Journal of Head Trauma Rehabilitation最新文献

{"title":"Department of Defense Military Treatment Facility and Community Care Costs After Traumatic Brain Injury in Service Members and Veterans Treated in Veterans Affairs Polytrauma Rehabilitation Centers: A VA TBI Model Systems Study.","authors":"Clara E Dismuke-Greer, Emily Almeida, Jessica L Ryan, Risa Nakase-Richardson","doi":"10.1097/HTR.0000000000001028","DOIUrl":"10.1097/HTR.0000000000001028","url":null,"abstract":"<p><strong>Objective: </strong>To estimate cost models of military traumatic brain injury (TBI) that can provide evidence for future cost-effectiveness analyses highlighted as a gap in the recent National Academies of Sciences, Engineering, and Medicine (NASEM) report on accelerating progress in TBI.</p><p><strong>Setting: </strong>Military Treatment Facilities (MTFs) and community care facilities within the Military Health System (MHS).</p><p><strong>Participants: </strong>1,101 service members/veterans (SMV) diagnosed with a TBI and treated at a Veterans Administration (VA) Polytrauma Rehabilitation Center (PRC).</p><p><strong>Design: </strong>This retrospective study analyzed healthcare costs in MTFs and community care facilities among SMVs diagnosed with TBI and treated at 1 of 5 VA PRCs. MTF and community care records were assessed.</p><p><strong>Main measures: </strong>Annual MTF and community care inpatient and outpatient costs. TBI disability was measured by the Disability Rating Scale (DRS).</p><p><strong>Results: </strong>Mean age was 31, with 9.8 years of service, and time in MHS post-TBI was 7.18 years. The mean annual inpatient cost was $22,126 in MTFs and $112,218 in community. The mean annual outpatient cost was $17,983 in MTFs and $9,141 in community. Each year of age was associated with $8,276 (95% CI 4,068-12,483), each day of acute care length of stay (LOS) before rehabilitation with $1,024 (95% CI 8-2039), and each additional point on the DRS with $10,858 (95% CI 4,273-17,442) higher costs.</p><p><strong>Conclusion: </strong>Findings describe MHS annualized costs across acute and chronic stages in MTFs and the community and their association with SMVs' TBI disability measured by the DRS. These foundational cost data are critical for informing future hybrid design trials in TBI that examine the economic impact of TBI interventions being studied in future research.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"E300-E307"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006737","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":"Erratum to \"INTIMASY-TBI Guideline: Optimization of INTIMAcy, SexualitY, and Relationships Among Adults With Traumatic Brain Injury\".","authors":"","doi":"10.1097/HTR.0000000000001046","DOIUrl":"10.1097/HTR.0000000000001046","url":null,"abstract":"","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"307"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752897","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":"Co-Occurrence of Traumatic Brain Injury and Post-Traumatic Stress Disorder in a National Sample of UK Police Officers: Impact on Social Well-Being and Employment Outcomes.","authors":"Nicholas I J Smith, Lee Hogarth, James Tonks, John D Corrigan, Stan Gilmour, W Huw Williams","doi":"10.1097/HTR.0000000000001041","DOIUrl":"10.1097/HTR.0000000000001041","url":null,"abstract":"<p><strong>Objective: </strong>To determine the lifetime prevalence of traumatic brain injury (TBI) in UK police officers and evaluate associations between mild TBI (mTBI), persistent post-concussion-like symptoms (PPCS), post-traumatic stress disorder (PTSD) and complex PTSD (C-PTSD).</p><p><strong>Setting: </strong>Online survey of serving police officers across England, Scotland and Wales.</p><p><strong>Participants: </strong>A total of 617 currently serving police officers were eligible for the study and the final sample consisted of 573 participants. Subgroup comparisons were made between individuals with no TBI history (n = 355), a single mTBI (n = 88) and multiple mTBIs (n = 130).</p><p><strong>Design: </strong>Cross-sectional survey assessing lifetime history of TBI, PPCS and PTSD symptoms.</p><p><strong>Main measures: </strong>Lifetime TBI prevalence was assessed with the Ohio State TBI-Identification Method. Post-concussion-like symptoms were evaluated with the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) and PTSD/C-PTSD were measured using the International Trauma Questionnaire.</p><p><strong>Results: </strong>Lifetime prevalence of TBI was 38% (n = 234), with 23% reporting multiple TBIs. One-way ANOVAs demonstrated that individuals with multiple TBIs exhibited significantly greater cognitive (unadjusted R 2  = .02, P  = .001) and somatic symptoms (unadjusted R 2  = .02, P  < .001) and reported more severe total RPQ symptoms (unadjusted R 2  = .02, P = .009) compared to those without mTBI history. Multiple TBI history was associated with increased severity across all PTSD/C-PTSD domains ( P < .004), and a significantly higher C-PTSD prevalence ( P  = .001). These results remained significant in ANCOVAs, adjusting for demographic, occupational and trauma-exposure variables ( P < .04).