Faculty Bibliography

OBJECTIVE:To develop a pain interference item bank, computer adaptive test (CAT), and short form for use by individuals with traumatic brain injury (TBI). DESIGN/METHODS:Cross-sectional survey study. SETTING/METHODS:Five TBI Model Systems rehabilitation hospitals. PARTICIPANTS/METHODS:Five hundred ninety individuals with TBI. INTERVENTIONS/METHODS:Not Applicable. OUTCOME MEASURES/METHODS:TBI-QOL Pain Interference item bank. RESULTS:(740) = 3254.030, p < .001; Comparative Fix Index = .988; Tucker Lewis Index = .980; Root Mean Square Error of Approximation = .076) and a graded response model (GRM) supported item fit of 40 Pain Interference items. Items did not exhibit differential item functioning or local item dependence. GRM calibration data were used to inform the selection of a 10-item static short form, and to program a TBI-QOL Pain Interference CAT. Comparative analyses indicated excellent comparability and reliability across test administration formats. CONCLUSION/CONCLUSIONS:The 40-item TBI-QOL Pain Interference item bank demonstrated strong psychometric properties. End users can administer this measure as either a 10-item short form or CAT.

Objective: To examine the factors associated with the remission of insomnia by examining a sample of individuals who had insomnia within the first two years after traumatic brain injury (TBI) and assessing their status at a secondary time point. Design and Methods: Secondary data analysis from a multicenter longitudinal cohort study. A sample of 40 individuals meeting inclusion criteria completed a number of self-report scales measuring sleep/wake characteristics (Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Insomnia Severity Index, Sleep Hygiene Index), fatigue and depression (Multidimensional Assessment of Fatigue, Patient Health Questionnaire-9), and community participation (Participation Assessment with Recombined Tools-Objective). One cohort was followed at 1 and 2 years post-injury (n = 19) while a second cohort was followed at 2 and 5 years post-injury (n = 21). Results: Remission of insomnia was noted in 60% of the sample. Those with persistent insomnia had significantly higher levels of fatigue and depression at their final follow-up and poorer sleep hygiene across both follow-up time-points. A trend toward reduced community participation among those with persistent insomnia was also found. Conclusion: Individuals with persistent post-TBI insomnia had poorer psychosocial outcomes. The chronicity of post-TBI insomnia may be associated with sleep-related behaviors that serve as perpetuating factors.

