Health Conditions Among Special Operations Forces Versus Conventional Military Service Members: A VA TBI Model Systems Study.

OBJECTIVE: To examine traumatic brain injury (TBI) characteristics and comorbid medical profiles of Special Operations Forces (SOF) Active Duty Service Member/Veterans (ADSM/Vs) and contrast them with conventional military personnel. SETTING: The 5 Veterans Affairs (VA) Polytrauma Rehabilitation Centers. PARTICIPANTS: A subset of participants in the VA TBI Model Systems multicenter longitudinal study with known SOF status. These included 157 participants who identified as SOF personnel (average age = 41.8 years; 96% male, 81% active duty), and 365 who identified as Conventional Forces personnel (average age = 37.4 years; 92% male, 30% active duty). DESIGN: Retrospective analysis of prospective cohort, cross-sectional. MAIN MEASURES: The Health Comorbidities Interview. RESULTS: SOF personnel were more likely to have deployed to a combat zone, had more years of active duty service, and were more likely active duty at time of TBI. SOF personnel were more likely to have had mild TBI (vs moderate/severe) and their TBI caused by violent mechanism. SOF personnel had a higher number of comorbidities, with more diagnoses of chronic pain, osteoarthritis, hyperlipidemia, hip fractures, and obstructive sleep apnea. CONCLUSION: SOF personnel are at a higher risk for multimorbidity after TBI. Current rehabilitation practices should incorporate early screening and treatment of common conditions in this population, while future practices may benefit from a focus on prevention.

Neurobehavioral Management of the Polytrauma Veteran.

Since the inception of the Afghanistan and Iraq wars, an increasing number of veterans have sought treatment from the Department of Veterans Affairs for combat-related injuries. Many veterans experience postconcussive symptoms, traumatic stress, chronic pain, sensory deficits, and/or headaches. The goal of this article was to highlight some of the challenges treatment providers may face, while providing rehabilitation specialists with important evaluation and treatment considerations in working with this population to maximize outcomes for these veterans.

Prevalence and predictors of tobacco smoking in veterans and service members following traumatic brain injury rehabilitation: a VA TBIMS study.

OBJECTIVE: To identify prevalence and predictors of tobacco smoking among veterans and military service members (V/SM) with traumatic brain injury (TBI) admitted for rehabilitation. METHODS: Participants were drawn from the VA TBI Model Systems multicentre longitudinal research study. Tobacco smoking was assessed both preinjury and at 1- or 2-year post-TBI follow-up for 336 participants. RESULTS: Smoking prevalence was 32% preinjury and 28% at follow-up. Most participants had a stable smoking pattern but 12% of preinjury non-smokers became smokers at follow-up. Preinjury smoking was the strongest predictor of post-TBI smoking. Higher cognitive function also predicted smoking at follow-up. In univariate analyses, smoking was predicted by lower education, preinjury mental health (MH) history, selected TBI severity metrics, and higher functional status at rehabilitation hospital discharge (Disability Rating Scale [DRS] and motor subscale of the Functional Independence Measure [FIM]). CONCLUSION: Study findings may help clinicians and administrators recognize who is at high risk for smoking following TBI, to plan for in-hospital and postdischarge screening and interventions.

Change in body mass index within the first-year post-injury: a VA Traumatic Brain Injury (TBI) model systems study.

OBJECTIVE: To describe change in body mass index (BMI) and weight classification 1-year post- traumatic brain injury (TBI) among Veterans and service members. DESIGN: Prospective observational cohort study. SETTING: VA Polytrauma Rehabilitation Centers. PARTICIPANTS: Veterans and service members (N = 84) enrolled in VA Traumatic Brain Injury Model Systems (VA TBIMS) study with BMI scores at enrollment and 1-year post-injury. INTERVENTIONS: N/A. MAIN OUTCOME MEASURES: BMI scores from height and weight and weight classifications (underweight, normal weight, overweight, obese classes 1-3) defined by WHO. RESULTS: Twenty per cent were obese at time of injury and 24% were obese at 1-year post-injury. Cross-tab analyses revealed 7% of normal weight and 24% overweight participants at time of injury as obese Class 1 one-year post-injury. Univariate models found BMI and tobacco smoking at time of injury were significant predictors of higher BMI scores 1-year post-TBI. Multivariable models found BMI at time of injury and motor functioning, were significant predictors. Preinjury BMI, tobacco smoking and PTSD symptom severity predicted change in weight category. CONCLUSION: While obesity among service members and Veterans post-TBI is below national averages, trends in weight gain between time of injury and 1-year follow-up were observed. Implications for health promotion and chronic disease management efforts with regards to rehabilitation for injured military are discussed. List of Abbreviations: BMI, Body mass index; BRFSS, Behavioural Risk Factor Surveillance; GCS, Glasgow Coma Scale; FIM, Functional Independence Measure; NIDILRR, National Institute on Independent Living and Rehabilitation Research; PCL-C, PTSD checklist-civilian; PSTD, Post-traumatic stress disorder; VA, Veterans Affairs; VA PRC, Veterans Affairs Polytrauma Rehabilitation; VA TBIMS, Veterans Affairs TBI Model Systems.

Utility of the Neurobehavioral Symptom Inventory As an Outcome Measure: A VA TBI Model Systems Study.

OBJECTIVE: To examine the utility of the Neurobehavioral Symptom Inventory (NSI)-a measure of postconcussion symptoms used within the Veterans Health Administration-as an index of rehabilitation outcome. SETTING: Veterans Administration Polytrauma Rehabilitation Centers Traumatic Brain Injury (TBI) Model Systems program. PARTICIPANTS: A total of 159 Veterans (14% with mild TBI; 86% with moderate-severe TBI). MAIN MEASURES: Disability Rating Scale; Functional Independence Measure; Glasgow Outcome Scale-Extended; NSI; Participation Assessment with Recombined Tools-Objective; Posttraumatic Stress Disorder Checklist-Civilian Version; Satisfaction With Life Scale; Supervision Rating Scale. ANALYSES: Correlations and exploratory factor analyses examined the interrelations among outcome measures. Hierarchical regression analyses were utilized to determine if the NSI predicted rehabilitation outcome measures after controlling for demographic variables, TBI severity, and time since injury. NSI reliable changes from pretreatment to 1-year follow-up were examined. Receiver operating characteristics curve analyses were conducted to evaluate the ability of changes in the NSI to predict meaningful change in functioning and employment status. RESULTS: The NSI correlated with psychological distress measures. The NSI administered prior to brain injury rehabilitation had limited predictive utility beyond satisfaction with life. A minority of patients (32%) demonstrated reliable changes on the NSI from baseline to 1-year follow-up. Changes on the NSI were not predictive of meaningful change in employment or functioning. CONCLUSION: The NSI was not useful for assessing meaningful change in a sample of mixed severity TBI patients.