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Perrin PB, Haun JN, Klyce DW, Melillo C, Nakase-Richardson R, Seel RT, Martindale-Adams J, Nichols LO, Perera RA, Xia B, Hahm B, Zuber J. Efficacy and Implementation Planning Across the Veterans Affairs Polytrauma System of Care: Protocol for the REACH Intervention for Caregivers of Veterans and Service Members With Traumatic Brain Injury. JMIR Res Protoc 2024; 13:e57692. [PMID: 39145996 PMCID: PMC11362706 DOI: 10.2196/57692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 05/22/2024] [Accepted: 06/14/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND The responsibility of care for Veterans and Service Members (V/SMs) with traumatic brain injury (TBI) often defaults to informal family caregivers. Caregiving demands considerable knowledge, skill, and support to facilitate the health and well-being of V/SMs and themselves. Persistent and common TBI caregiver issues include strain, depression, and anxiety. While evidence-based, brief interventions have been developed and implemented for family caregivers in Veteran neurodegenerative populations, few interventions have been developed, adapted, or tested to support the unique needs of caregivers of V/SMs with TBI. OBJECTIVE This study will adapt and test an evidence-based, personalized, 6-session telehealth caregiver intervention, "Resources for Enhancing All Caregivers' Health" (REACH), to meet the unique needs of caregivers of V/SMs with TBI. If successful, a community-based participatory research team will develop an implementation plan to roll out REACH TBI across the national Veterans Affairs Polytrauma System of Care. METHODS This mixed methods, crossover waitlist control clinical trial will use a Type 1 Hybrid Effectiveness-Implementation approach to adapt and then test the effects of REACH TBI on key TBI caregiver outcomes. RESULTS This study was funded by the Department of Defense in September 2023. Participant enrollment and data collection will begin in 2024. CONCLUSIONS If effective, REACH TBI will be the first evidence-based intervention for caregivers of V/SMs with TBI that can be scaled to implement across the Veterans Affairs Polytrauma System of Care and fill a notable gap in clinical services. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/57692.
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Affiliation(s)
- Paul B Perrin
- School of Data Science, University of Virginia, Charlottesville, VA, United States
- Central Virginia Veterans Affairs Health Care System, Richmond, VA, United States
| | - Jolie N Haun
- Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT, United States
- James A. Haley Veterans' Hospital, Tampa, FL, United States
| | - Daniel W Klyce
- Central Virginia Veterans Affairs Health Care System, Richmond, VA, United States
- Department of Physical Medicine & Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
- Sheltering Arms Institute, Richmond, VA, United States
| | - Christine Melillo
- Seattle-Denver Center of Innovation, Rocky Mountain Regional VA Medical Center, Aurora, VA, United States
| | - Risa Nakase-Richardson
- James A. Haley Veterans' Hospital, Tampa, FL, United States
- Division of Pulmonary and Sleep Medicine, Department of Internal Medicine, University of South Florida, Tampa, FL, United States
| | - Ronald T Seel
- Department of Physical Medicine & Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Jennifer Martindale-Adams
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
- Lt. Col. Luke Weathers, Jr. Veterans Affairs Medical Center, Memphis, TN, United States
| | - Linda O Nichols
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
- Lt. Col. Luke Weathers, Jr. Veterans Affairs Medical Center, Memphis, TN, United States
| | - Robert A Perera
- Department of Biostatistics, School of Public Health, Virginia Commonwealth University, Richmond, VA, United States
| | - Bridget Xia
- School of Data Science, University of Virginia, Charlottesville, VA, United States
- Central Virginia Veterans Affairs Health Care System, Richmond, VA, United States
| | - Bridget Hahm
- Edward Hines, Jr. VA Hospital, Hines, IL, United States
| | - Jeffrey Zuber
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
- Lt. Col. Luke Weathers, Jr. Veterans Affairs Medical Center, Memphis, TN, United States
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Zarzycki M, Seddon D, Petrovic M, Morrison V. Supporting Individuals With an Acquired Brain Injury: An Interpretative Phenomenological Study Exploring the Everyday Lives of Caregivers. QUALITATIVE HEALTH RESEARCH 2024:10497323241242046. [PMID: 38884621 DOI: 10.1177/10497323241242046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Acquired brain injury (ABI) is one of the most common causes of disability and death globally. Support from informal caregivers is critical to the well-being and quality of life of people with ABI and supports the sustainability of global health and social care systems. This study presents an in-depth qualitative analysis of the experiences of eight British informal caregivers supporting someone with ABI. Semi-structured interviews were conducted with narratives transcribed verbatim and analysed using interpretative phenomenological analysis (IPA). Three superordinate themes were generated: making sense of brain injury; being consumed by caregiving; and, the changing self. These data highlight the impact of caregiving on the caregiver's illness perceptions and sense of self. By identifying negative and positive changes in the caregiver's sense of self, and dilemmas regarding the care recipient's behaviour, we address less understood aspects of caregiver experiences. Caregiving can pose both challenges to the caregiver's sense of identity and an opportunity for self-growth. Some caregivers exhibit resilience throughout their journey, with post-traumatic growth more apparent in the later stages of caregiving. Illness perceptions shape caregiver well-being and family dynamics and indicate the need to address stigmatisation and discrimination faced by ABI survivors and caregivers. Although some caregivers acquired positive meaning and enrichment from their caregiving, previously described challenges of ABI caregiving are supported. Overall, our findings support the need for timely psychological/mental health support for caregivers, caregiver education, and the provision of short breaks from caregiving.
