The Interaction of Opiate Misuse and Marijuana Use on Behavioral Health Outcomes Using the Traumatic Brain Injury Model Systems Pain Collaborative Dataset.

OBJECTIVE: To determine if the interaction of opiate misuse and marijuana use frequency is associated with behavioral health outcomes. SETTING: Community. PARTICIPANTS: Three thousand seven hundred fifty participants enrolled in the Traumatic Brain Injury Model Systems who completed the Pain Survey and had complete opioid use and marijuana use information. DESIGN: Cross-sectional, secondary analysis from a multisite observational cohort. MAIN OUTCOME MEASURES: Clinically significant behavioral health symptoms for posttraumatic stress disorder (PTSD), depression, anxiety, and sleep quality. RESULTS: Three thousand five hundred thirty-five (94.3%) participants did not misuse opiates, 215 (5.7%) did misuse opiates (taking more opioid pain medication than prescribed and/or using nonprescription opioid pain medication); 2683 (70.5%) participants did not use marijuana, 353 (9.3%) occasionally used marijuana (less than once a week), and 714 (18.8%) regularly used marijuana (once a week or more frequently). There was a statistically significant relationship (P < .05) between the interaction of opiate misuse and marijuana use frequency and all behavioral health outcomes and several covariates (age, sex, cause of injury, severity of injury, and pain group category). Pairwise comparisons confirm that statistically significant associations on behavioral health outcomes are driven by endorsing opiate misuse and/or regular marijuana use, but occasional marijuana use was not associated. CONCLUSIONS: Higher odds of clinically significant PTSD, depression, anxiety, and poor sleep quality are present in people with traumatic brain injury (TBI) who misuse opiates and/or who use marijuana regularly. In the absence of opiate misuse, regular marijuana use had higher odds of worse behavioral health outcomes than occasional and no use. The interaction of opiate misuse and regular marijuana use yielded the highest odds. Individuals with TBI should be informed of the relationship of substance use and behavioral health outcomes and that current chronic pain may mediate the association.

Linking biomarkers with healthy lifestyle outcomes after stroke: Supplementary results of a 12-month randomized controlled trial.

BACKGROUND AND AIMS: Participation in a healthy lifestyle intervention such as the Diabetes Prevention Program Group Lifestyle Balance-adapted for stroke (GLB-CVA) may reduce stroke burden. Identifying biomarkers associated with lifestyle changes may enhance an individualized approach to stroke recovery. We investigated metabolic biomarkers related to cardiovascular and neurological function in individuals with stroke in the GLB-CVA study and healthy (non-stroke) individuals. METHODS AND RESULTS: Participants with chronic (>12 months) stroke were recruited to this wait-list randomized controlled trial if they were overweight (BMI ≥25 kg/m2). Participants were randomized to (1) the GLB-CVA program to complete 22 educational sessions addressing behavioral principals of dietary and physical activity or (2) a 6 month wait-list control (WLC). Biomarkers [Plasma irisin, vascular endothelial growth factor, lipoprotein-associated phospholipase A2 (Lp-PLA2), insulin-like growth factor 1 and brain-derived neurotrophic factor (BDNF)] were collected at baseline, 3, and 6 months. Age-matched healthy individuals were recruited for biomarker assessment. Compared to healthy adults (n = 19), participants with stroke (GLB-CVA = 24; WLC = 24) at baseline had higher tHcy levels (p < 0.001) and lower PLA2 levels (p = 0.016). No statistically significant interactions were observed for any biomarkers between the GLB-CVA and WLC or between people who achieved 5% weight loss and those who did not. CONCLUSION: Participation in a 6-month healthy lifestyle program did not result in statistically significant changes to select metabolic biomarker levels for our participants with chronic stroke. However, participants with stroke demonstrated a unique biomarker profile compared to age-matched healthy individuals.

Efficacy of the Diabetes Prevention Program Group Lifestyle Balance Program Modified for Individuals with TBI (GLB-TBI): Results from a 12-month Randomized Controlled Trial.

BACKGROUND: Obesity after traumatic brain injury (TBI) is a public health issue and no evidence-based weight loss interventions exist to meet the unique needs of individuals after TBI. PURPOSE: To (a) examine the efficacy of the Diabetes Prevention Program Group Lifestyle Balance for TBI (GLB-TBI) weight-loss intervention compared to an attention control for primary (weight-loss) and secondary health outcomes; (b) determine participant compliance with the GLB-TBI; and (c) determine if compliance is associated with improved outcomes. METHODS: Individuals with moderate to severe TBI, age 18-64 years, ≥6 months postinjury, and body mass index of ≥25 kg/m2 were randomized to a 12-month, 22-session GLB-TBI intervention or attention control condition. Weight-loss (lbs.), anthropometric, biomarkers, and patient-reported outcomes were collected at baseline, 3, 6, and 12 months. RESULTS: The GLB-TBI group (n = 27) lost 17.8 ± 41.4lbs (7.9%) over the 12-month program and the attention control group (n = 27) lost 0 ± 55.4lbs (0%). The GLB-TBI group had significant improvements in diastolic blood pressure, triglycerides, and HDL cholesterol. GLB-TBI attendance was 89.6% and weekly self-monitoring of diet and activity was 68.8%. Relative to baseline, the GLB-TBI compliant group (≥80% attendance; ≥85% self-monitoring; n = 10) had a statistically significant decrease in weight at each assessment, the noncompliant group had a significant decrease between 6 and 12 months (n = 17), with no change in weight in the attention control group (n = 27). CONCLUSIONS: Findings suggest for adults with TBI who are overweight or obese, participation in the GLB-TBI can significantly reduce weight and metabolic risk factors and increase self-reported habits for diet and exercise.

