.0000000000001178","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001178","url":null,"abstract":"<p><strong>Objective: </strong>This study examined 1) longitudinal trajectories of depression and suicidal ideation (SI) trajectories over the first 10 years after traumatic brain injury (TBI) in a sample of Asian American and Pacific Islander (AAPI) individuals; 2) demographic and injury-related predictors of these trajectories; and 3) time-varying depression symptoms as predictors of SI.</p><p><strong>Setting: </strong>Participants who completed inpatient rehabilitation at a TBI Model Systems (TBIMS) center.</p><p><strong>Participants: </strong>Three hundred seven AAPI participants with moderate-to-severe TBI.</p><p><strong>Design: </strong>Multisite, longitudinal observational cohort study.</p><p><strong>Main measures: </strong>Patient Health Questionnaire (PHQ-9) completed at least once for any follow-up time point (ie, 1, 2, 5, or 10 years after TBI), demographic variables, functional characteristics, and injury characteristics. Depression was assessed using PHQ-8 total score, and SI was assessed from the PHQ-9 item 9 score.</p><p><strong>Results: </strong>Rates of clinically significant depression symptoms ranged from 10.1% to 20.6% over 10 years across the 4 time points. Depression symptom trajectories remained flat over time. Higher education was associated with lower overall depression trajectories, whereas a prior history of mental health treatment and violent cause of injury were associated with higher depression trajectories. SI trajectories also remained stable, with higher overall levels observed among participants who were unmarried at injury, were employed at injury, and had a lifetime history of suicide attempts. Higher depression symptoms-both within individuals over time and between individuals-were associated with higher SI.</p><p><strong>Conclusion: </strong>The findings reinforce the importance of detection, long-term monitoring, and targeted support through culturally responsive mental health services for AAPI individuals with TBI.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148150052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations Between Cognitive Functioning and Cyberscam Risk for People With and Without Acquired Brain Injury.","authors":"Jao-Yue Carminati, Jennie L Ponsford, Kate Rachel Gould","doi":"10.1097/HTR.0000000000001166","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001166","url":null,"abstract":"<p><strong>Objective: </strong>Cyberscams represent a significant global crime. As a result of injury-related cognitive and social difficulties, individuals with acquired brain injury (ABI) may experience greater difficulty recognizing cyberscams, learning cybersafety, and seeking appropriate help. This study aimed to objectively examine the association between cognitive function and cyberscam risk in people with and without ABI. We hypothesized that poorer cognitive functioning would be associated with poorer cybersafety and higher frequency of scam experiences.</p><p><strong>Participants: </strong>Participants were recruited from a larger longitudinal traumatic brain injury outcome study through research databases, social media, and word-of-mouth. Participants with and without ABI were eligible if they were aged ≥18 years, living within Australia or New Zealand, and fluent in English. The final sample comprised 85 participants with and 94 without ABI.</p><p><strong>Design: </strong>Cross-sectional design.</p><p><strong>Measures: </strong>Participants completed an online survey including demographic and cyberscam questions and The CyberAbility Scale, followed by a phone-administered cognitive assessment battery (Brief Test of Adult Cognition by Telephone [BTACT]).</p><p><strong>Results: </strong>Group differences in standardized BTACT scores were examined using 2-sample t-tests and Wilcoxon rank sum tests, and Spearman correlations were run between BTACT and CyberAbility Scale scores. Mediation analysis evaluated the role of cognition in the relationship between ABI and cybersafety. Those reporting prior scam experience showed significantly poorer executive function and overall cognition in both groups. Worse self-rated cybersafety on The CyberAbility Scale was significantly associated with poorer overall cognition. The association between ABI and cybersafety was primarily mediated through cognition.</p><p><strong>Conclusions: </strong>Findings highlight the association of cognitive impairment, particularly executive dysfunction, with increased cyberscam vulnerability. People with ABI, who commonly experience such cognitive impairments, represent a high-risk group, underscoring the need for tailored cybersafety resources that accommodate for cognitive impairment.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148143698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Capacity Versus Performance of Volitional Head Turns After Mild Traumatic Brain Injury.","authors":"Selena Y Cho, Leland E Dibble, Peter C Fino","doi":"10.1097/HTR.0000000000001175","DOIUrl":"10.1097/HTR.0000000000001175","url":null,"abstract":"<p><strong>Objective: </strong>To compare head motion capacity during a prescribed in-laboratory task with head motion performance in free-living daily life in individuals with mild traumatic brain injury (mTBI) and healthy controls. A secondary objective was to assess whether in-laboratory peak head motion metrics were associated with near maximal (95th percentile) free-living movements.</p><p><strong>Setting: </strong>Research laboratory and participants' daily environments over 7 days of continuous monitoring.</p><p><strong>Participants: </strong>Twenty-three adults participated: 10 individuals with subacute, symptomatic mTBI (5F; age 30.3 (7.7) years; 35.2 (20.1) days postinjury) and 13 healthy controls (7F; age 31.9 (9.6) years). Participants were free of neurological, musculoskeletal, or balance-affecting conditions.</p><p><strong>Design: </strong>Observational study combining a laboratory gait task with horizontal head turns and a 7-day free-living monitoring period using wearable inertial sensors on the head and lumbar spine.</p><p><strong>Main outcome measures: </strong>In-laboratory head turn amplitude and peak angular velocity (capacity); daily-life amplitude and angular velocity distributions (mean, median, 95th percentile), intra- and interday variability (performance); and associations with free-living measures.