</p><p><strong>Conclusions: </strong>Comorbidity between TBI and C-PTSD is prevalent in this sample of police officers. Symptom endorsement is additive in those with mTBI history, this could lead to risk to employment, relationship breakdown, and further mental health problems. Routine occupational health checks should monitor both TBI and associated symptoms over time. If necessary, police officers with head or neck injuries should follow a graduated return-to-duty protocol, including a gradual increase in activity level and appropriate mental health intervention.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"247-257"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143408647","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":"Can Exposure Therapy Be Effective for Persistent Post-Concussion Symptoms? A Nonconcurrent Multiple Baseline Design Across 4 Cases.","authors":"Lynn Hecker, Skye King, Sven Stapert, Chantal Geusgens, Marlies den Hollander, Britt Fleischeuer, Caroline van Heugten","doi":"10.1097/HTR.0000000000001023","DOIUrl":"10.1097/HTR.0000000000001023","url":null,"abstract":"<p><strong>Objective: </strong>After a concussion, some patients develop persistent post-concussion symptoms, which interferes with functioning in daily life. A biopsychosocial explanation for the development and continuation of persistent post-concussion symptoms is the fear avoidance model (FAM). This study aimed to investigate the effectiveness and feasibility of an individual 14-week exposure therapy for patients with persistent symptoms after concussion.</p><p><strong>Participants: </strong>Four participants from a medical psychology outpatient clinic participated in the study. Their age ranged between 51 and 68 years old ( M = 62.8, SD  = 7). The average length of time since the concussion was 10 months.</p><p><strong>Design: </strong>A single-case experimental design (SCED) with nonconcurrent multiple baselines was used. Participants were randomly assigned to a baseline period (A phase) length between 21 and 42 days. The intervention phase (B phase) consisted of 14 treatment sessions in 14 weeks. The follow-up phase was 12 weeks.</p><p><strong>Main measures: </strong>Participants answered questions on a visual analogue scale about their satisfaction with functioning in daily life, avoidance behavior, and symptoms experience on a daily basis during baseline and on a weekly basis during intervention and follow-up. Additional outcomes included symptom severity, catastrophizing, quality of life, participation, avoidance behavior, and feasibility interviews.</p><p><strong>Results: </strong>Tau-U yielded significant effects ( P < .05) on all measures when comparing intervention and follow-up with the baseline in 3 out of 4 participants. Satisfaction with daily life increased and avoidance behavior and post-concussion symptoms experienced decreased. Participants and therapists rated the intervention protocol with an average of 8.8 out of 10.</p><p><strong>Conclusion: </strong>The findings suggest that exposure therapy seems effective and feasible in treating patients with persistent symptoms after concussion in a clinical setting. Larger randomized controlled trials or replication with SCED studies are advised to obtain additional evidence on the effectiveness of exposure for individuals with persistent symptoms after concussion.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"269-278"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769522","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":"Health and Health Care Utilization Outcomes for Individuals With Traumatic Brain Injury: A 1-Year Longitudinal Study.","authors":"Dana Waltzman, Gabrielle F Miller, Likang Xu, Juliet Haarbauer-Krupa, Flora M Hammond","doi":"10.1097/HTR.0000000000001008","DOIUrl":"10.1097/HTR.0000000000001008","url":null,"abstract":"<p><strong>Objective: </strong>Traumatic brain injury (TBI) can result in new onset of comorbidities and limited studies suggest health care utilization following TBI may be high. Setting, Participants, Mean Measures, and Design: This study used 2018 and 2019 MarketScan Commercial Claims and Encounters data to examine differences in longitudinal health outcomes (health care utilization and new diagnoses) by various demographic factors (age, sex, U.S. region, intent/mechanism of injury, urbanicity, and insurance status) among individuals with and without a TBI in the year following an index health care encounter.