创伤性脑损伤后 5 年的康复需求：VA TBI 模型系统研究。
Rehabilitation Needs at 5 Years Post-Traumatic Brain Injury: A VA TBI Model Systems Study.
机构信息
Mental Health and Behavioral Sciences (MHBS) (Drs Mahoney, Silva, and Nakase-Richardson) and Defense and Veterans Brain Injury Center (DVBIC) (Drs Silva and Nakase-Richardson), James A. Haley Veterans' Hospital, Tampa, Florida; Departments of Psychiatry and Behavioral Neurosciences (Dr Silva), Psychology (Dr Silva), Child & Family Studies (Dr Dillahunt-Aspillaga), and Internal Medicine, Division of Pulmonary and Sleep Medicine (Dr Nakase-Richardson), University of South Florida, Tampa; Morsani College of Medicine, University of South Florida, Tampa (Ms Reljic); Departments of Rehabilitation Medicine (Dr Dams-O'Connor) and Neurology (Dr Dams-O'Connor), Icahn School of Medicine at Mount Sinai, New York, New York; Department of Physical Medicine & Rehabilitation, Indiana University School of Medicine, Indianapolis (Dr Hammond); Rehabilitation Hospital of Indiana, Indianapolis (Dr Hammond); Research Department, Craig Hospital, Englewood, Colorado (Dr Monden); Department of Rehabilitation Medicine, University of Minnesota, Minneapolis (Dr Monden); VA Palo Alto Health Care System, Palo Alto, California (Dr Chung); and Research Service, James A. Haley Veterans' Hospital, Tampa, Florida (Dr Dillahunt-Aspillaga).
出版信息
J Head Trauma Rehabil. 2021;36(3):175-185. doi: 10.1097/HTR.0000000000000629.
OBJECTIVE
Describe rehabilitation needs and factors associated with unmet needs at 5 years post-traumatic brain injury (TBI).
SETTING
Five Veterans Affairs (VA) polytrauma rehabilitation centers (PRCs).
PARTICIPANTS
VA TBI Model Systems participants (N = 283; 96% male, 75%, 57% severe TBI).
DESIGN
Prospective observational cohort.
MAIN MEASURES
Rehabilitation Needs Survey (21-item survey that assesses cognitive, emotional, social, and functional needs); Craig Hospital Inventory of Environmental Factors (25-item survey of potential environmental barriers).
RESULTS
Participants endorsed a mean of 8 (SD: 6.2) ongoing and 3 (SD: 4.7) unmet rehabilitation needs at 5 years post-TBI. Approximately 65% of participants reported at least 1 rehabilitation need that remained unmet. The number and nature of needs differed across TBI severity groups. In unadjusted and adjusted linear regression models, Black race and environmental barriers (Craig Hospital Inventory of Environmental Factors total score) were predictive of unmet needs (P < .001). Those with greater unmet needs reported the physical environment (54%-63%), informational sources (54%), social attitudes (55%), healthcare access (40%), public policy (32%-37%), transportation availability (33%), and in-home assistance (32%) as the most frequent environmental barriers at 5 years post-TBI.
CONCLUSION
Veterans and Service Members continue to have rehabilitation needs at 5 years post-TBI. Veterans Affairs programs to address ongoing needs and policy to support them are needed.
目的
描述创伤性脑损伤（TBI）后 5 年的康复需求和未满足需求的相关因素。
地点
五个退伍军人事务部（VA）多发创伤康复中心（PRC）。
参与者
VA TBI 模型系统参与者（N=283；96%男性，75%，57%严重 TBI）。
设计
前瞻性观察队列。
主要措施
康复需求调查（21 项调查，评估认知、情感、社会和功能需求）；克雷格医院环境因素清单（25 项调查潜在的环境障碍）。
结果
参与者在 TBI 后 5 年报告了平均 8（SD：6.2）项持续和 3（SD：4.7）项未满足的康复需求。约 65%的参与者报告至少有 1 项康复需求未得到满足。TBI 严重程度不同的组别需求的数量和性质不同。在未调整和调整后的线性回归模型中，黑人种族和环境障碍（克雷格医院环境因素清单总分）是未满足需求的预测因素（P<0.001）。未满足需求较多的患者报告在物理环境（54%-63%）、信息来源（54%）、社会态度（55%）、医疗保健获取（40%）、公共政策（32%-37%）、交通可用性（33%）和家庭援助（32%）方面存在最频繁的环境障碍。
结论
退伍军人和军人在 TBI 后 5 年仍有康复需求。需要制定退伍军人事务部方案来满足他们的持续需求，并制定支持他们的政策。
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