</p><p><strong>Results: </strong>Individuals with mTBI demonstrated slower in-laboratory head turns than controls (223.53 (62.32) deg/s versus 302.01 (55.88) deg/s; P = 0.006), with no difference in amplitude. Daily-life amplitude and velocity did not differ between the groups. However, mTBI participants showed consistently smaller intra- and interday variability (P < 0.05), indicating more constrained daily movement patterns. Associations between in-laboratory peaks and free-living 95th percentile values were weak (r = -0.22 for amplitude; r = 0.10 for angular velocity).</p><p><strong>Conclusion: </strong>Although mTBI participants show reduced head motion capacity in laboratory tasks, their average daily-life kinematics are comparable to healthy adults. Reduced variability suggests constrained free-living movement strategies. These findings highlight the dissociation between capacity and performance and support integrating both laboratory assessments and continuous monitoring as complementary measures to fully characterize motor behavior following mTBI.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13378535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147987865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Military Mild Traumatic Brain Injury Predicts Greater Negative Metacognitive Bias.","authors":"Alan Chen, Catherine B Fortier, William P Milberg, Michael Esterman, Joseph DeGutis","doi":"10.1097/HTR.0000000000001172","DOIUrl":"10.1097/HTR.0000000000001172","url":null,"abstract":"<p><strong>Objective: </strong>To determine if remote military mild traumatic brain injury (mTBI) is uniquely associated with deficits in global metacognition, independent of psychopathology.</p><p><strong>Setting: </strong>Translational Research Center for TBI and Stress Disorders, VA Boston Healthcare System.</p><p><strong>Participants: </strong>A total of 567 community-dwelling post-9/11 veterans (mean age = 34): 182 veterans with no mTBI, 134 with at least one nonmilitary mTBI, and 251 with at least one military mTBI. Exclusion criteria were severe neurologic, psychiatric, or cognitive impairment; moderate/severe TBI; or effort-measure failure.</p><p><strong>Design: </strong>Cross-sectional examining predictors of global metacognition of cognitive abilities.</p><p><strong>Main measures: </strong>Global metacognitive bias, calculated as self-reported cognition (WHODAS-II Understanding/Communicating) minus objective cognitive performance (attention, memory, executive composite). Secondary measures included self-reported and objective cognition and global metacognitive sensitivity (correlation between self-reported and objective cognition).</p><p><strong>Results: </strong>Self-reported cognition scores for veterans with remote military mTBI were significantly lower than their objective cognition scores, resulting in significantly more negative metacognitive bias (M = -0.27, SD = 1.05) than those with a nonmilitary mTBI (M = 0.24, SD = 0.84) or no mTBI (M = 0.33, SD = 0.99). Notably, this effect remained significant after accounting for post-traumatic stress disorder (PTSD), depression, and anxiety/stress. It was not explained by blast exposure, peritraumatic context, or time since last mTBI, although it was modestly related to lifetime mTBI count.</p><p><strong>Conclusion: </strong>Military mTBI is associated with more negative metacognitive bias independent of psychiatric conditions. Such bias may impede recovery and treatment effectiveness, suggesting that metacognitive interventions could be a valuable component of mild TBI care.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147972990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Handling Missing Data in Longitudinal Rehabilitation Research: A Methodological Demonstration With Functional Trajectories of Older Adults With TBI.","authors":"Mia E Dini, Teague R Henry, Daniel W Klyce, Raj G Kumar, Kristen Dams-O'Connor, Joyce S Chung, Eric J Munger, Paul B Perrin","doi":"10.1097/HTR.0000000000001171","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001171","url":null,"abstract":"<p><strong>Objective: </strong>This study compared the effects of 3 different approaches to handling missing data (listwise deletion of participants with missing data, mean imputation, and full information maximum likelihood [FIML]) when predicting functional independence trajectories over 10 years in older adults after traumatic brain injury (TBI).</p><p><strong>Setting: </strong>Twenty-three TBI Model Systems (TBIMS) inpatient rehabilitation facilities in the United States.</p><p><strong>Participants: </strong>Adults who sustained a complicated mild, moderate, or severe TBI at age 60 years or older and needed inpatient rehabilitation. They had to meet all eligibility criteria and have one or more functional independence measure (FIM) scores at 1, 2, 5, or 10 years post-TBI from the TBIMS national database.</p><p><strong>Design: </strong>Retrospective analysis of observational data using hierarchical linear models.</p><p><strong>Main measures: </strong>FIM total scores at 1, 2, 5, and 10 years post-TBI.</p><p><strong>Results: </strong>Different missing data approaches led to drastically different findings. Model comparisons supported a quadratic effect of time only in the listwise deletion model and found no other significant predictors. Linear trajectories were found in the mean imputation and FIML models. For both these models, older age, underrepresented minority status, unemployment at injury, longer posttraumatic amnesia duration, and pre-injury limitations all predicted lower overall FIM trajectories. However, when compared with the mean imputation model, the FIML-estimated b-weights were larger with smaller P-values. Years of education significantly predicted higher overall FIM trajectories in the mean imputation model but not the FIML model, likely because of the artificial shrinking of the estimated b-weight standard errors in mean imputation. History of mental health treatment predicted lower FIM trajectories only in the FIML model.</p><p><strong>Conclusions: </strong>These findings show that it is critical to use appropriate modern methods to handle missing data because the method can affect outcome trajectory shape and identification of relevant predictor variables. Using older methods for handling missing data, such as listwise deletion, greatly reduces predictive ability, resulting in less generalizability and imprecision in longitudinal rehabilitation research.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147963941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}