Journal of rehabilitation research and development
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Concordance of clinician judgment of mild traumatic brain injury history with a diagnostic standard.
The concordance of Department of Veterans Affairs (VA) clinician judgment of mild traumatic brain injury (mTBI) history with American Congress of Rehabilitation Medicine (ACRM)-based criteria was examined for Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) Veterans. In order to understand inconsistencies in agreement, we also examined the associations between evaluation outcomes and conceptually relevant patient characteristics, deployment-related events, current self-reported health symptoms, and suspected psychiatric conditions. The Veteran sample comprised 14,026 OIF/OEF VA patients with deployment-related mTBI history (n = 9,858) or no history of mTBI (n = 4,168) as defined by ACRM-based criteria. ⋯ The most common inconsistency was between clinician judgment (no) and ACRM-based criteria (yes) for 21.3% of the patients. Injury etiology, current self-reported health symptoms, and suspected psychiatric conditions were additional factors associated with clinician diagnosis and ACRM-based criteria disagreement. Adherence to established diagnostic guidelines is essential for accurate determination of mTBI history and for understanding the extent to which mTBI symptoms resolve or persist over time in OIF/OEF Veterans.
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The study objective was to examine postacute changes in bowel and bladder continence and cognition after severe traumatic brain injury (TBI) in persons with long-term functional recovery to full independence. This case series included nine patients initially admitted to inpatient rehabilitation (IR) with severe TBI who had returned to prior responsibilities and functional independence by 8 to 15 mo. Patients had initial Glasgow Coma Scale scores of 3 to 6, posttraumatic amnesia durations of 18 to 70 d, time-to-follow-commands of 16 to 56 d, initial abnormal brain computed tomography scans, and initial pupil abnormalities. ⋯ All patients had combined IR discharge sphincter FIM scores that were 12 or greater, indicating independence to modified independence with bowel and bladder function with no incontinence. Five participants (55%) were admitted to IR with sphincter FIM scores of 11 to 12, indicating recovery of continence during acute care. These findings suggest potential usefulness of IR cognitive FIM score changes and of the recovery of bowel and bladder continence for predicting favorable functional outcomes following severe TBI.
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Survivability characteristics after cardiopulmonary resuscitation in the population with spinal cord injury (SCI) are unclear but may be useful for advanced care planning discussions with patients. Retrospective evaluation from records of all SCI patients over 10 yr at a Department of Veterans Affairs medical center who experienced in-hospital cardiac arrest was performed. Demographic data and other common measurements were recorded. ⋯ No significant demographic parameters were identified. Overall, SCI likely portends worse outcome for acutely ill patients in the situation of a cardiac arrest. Conclusions are limited by sample size.
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The aim of this study was to examine the relationship between biopsychosocial functioning and pain severity and to evaluate whether pain self-efficacy (PSE) mediates this relationship. This study used archival data from a multidisciplinary pain management program. Participants were 99 individuals (69% female) with chronic low back pain who completed measures of biological, psychological, and social functioning, pain severity, and PSE at admission. ⋯ As we predicted, lower biological functioning (beta = -0.011; 95% confidence interval [CI] = -0.019 to -0.004, p = 0.002) and social functioning (beta = -0.009; 95% CI = -0.016 to -0.003, p = 0.007) were found to significantly predict higher pain severity, and lower social functioning was found to significantly predict lower PSE (beta = 0.196; 95% CI = -0.130 to 0.273, p = 0.002). PSE did not mediate the relationship between biopsychosocial functioning and pain severity, and psychological functioning did not significantly predict pain severity or PSE. These findings suggest that social functioning is an important factor in predicting outcomes and has a number of treatment implications.
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Randomized Controlled Trial
Effects of hyperbaric oxygen on eye tracking abnormalities in males after mild traumatic brain injury.
The effects of hyperbaric oxygen (HBO2) on eye movement abnormalities in 60 military servicemembers with at least one mild traumatic brain injury (TBI) from combat were examined in a single-center, randomized, double-blind, sham-controlled, prospective study at the Naval Medicine Operational Training Center. During the 10 wk of the study, each subject was delivered a series of 40, once a day, hyperbaric chamber compressions at a pressure of 2.0 atmospheres absolute (ATA). ⋯ Between and within groups testing of pre- and postintervention means revealed no significant differences on eye movement abnormalities and no significant main effect for HBO2 at either 1.5 ATA or 2.0 ATA equivalent compared with the sham-control. This study demonstrated that neither 1.5 nor 2.0 ATA equivalent HBO2 had an effect on postconcussive eye movement abnormalities after mild TBI when compared with a sham-control.