</p><p><strong>Results: </strong>Results show that within 1 year of the initial encounter, a higher percentage of patients with TBI versus without TBI had at least one outpatient visit (96.7% vs 86.1%), emergency department (ED) visit (28.5% vs 13.1%), or hospital admission (6.4% vs 2.6%). Both children (33.8% vs 23.4%) and adults (43.8% vs 31.4%) who sustained a TBI had a higher percentage of new diagnoses within 1 year compared to the non-TBI group. Additionally, individuals with a TBI had greater health care utilization across all types of health care settings (outpatient and inpatient), visits (ED visits and hospital admissions), and across all demographic factors ( P < .001).</p><p><strong>Conclusion: </strong>These results may inform future research around the development of systems of care to improve longer-term outcomes in individuals with TBI.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"233-246"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12237604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143032933","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":"Performance and Physiological Response to the Buffalo Concussion Treadmill Test Can Identify Autonomic Dysfunction in the General Adult Population With Mild Traumatic Brain Injury: A Prospective Observational Study.","authors":"Sally Vuu, Maayken E L van den Berg, Selena Hutchins, Joanne Howie, Claire Gough, Christopher J Barr","doi":"10.1097/HTR.0000000000001076","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001076","url":null,"abstract":"<p><strong>Objective: </strong>To explore the underlying mechanisms impacting on the Buffalo Concussion Treadmill Test (BCTT) performance in a general adult population with mild traumatic brain injury (TBI).</p><p><strong>Setting: </strong>Outpatient TBI rehabilitation service.</p><p><strong>Participants: </strong>Twenty-one adults with mild TBI, 17 healthy active adults, and 14 healthy sedentary adults.</p><p><strong>Design: </strong>Prospective observational study comparing BCTT performance and associated physiological responses between 3 participant groups.</p><p><strong>Main measures: </strong>During a single BCTT session, test duration, reason for test termination, age-predicted maximum heart rate (HR), and HR recovery (HRR) were recorded.</p><p><strong>Results: </strong>Fifty-two adults (60.8% male, mean ± SD age: 37.8 ± 14.6 years) were recruited. The group with mild TBI demonstrated a significantly shorter test duration (10.8 ± 5.7 min) compared to the healthy active (14.1 ± 2.9 min) and sedentary (11.6 ± 3.0 min) groups (P < .05). Eight participants (38.1%) stopped due to symptom exacerbation. The group with mild TBI had a significantly (P < .05) lower age-predicted maximum HR (84.3 ± 9.8%), compared to both healthy active (90.0 ± 0.2%) and sedentary adults (89.3 ± 2.8%) at test termination. Fast and slow phase HRR were significantly better in the healthy active group (fast: 69.6 ± 18.2 beats per minute [bpm], slow: 79.0 ± 13.8 bpm) compared to both the mild TBI (fast: 44.5 ± 18.7 bpm, slow: 61.1 ± 20.4 bpm) and healthy sedentary groups (fast 49.6 ± 20.1 bpm, slow 63.0 ± 11.7 bpm) (P < .05), with no significant difference between adults with mild TBI and healthy sedentary groups. When controlling for levels of physical activity there was no longer a detectable significant difference between the healthy active and sedentary groups in HRR.</p><p><strong>Conclusion: </strong>This study demonstrates that the inability to exercise to a threshold HR of 90% of an individual's age-predicted maximum HR is a better indicator of autonomic dysfunction. HRR may be prolonged in those with a mild TBI, but caution should be taken if attributing this to physiological dysfunction as the predominant factor appears to be physical activity levels.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144528257","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":"Purpose Renewal in Adults With Persisting Symptoms After Concussion: Results of a Non-Randomized Feasibility Trial.","authors":"Natalie V Covington, Mary Vining Radomski, Alisa Kocian, Sandra Castro-Pearson, Amanda A Herrmann, Kristina Kath, Libby Lindenfelser, Sandy Arntson Schwalbe, Sharon Gowdy Wagener, Joette Zola","doi":"10.1097/HTR.0000000000001073","DOIUrl":"10.1097/HTR.0000000000001073","url":null,"abstract":"<p><strong>Background: </strong>Living with a sense of purpose in life is associated with numerous health benefits; however, some individuals with persisting symptoms after concussion are at risk for purpose disruption. The Compass Course is a group-based tele-practice intervention that supports purpose renewal after major health transitions.</p><p><strong>Objectives: </strong>To assess the feasibility, acceptability, and implementability of the Compass Course for adults with persisting symptoms after concussion, in preparation for a future randomized controlled trial.</p><p><strong>Setting: </strong>Large healthcare system in the Midwestern United States.</p><p><strong>Participants: </strong>Convenience sample of 37 adults with persisting symptoms after concussion.</p><p><strong>Design: </strong>Non-randomized pilot prospective cohort design.