Objective: To capture the need for TBI educational materials and resources for those affected by traumatic brain injury (TBI) years after inpatient rehabilitation discharge.
Design(s): This observational study tracked the different types of resources and educational TBI factsheets from Model Systems Knowledge Translation Center (MSKTC) shared with TBI Model Systems (TBIMS) participants and caregivers who completed Form II at Year 1, 2 and 5.
Setting(s): Two urban hospitals in New York City. Participants (or Animals, Specimens, Cadavers): Participants and caregivers (N=94) followed between June 2018 and February 2019. Participants were primarily male (83%), Hispanic (37.2%) or White (34.0%), and spoke English (77.7%); and had an average age of 52.
Intervention(s): Provided resources and educational information after each completed follow-up. Main Outcome Measure(s): MSKTC factsheets and resources include hospital-outpatient services and TBI internet resources including advocacy and support.
Result(s): Descriptive statistics were used to analyze the most requested materials at years 1, 2 and 5. At year 1, participants (N=35) requested internet resources (63.6%) and hospital-outpatient services (22.7%), and the following TBI educational materials: introduction to TBI (59.1%), seizures, alcohol use, cognitive problems, balance problems, and memory (22.7% per topic). At year 2, participants (N=25) requested internet resources (48.0%), and educational materials: introduction to TBI (64.0%), headaches, cognitive problems, and seizures (16.0% per topic). At Year 5, participants (N=10) requested internet resources (100.0%) and hospital-outpatient services (40.0%).
Conclusion(s): As scientific evidence classifies TBI as a chronic condition, it is important to understand the needs and knowledge gaps of those affected by TBI. These results suggest case management is necessary throughout inpatient rehabilitation and immediately after discharge, but also throughout the post-injury period in order to help individuals attain and access appropriate service referrals, resources and educational materials as needs change over time. Author(s) Disclosures: Nothing to disclose. Key Words: Traumatic Brain Injury, Cross-cultural, Community Integration, Community Outreach, Case Management
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OBJECTIVE:To link scores on commonly used measures of anxiety (7-item Generalized Anxiety Disorder Scale; GAD-7) and depression (9-item Patient Health Questionnaire; PHQ-9) to the Traumatic Brain Injury Quality of Life (TBI-QOL) measurement system. SETTING/METHODS:5 Traumatic Brain Injury Model Systems. PARTICIPANTS/METHODS:A total of 385 individuals with traumatic brain injury (TBI) (31% complicated mild; 14% moderate; and 54% severe). DESIGN/METHODS:Observational cohort. MAIN MEASURES/METHODS:GAD-7, PHQ-9, TBI-QOL Anxiety v1.0 and TBI-QOL Depression v1.0. RESULTS:Item response theory-based linking methods were used to create crosswalk tables that convert scores on the GAD-7 to the TBI-QOL Anxiety metric and scores on the PHQ-9 to the TBI-QOL Depression metric. Comparisons between actual and crosswalked scores suggest that the linkages were successful and are appropriate for group-level analysis. Linking functions closely mirror crosswalks between the GAD-7/PHQ-9 and the Patient-Reported Outcomes Measurement Information System (PROMIS), suggesting that general population linkages are similar to those from a TBI sample. CONCLUSION/CONCLUSIONS:Researchers and clinicians can use the crosswalk tables to transform scores on the GAD-7 and the PHQ-9 to the TBI-QOL metric for group-level analyses.

OBJECTIVE:To develop a traumatic brain injury (TBI)-specific, item response theory (IRT)-calibrated Fatigue item bank, short form, and computer adaptive test (CAT) as part of the Traumatic Brain Injury-Quality of Life (TBI-QOL) measurement system. SETTING/METHODS:Five TBI Model Systems rehabilitation centers in the US PARTICIPANTS:: Adults with complicated mild, moderate, or severe TBI confirmed by medical record review. DESIGN/METHODS:Cross-sectional field testing via phone or in-person interview. MAIN MEASURES/METHODS:TBI-QOL Fatigue item bank, short form, and CAT. RESULTS:A total of 590 adults with TBI completed 95 preliminary fatigue items, including 86 items from the Patient-Reported Outcomes Measurement Information System (PROMIS) and 9 items from the Quality of Life in Neurological Disorders (Neuro-QOL) system. Through 4 iterations of factor analysis, 22 items were deleted for reasons such as local item dependence, misfit, and low item-total correlations. Graded response model IRT analyses were conducted on the 73-item set, and Stocking-Lord equating was used to transform the item parameters to the PROMIS (general population) metric. A short form and CAT, which demonstrate similar reliability to the full item bank, were developed. Test-retest reliability of the CAT was established in an independent sample (Pearson's r and intraclass correlation coefficient = 0.82 [95% confidence interval: 0.72-0.88]). CONCLUSIONS:The TBI-QOL Fatigue item bank, short form, and CAT provide rehabilitation researchers and clinicians with TBI-optimized tools for assessment of the patient-reported experience and impact of fatigue on individuals with TBI.

