Environmental Barriers are Associated With Rehabilitation Needs 10 to 15 Years After Traumatic Brain Injury: A Veterans Affairs TBI Model Systems Study

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Abstract
Objective: To examine the association between environmental barriers and unmet rehabilitation needs during chronic recovery from traumatic brain injury (TBI) in persons discharged from inpatient rehabilitation. Setting: Five Veterans Affairs Polytrauma Rehabilitation Centers. Design: Cohort study of Veterans Affairs TBI Model Systems study participants who completed a 10 or 15 year follow up (N = 474). Main Measures: Craig Hospital Inventory of Environmental Factors, Short Form (CHIEF-SF); TBI Rehabilitation Needs Survey (RNS). Results: RNS scores ranged from 0 to 42 with an average score of 6.9 (SD = 7.7). The most frequent unmet needs endorsed included the need to improve memory, solve problems, and control physical symptoms. In the adjusted model, unmet rehabilitation needs (RNS total) was associated with overall environmental barriers (CHIEF-SF Total Score) and three of five CHIEF-SF subscales: Policy barriers, Attitudes/Support barriers, and Services/Assistance barriers. Conclusions: Results from this study suggest that rehabilitation needs persist for at least a decade after TBI and occur in areas that may be modifiable with intervention. Health care providers shoulder consider periodic screening for unmet needs and consider potential treatments to address them as medically indicated Also, results support the growing recognition of TBI as a dynamic and lifelong condition necessitating a chronic disease management model. Despite significant investment in healthcare infrastructure for Veterans and Service Members, knowledge gaps remain regarding understanding and addressing their long-term rehabilitation needs, as well as and how environmental barriers impact the ability to address those needs. Unmet needs among women and minority groups; as well as evaluation of systems interventions to ameliorate environmental barriers they face are important foci of future research.

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