退伍军人事务部（VA）和国家残疾与康复研究所（NIDILRR）创伤性脑损伤模型系统队列的比较。
Comparison of the VA and NIDILRR TBI Model System Cohorts.
作者信息
Nakase-Richardson Risa, Stevens Lillian Flores, Tang Xinyu, Lamberty Greg J, Sherer Mark, Walker William C, Pugh Mary Jo, Eapen Blessen C, Finn Jacob A, Saylors Mimi, Dillahunt-Aspillaga Christina, Adams Rachel Sayko, Garofano Jeffrey S
机构信息
MHBS, James A. Haley Veterans' Hospital, Tampa, Florida (Dr Nakase-Richardson); Defense and Veterans Brain Injury Center, Tampa, Florida (Dr Nakase-Richardson); Department of Internal Medicine, University of South Florida, Tampa (Dr Nakase-Richardson); VA HSRD Center of Innovation on Disability and Rehabilitation Research, Tampa, Florida (Dr Nakase-Richardson); Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia (Drs Stevens and Walker); Departments of Psychology (Dr Stevens) and Physical Medicine and Rehabilitation (Drs Stevens, and Walker), Virginia Commonwealth University, Richmond; Defense and Veterans Brain Injury Center, Richmond, Virginia (Drs Stevens, and Walker); Biostatistics Program, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock (Dr Tang and Ms Saylors); Mental Health Service, Minneapolis VA Health Care System, Minneapolis, Minnesota (Drs Lamberty and Finn); Department of Psychiatry, University of Minnesota School of Medicine, Minneapolis (Drs Lamberty and Finn), Defense and Veterans Brain Injury Center (DVBIC), Minneapolis, Minnesota (Drs Lamberty and Finn); Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas (Dr Sherer); Polytrauma Rehabilitation Center, South Texas Veterans Health Care System, San Antonio (Drs Pugh and Eapen); Department of Epidemiology and Biostatistics, University of Texas Health Sciences Center, San Antonio (Dr Pugh); College of Behavioral and Community Sciences, University of South Florida, Tampa (Dr Dillahunt-Aspillaga); Brandeis University, Boston, Massachusetts (Dr Adams); and College of Education, University of South Florida, Tampa, Florida (Mr. Garafano).
出版信息
J Head Trauma Rehabil. 2017 Jul/Aug;32(4):221-233. doi: 10.1097/HTR.0000000000000334.
OBJECTIVE
Within the same time frame, compare the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) and VA Traumatic Brain Injury Model System (TBIMS) data sets to inform future research and generalizability of findings across cohorts.
SETTING
Inpatient comprehensive interdisciplinary rehabilitation facilities.
PARTICIPANTS
Civilians, Veterans, and active duty service members in the VA (n = 550) and NIDILRR civilian settings (n = 5270) who were enrolled in TBIMS between August 2009 and July 2015.
DESIGN
Prospective, longitudinal, multisite study.
MAIN MEASURES
Demographics, Injury Characteristics, Functional Independence Measures, Disability Rating Scale.
RESULTS
VA and NIDILRR TBIMS participants differed on 76% of comparisons (18 Important, 8 Minor), with unique differences shown across traumatic brain injury etiology subgroups. The VA cohort was more educated, more likely to be employed at the time of injury, utilized mental health services premorbidly, and experienced greater traumatic brain injury severity. As expected, acute and rehabilitation lengths of stay were longer in the VA with no differences in death rate found between cohorts.
CONCLUSIONS
Substantial baseline differences between the NIDILRR and VA TBIMS participants warrant caution when comparing rehabilitation outcomes. A substantive number of NIDILRR enrollees had a history of military service (>13%) warranting further focused study. The TBIMS participant data collected across cohorts can be used to help evidence-informed policy for the civilian and military-related healthcare systems.
目的
在同一时间范围内，比较美国国立残疾、独立生活和康复研究机构（NIDILRR）与退伍军人事务部创伤性脑损伤模型系统（TBIMS）的数据集，以为未来研究及各队列研究结果的可推广性提供信息。
背景
住院综合跨学科康复机构。
参与者
2009年8月至2015年7月期间纳入TBIMS的退伍军人事务部中的平民、退伍军人及现役军人（n = 550）以及NIDILRR平民机构中的人员（n = 5270）。
设计
前瞻性、纵向、多地点研究。
主要测量指标
人口统计学、损伤特征、功能独立性测量、残疾评定量表。
结果
退伍军人事务部和NIDILRR的TBIMS参与者在76%的比较项目上存在差异（18项重要差异，8项次要差异），不同创伤性脑损伤病因亚组显示出独特差异。退伍军人事务部队列的参与者受教育程度更高，受伤时更有可能就业，病前使用过心理健康服务，且创伤性脑损伤严重程度更高。正如预期的那样，退伍军人事务部的急性住院和康复住院时间更长，各队列间死亡率无差异。
结论
在比较康复结果时，NIDILRR和退伍军人事务部TBIMS参与者之间存在大量基线差异，需谨慎对待。相当数量的NIDILRR登记者有军事服役史（>13%），值得进一步深入研究。跨队列收集的TBIMS参与者数据可用于帮助为民事和军事相关医疗系统制定基于证据的政策。
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