PURPOSE/OBJECTIVE/OBJECTIVE:Racial/ethnic minorities and other vulnerable social groups experience health care disparities. There is a lack of research exploring how time to acute rehabilitation admission is impacted by race/ethnicity and other marginalizing systemic vulnerabilities. The purpose of this study is to investigate whether race/ethnicity and other sociodemographic vulnerabilities impact expediency of acute rehabilitation admission following traumatic brain injury (TBI). Research Method/Design: This study is a secondary analysis of an existing dataset of 111 patients admitted for acute TBI rehabilitation at an urban public hospital. Patient groups were defined by race/ethnicity (People of color or White) and vulnerable group status (high or low vulnerable group membership [VGM]). RESULTS:White patients are admitted to acute TBI rehabilitation significantly faster than people of color. After taking vulnerabilities into account, high VGM people of color experience the most severe injuries and take the longest to receive acute TBI rehabilitation. Despite small differences in injury severity, low VGM people of color take longer to be admitted to acute TBI rehabilitation than White patients. High VGM White patients have less severe injuries yet take longer to be admitted to acute rehabilitation than low VGM White patients. Finally, notable differences exist between White patients and patients of color on rater-based injury severity scales that are discordant with severity as measured by more objective markers. CONCLUSIONS/IMPLICATIONS/CONCLUSIONS:Overall, findings indicate that sociodemographic factors including race/ethnicity and systemic vulnerabilities impact injury severity and time to acute TBI rehabilitation admission. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

OBJECTIVE:To examine the influence of nativity and residential characteristics on productive activity among Hispanics at 1 year after traumatic brain injury (TBI). SETTING/METHODS:Acute rehabilitation facilities and community follow-up. PARTICIPANTS/METHODS:A total of 706 Hispanic individuals in the TBI Model Systems National Database. DESIGN/METHODS:Secondary data analysis from a multicenter longitudinal cohort study. MAIN MEASURES/METHODS:Nativity (foreign born or US native), productive activity derived from interview questions regarding employment status, and other demographic information. Census data were extracted by zip code to represent residential characteristics of aggregate household income and proportion of foreign language speakers (FLS). RESULTS:Among foreign-born individuals with TBI, those living in an area with a higher proportion of FLS were 2.8 times more likely to be productive than those living in areas with a lower proportion of FLS. Among individuals living in an area with a lower proportion of FLS, US-born Hispanics were 2.7 times more likely to be productive compared with Hispanic immigrants. CONCLUSION/CONCLUSIONS:The relationship between nativity and productive activity at 1 year post-TBI was moderated by the residential proportion of FLS. Findings underscore the importance of considering environmental factors when designing vocational rehabilitation interventions for Hispanics after TBI.

OBJECTIVE:To analyze the complex relationship between various social indicators that contribute to socioeconomic status and healthcare barriers. DESIGN/METHODS:Cluster analysis of historical patient data obtained from inpatient visits. SETTING/METHODS:Setting: Inpatient rehabilitation unit in a large, urban university hospital PARTICIPANTS: Adult patients receiving acute inpatient care, predominantly for closed head injury. INTERVENTIONS/METHODS:Not applicable MAIN OUTCOME MEASURES: We examined the membership of TBI patients in various "vulnerable group" (VG) clusters (e.g., homeless, unemployed, racial/ethnic minority) and characterized the rehabilitation outcomes of the patients (e.g., duration of stay, changes in Functional Independence Measure [FIM] scores between admission to inpatient stay and discharge). RESULTS:Analysis revealed four major clusters (i.e., Clusters A-D) separated by VG memberships, with distinct durations of stay and FIM gains during their stay. Cluster B, the largest cluster and also consisting of mostly racial/ethnic minorities, had the shortest duration of hospital stay and one of the lowest FIM improvements among the four clusters despite higher FIM scores at admission. In cluster C, also consisting of mostly ethnic minorities with multiple SES vulnerabilities, patients were characterized by low cognitive FIM scores at admission and the longest duration of stay, and they showed good improvement in FIM scores. CONCLUSIONS:Application of clustering techniques to inpatient data identified distinct clusters of patients who may experience differences in their rehabilitation outcome due to their membership in various "at-risk" groups. Results identified patients (i.e., cluster B, with minority patients and Cluster D, with elderly patients) who attain below-average gains in brain injury rehabilitation. Results also suggested that systemic (e.g., duration of stay) or clinical service improvements (e.g., staff's language skills, ability to offer substance abuse therapy, provide appropriate referrals or liaise with intensive social work services or plan subacute rehabilitation phase) could be beneficial for acute settings. Stronger recruitment, training and retention initiatives for bilingual and multiethnic professionals may also be considered to optimize gains from acute inpatient rehabilitation following traumatic brain injury.