</p><p><strong>Intervention: </strong>Compass Course purpose renewal intervention delivered in a group setting via Zoom by an interdisciplinary team of allied health clinician-researchers (occupational therapy, speech-language pathology, psychology).</p><p><strong>Main outcome measures: </strong>Participants completed Likert scales to rate acceptability of the Compass Course intervention. Treatment fidelity was assessed by tracking the number of key intervention elements presented in each treatment session. Potential benefits of the intervention were assessed using validated measures of purpose and meaning in life.</p><p><strong>Results: </strong>Acceptability ratings were strong across the vast majority of participants. Treatment fidelity was strong with nearly perfect adherence to prespecified intervention elements. Participants who completed the intervention had gains across all purpose in life outcomes, with improvements maintained at 2-month follow-up.</p><p><strong>Conclusions: </strong>The Compass Course was highly acceptable to participants who completed the intervention; however, there was significant attrition suggesting a need for adaptations to the intervention and to trial procedures. Future work includes further intervention development, and a controlled feasibility trial to estimate treatment effects for a future well-powered clinical trial.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144317080","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":"Post-Concussion Symptoms in Older Adults Following a Mild Traumatic Brain Injury.","authors":"Mathieu Massé-Pelletier, Valérie Boucher, Natalie Le Sage, Xavier Neveu, Lynne Moore, Marcel Émond, Eric Mercier","doi":"10.1097/HTR.0000000000001077","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001077","url":null,"abstract":"<p><strong>Objective: </strong>Main objective: to estimate the prevalence of post-concussion symptoms (PPCS) in patients aged ≥55 years. Secondary objective: to identify the predictive factors associated with PPCS in this age group.</p><p><strong>Setting: </strong>Seven Canadian academic Level I and Level II trauma centers' emergency department (ED).</p><p><strong>Participants: </strong>356 patients aged ≥55 years consulting in the ED within 24 hours of a mild traumatic brain injury (TBI) between July 2013 and October 2016 were included in this study.</p><p><strong>Design: </strong>This is a planned sub-analysis of a prospective multicenter cohort study. Patients were identified in the ED by emergency physicians and research assistants. Participants were contacted via telephone for follow-up at 7, 30, and 90 days post-mild TBI. During these follow-ups, research assistants assessed PPCS using the Rivermead Post-Concussion Symptoms Questionnaire (RPQ). A modified Poisson regression assessed the association between PPCS and potential predictors.</p><p><strong>Main measures: </strong>The main outcome of this study was the presence of PPCS at 90 days, defined as the presence of spontaneously described severe (RPQ ≥1 symptom of 4 points, or 2 symptoms of 3 points), persistent symptoms that affect the patients' life.</p><p><strong>Results: </strong>PPCS at 90 days was observed in 16%, [95% CI 12.6-20.2] of our cohort, and most of those reporting PPCS were aged between 55 and 65 years (63.2%). We identified 4 variables associated with PPCS: cervical sprains (RR: 2.28, [95% CI 1.34-3.86], P < .01), female sex (RR: 3.12 [95% CI 1.90-5.12], P < .01), at least 3 different prescribed medications (RR: 1.68 [95% CI 1.02-2.76], P < .05) and age, which appeared to be protective (RR: 0.63 [95% CI 0.42-0.92], P < .01).</p><p><strong>Conclusion: </strong>Our results identified patient characteristics associated with PPCS that can be easily recognized in the ED, such as patient sex, the use of at least 3 different medications and the presence of cervical sprain. Early identification of older adults at higher risk of PPCS is important to optimize care and guide post-ED management.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325947","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 Interaction Between Race/Ethnicity and Sex on Societal Participation Among Individuals With Traumatic Brain Injury: A NIDILRR Model Systems Study.","authors":"Anthony H Lequerica, Jennifer A Bogner, Shannon B Juengst, Denise Krch, Monique R Pappadis, Paul B Perrin, Angelle M Sander, Gale G Whiteneck","doi":"10.1097/HTR.0000000000001074","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001074","url":null,"abstract":"<p><strong>Objective: </strong>To examine the interaction of race/ethnicity and sex on societal participation (productivity and overall participation) among individuals with traumatic brain injury (TBI).</p><p><strong>Setting: </strong>Community.