A narrative review of biopsychosocial factors which impact overweight and obesity for individuals with acquired brain injury.

Primary Objective: To discuss the biopsychosocial factors that affect being overweight or obese after acquired brain injury (ABI)Research Design: Narrative reviewMethods and Procedures: Based on the biopsychosocial model, we discuss the unique injury-specific factors that can affect bring overweight or obese among individuals with ABI including: (1) biological, (2) psychological and (3) social/ecological factors.Main Outcomes and Results: Injury-specific factors that impact being overweight or obese following ABI include endocrine dysfunction, pain, bowel and bladder incontinence, balance problems and motor impairment, medications, sleep quality and fatigue, alcohol and tobacco use, psychological disorders and symptoms, cognitive changes, social support, isolation, participation, transportation, independence, and knowledge. These factors may also compound general factors impacting weight management, making it difficult for individuals with ABI to maintain a healthy lifestyle.Conclusions: It is important to recognize the biopsychosocial factors that impact weight-loss and lifestyle change after ABI so that interventions can be tailored to meet individuals' unique needs. Empirical research is needed to better understand how biopsychosocial factors interact and impact overweight/ obesity after ABI.

Healthy lifestyle after traumatic brain injury: a brief narrative.

Individuals living with traumatic brain injury (TBI) are at an increased risk for developing chronic conditions such as diabetes, heart disease, and hypertension compared to the non-injured population. Furthermore, TBI-specific challenges such as physical limitations, pain, mood, and impaired cognition make it difficult to live a healthy lifestyle. Key health behaviors that contribute to overall health and well-being after TBI include physical activity and healthy eating, sleep, participation, eliminating substance abuse, and managing stress. The objectives of this narrative are to (1) describe the key components of a healthy lifestyle for individuals with a TBI, (2) identify the challenges that individuals with TBI face when attempting to establish these health behaviors, and (3) discuss approaches and supports to achieve these health behaviors after TBI, including the role of self-management.

Physical activity intensity of patient's with traumatic brain injury during inpatient rehabilitation.

OBJECTIVE: Use actigraphy to (1) describe the intensity of physical activity completed by patients with traumatic brain injury (TBI) during inpatient rehabilitation, and (2) examine the association between physical activity intensity and demographic, injury, and programmatic characteristics. DESIGN: Observational. METHOD: Fifty individuals with TBI undergoing inpatient rehabilitation wore accelerometers for an average of 8.7 ± 1.8 days to capture physical activity intensity that was summarized using activity counts (ACs). Intensity of activity was described for categories of the participant's day including physical and occupational therapy, non-active therapy, recreation, and sleep. Descriptive statistics, Pearson's correlations, and general linear regression were computed. RESULTS: Participants average physical activity intensity was considered "inactive" during physical (M = 242.7.7 ± 105.2 AC/min) and occupational therapy (M = 244 ± 105), non-active therapy (M = 142.2 ± 74.1), and recreation (M = 112.8 ± 59.5), and "sedentary" during sleep (M = 26.7 ± 14.8). Significant positive associations were identified between physical activity intensity and categories of the participant's day suggesting that participants who complete more intense activity in therapy also complete more intense activity during non-active therapy and recreation time. General linear regression indicated that age significantly predicted physical activity intensity. CONCLUSIONS: Findings demonstrate that patients with TBI undergoing inpatient rehabilitation are largely inactive or sedentary. Strategies to promote a safe increase in physical activity intensity are required if cardiovascular conditioning is to be improved during inpatient rehabilitation.

Seizure Prophylaxis Guidelines Following Traumatic Brain Injury: An Evaluation of Compliance.

OBJECTIVE: To determine degree of adherence to guidelines for seizure prophylaxis following traumatic brain injury (TBI). SETTING: Tertiary care level 1 trauma center and affiliated inpatient rehabilitation facility. PARTICIPANTS: A total of 173 individuals with TBI who required inpatient rehabilitation from January 1, 2007, to December 31, 2013. DESIGN: Retrospective medical record review. MAIN MEASURES: Overutilization rate of prophylactic antiepileptic drugs (AEDs); failure to stop rate of AED utilization upon admission to and during inpatient rehabilitation; and duration of overutilization. RESULTS: Of the 173 participants included, 77 were started on seizure prophylaxis at hospital presentation and 96 were not. Of the 77 participants, 11 had a posttraumatic seizure. Of the 66 remaining, 18 participants (10.4%) were continued on AEDs for more than 7 days after injury. Of these 18 participants, 12 were continued on AEDs without indication upon admission to inpatient rehabilitation. Finally, 8 of the 12 were continued on AEDs at discharge from rehabilitation, resulting in a failure to stop rate of 66.67%. CONCLUSION: Despite existing guidelines for stopping seizure prophylaxis after TBI, some patients remain on AEDs and may be inappropriately exposed to possible medication side effects. These findings highlight the importance of communication at the time of rehabilitation transfer and the need for ongoing education about AED guidelines.