VA Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC), Aurora, CO; University of Colorado, Anschutz Medical Campus, Department of Physical Medicine and Rehabilitation, Aurora, CO.
VA Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC), Aurora, CO; Boston University School of Public Health, Department of Health Law, Policy and Management, Boston, MA.
Arch Phys Med Rehabil. 2023 Jun;104(6):892-901. doi: 10.1016/j.apmr.2022.12.191. Epub 2023 Jan 11.
Among service members (SMs) with mild traumatic brain injury (mTBI) admitted to an intensive outpatient program (IOP), we identified qualitatively distinct subgroups based on post-concussive symptoms (PCSs) and characterized changes between subgroups from admission to discharge. Further, we examined whether co-morbid posttraumatic stress disorder (PTSD) influenced changes between subgroups.
Quasi-experimental. Latent transition analysis identified distinctive subgroups of SMs and examined transitions between subgroups from admission to discharge. Logistic regression examined the effect of PTSD on transition to the Minimal subgroup (low probability of any moderate-very severe PCS) while adjusting for admission subgroup designation.
National Intrepid Center of Excellence (NICoE) at Walter Reed National Military Medical Center.
1141 active duty SMs with persistent PCS despite prior treatment (N=1141).
NICoE 4-week interdisciplinary IOP.
MAIN OUTCOME MEASURE(S): Subgroups identified using Neurobehavioral Symptom Inventory items at admission and discharge.
Model fit indices supported a 7-class solution. The 7 subgroups of SMs were distinguished by diverging patterns of probability for specific PCS. The Minimal subgroup was most prevalent at discharge (39.4%), followed by the Sleep subgroup (high probability of sleep problems, low probability of other PCS; 26.8%). 41% and 25% of SMs admitted within the Affective (ie, predominantly affective PCS) and Sleep subgroups remained within the same group at discharge, respectively. The 19% of SMs with co-morbid PTSD were less likely to transition to the Minimal subgroup (odds ratio=0.28; P<.001) and were more likely to remain in their admission subgroup at discharge (35.5% with PTSD vs 22.2% without).
Most of SMs achieved symptom resolution after participation in the IOP, with most transitioning to subgroups characterized by reduced symptom burden. SMs admitted in the Affective and Sleep subgroups, as well as those with PTSD, were most likely to have continuing clinical needs at discharge, revealing priority targets for resource allocation and follow-up treatment.
在因轻度创伤性脑损伤（mTBI）而接受强化门诊治疗（IOP）的军人（SMs）中，我们根据脑震荡后症状（PCS）确定了性质不同的亚组，并描述了从入院到出院亚组之间的变化。此外，我们还研究了合并创伤后应激障碍（PTSD）是否会影响亚组之间的变化。
准实验。潜在转移分析确定了军人的独特亚组，并检查了从入院到出院亚组之间的转移情况。逻辑回归检查了 PTSD 对向最小亚组（任何中度至重度 PCS 概率低）转移的影响，同时调整了入院亚组指定。
位于 Walter Reed 国家军事医疗中心的国家坚韧卓越中心（NICoE）。
1141 名因持续存在 PCS 而接受治疗（N=1141）的现役军人。
NICoE 4 周的跨学科 IOP。
入院和出院时使用神经行为症状量表（Neurobehavioral Symptom Inventory）项目确定的亚组。
模型拟合指数支持 7 类解决方案。SMs 的 7 个亚组通过特定 PCS 概率的发散模式来区分。最小亚组在出院时最常见（39.4%），其次是睡眠亚组（睡眠问题发生率高，其他 PCS 发生率低；26.8%）。入院时在情感（即主要是情感 PCS）和睡眠亚组中的 41%和 25%的 SMs 分别在出院时仍留在同一组。合并 PTSD 的 19%的 SMs 向最小亚组转移的可能性较低（比值比=0.28；P<.001），并且更有可能在出院时留在入院亚组（35.5%有 PTSD 与 22.2%无 PTSD）。
大多数 SMs 在参加 IOP 后症状得到缓解，大多数人向症状负担减轻的亚组转移。入院时处于情感和睡眠亚组的 SMs，以及患有 PTSD 的 SMs，在出院时最有可能有持续的临床需求，这揭示了资源分配和后续治疗的优先目标。