</p><p><strong>Participants: </strong>A total of 8861 individuals aged ≥16 who identified as non-Hispanic White (1750 females, 4270 males), non-Hispanic Black (315 females, 1147 males), or Hispanic (314 females, 1065 males), and who completed a 1-year postinjury follow-up interview in the TBI Model Systems National Database.</p><p><strong>Design: </strong>Secondary analysis of a longitudinal cohort study at 1-year postinjury.</p><p><strong>Main measures: </strong>The Participation Assessment with Recombined Tools-Objective-17 (PART-O-17) Productivity items (ie, school, employment, and homemaking) and subscale, and total Summary scores were the primary outcomes used to assess societal participation. The covariates were age, years of education, and total score on the Functional Independence Measure (FIM).</p><p><strong>Results: </strong>A significant sex × race/ethnicity interaction with homemaking was identified (P = .047). Compared with Non-Hispanic White males, odds of not endorsing homemaking were 1.55 times greater for Non-Hispanic Black males and 1.71 times greater for Hispanic males. No significant sex × race/ethnicity interactions were found with employment (P = .221) or school items (P = .967). After adjusting for age, education, and FIM Total, a significant sex × race/ethnicity interaction on Productivity scores was found, F(28 852) = 10.3, P<.001, such that sex differences were observed for only Non-Hispanic Black and Hispanic participants compared to Non-Hispanic White participants. No significant interaction regarding sex differences across racial/ethnic groups was identified using the PART-O-17 Summary score.</p><p><strong>Conclusions: </strong>Compared with non-Hispanic White males, non-Hispanic Black and Hispanic males were less likely to report engaging in homemaking activities, resulting in greater sex differences among Non-Hispanic Black and Hispanic males and females on the Productivity subscale than were observed on this scale among non-Hispanic White individuals. Current community participation measures may not accurately capture the experiences of diverse populations with TBI.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159578","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":"Traumatic Brain Injury, Chronic Pain, and Associations With Suicidal Thoughts and Behaviors: A Traumatic Brain Injury Model Systems Study.","authors":"Laura E Boylan, Amol Karmarkar, Bani Malhotra, Charmi Kanani, Jessica M Ketchum, Katherine Abassi, Stephanie D Agtarap, Aaron M Martin, Kristen Dams-O'Connor, William C Walker, Daniel W Klyce","doi":"10.1097/HTR.0000000000001070","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001070","url":null,"abstract":"<p><strong>Objective: </strong>This study examined the association that chronic pain (CP) has with suicidal ideation (SI) and suicide attempt (SA) among individuals with moderate-to-severe traumatic brain injury (TBI).</p><p><strong>Setting: </strong>Participants who completed inpatient rehabilitation at a TBI Model Systems (TBIMS) center.</p><p><strong>Participants: </strong>In total, 2579 English-speaking participants within 10 years of moderate-to-severe TBI who completed the CP Survey at TBIMS follow-up.</p><p><strong>Design: </strong>A multisite, cross-sectional observational cohort study.</p><p><strong>Main outcomes and measures: </strong>Suicidal ideation and SA; experience with CP; demographic variables, injury characteristics, behavioral health, and functional characteristics.</p><p><strong>Results: </strong>At follow-up assessment, 45.2% endorsed current CP, 14.5% reported a history of CP after TBI that had resolved, and 40.3% reported no CP since the onset of TBI. There were significant differences in prevalence of SI (P < .001) and SA (P = .018) among the pain groups, with the highest prevalence observed within the current CP group (14.8% and 2.6%, respectively). Adjusting for other covariates, multivariate logistic regression models indicated a significantly higher likelihood of SI for the current CP versus no CP group (OR = 2.05, 95% CI = 1.38, 3.06). No significant association was found between the pain groups and SA. Clinical elevated symptoms of posttraumatic stress at follow-up were associated with both SI (OR = 3.87, 95% CI = 2.76, 5.44) and SA (OR = 2.43; 95% CI = 1.25, 4.75). Those with TBI caused by violence or falls had a lower risk of SI compared to those with a vehicular-related cause of TBI. Increased SI risk was also associated with lower functional independence and participation in preinjury mental health services; risk of SA was associated with Hispanic ethnicity.</p><p><strong>Conclusions: </strong>The current study supports further investigation on how CP and its specific attributes may influence suicide-related outcomes. These findings warrant consideration of strategies to proactively assess suicide risk and the potential development of interventions targeting suicidal behavior among individuals experiencing both CP and TBI.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159587","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}