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Affiliation(s)
- Mikołaj Zarzycki
- Department of Psychology, Liverpool Hope University, Liverpool, UK
| | - Diane Seddon
- School of Health Sciences, College of Medicine and Health, Bangor University, Bangor, UK
| | - Milica Petrovic
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- Depression Research Centre of the German Depression Foundation, Department for Psychiatry, Psychosomatics and Psychotherapy, Goethe University, Frankfurt, Germany
| | - Val Morrison
- School of Psychology and Sports Science, College of Medicine and Health, Bangor University, Bangor, UK
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Rattray NA, Flanagan M, Mann A, Danson L, Do AN, Natividad D, Spontak K, True G. Conceptualizing care partners' burden, stress, and support for reintegrating Veterans: a mixed methods study. Front Public Health 2024; 11:1295627. [PMID: 38440161 PMCID: PMC10910616 DOI: 10.3389/fpubh.2023.1295627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/07/2023] [Indexed: 03/06/2024] Open
Abstract
Background People who support Veterans as they transition from their military service into civilian life may be at an increased risk of psychological distress. Existing studies focus primarily on paid family caregivers, but few studies include spouses and informal non-family "care partners." We sought to identify key challenges faced by care partners of Veterans with invisible injuries. Methods Semi-structured interviews were conducted with 36 individuals involved in supporting a recently separated US military Veteran enrolled in a 2-year longitudinal study. CPs completed validated measures on perceived stress, caregiving burden, quality of their relationship, life satisfaction, and flourishing. Independent t-tests were used to compare cases in these groups on caregiving burden, quality of their relationship, life satisfaction, and flourishing. Care partners were categorized as reporting high and low levels of stress. Exemplar cases were used to demonstrate divergences in the experiences of CPs with different levels of stress over time. Results Care partners reported shifts in self-perception that occurred from supporting a Veteran, emphasizing how they helped Veterans navigate health systems and the processes of disclosing health and personal information in civilian contexts. Exemplar cases with high and low burdens demonstrated divergent experiences in self-perception, managing multi-faceted strain, and coping with stress over time. Case studies of specific care partners illustrate how multi-faceted strain shifted over time and is affected by additional burdens from childcare, financial responsibilities, or lack of education on mental health issues. Conclusions Findings suggest the unique needs of individuals who support military Veterans with invisible injuries, highlighting variations and diachronic elements of caregiving. This sample is younger than the typical caregiver sample with implications for how best to support unpaid care partners caring for Veterans in the early to mid-period of their use of VA and civilian health services.
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Affiliation(s)
- Nicholas A. Rattray
- VA Health Services Research and Development Center for Health Information and Communication, Roudebush Veteran Affairs Medical Center, Indianapolis, IN, United States
- Regenstrief Institute, Inc., Indianapolis, IN, United States
- Department of General Internal Medicine and Geriatrics, Indiana School of Medicine, Indianapolis, IN, United States
| | - Mindy Flanagan
- VA Health Services Research and Development Center for Health Information and Communication, Roudebush Veteran Affairs Medical Center, Indianapolis, IN, United States
| | - Allison Mann
- VA Health Services Research and Development Center for Health Information and Communication, Roudebush Veteran Affairs Medical Center, Indianapolis, IN, United States
- Department of Psychological Services, University of Indianapolis, Indianapolis, IN, United States
| | - Leah Danson
- VA Health Services Research and Development Center for Health Information and Communication, Roudebush Veteran Affairs Medical Center, Indianapolis, IN, United States
- Department of Psychological Services, University of Indianapolis, Indianapolis, IN, United States
| | - Ai-Nghia Do
- VA Health Services Research and Development Center for Health Information and Communication, Roudebush Veteran Affairs Medical Center, Indianapolis, IN, United States
| | - Diana Natividad
- VA Health Services Research and Development Center for Health Information and Communication, Roudebush Veteran Affairs Medical Center, Indianapolis, IN, United States
| | - Katrina Spontak
- VA Health Services Research and Development Center for Health Information and Communication, Roudebush Veteran Affairs Medical Center, Indianapolis, IN, United States
- Department of Psychological Services, University of Indianapolis, Indianapolis, IN, United States
| | - Gala True
- South Central Mental Illness Research, Education, and Clinical Center, Southeast Louisiana Veterans Health Care System, New Orleans, LA, United States
- Section of Community and Population Medicine, Louisiana State University School of Medicine, New Orleans, LA, United States
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Brickell TA, Wright MM, Sullivan JK, Varbedian NV, Tippett CE, Byrd AM, French LM, Lange RT. Health outcomes before and during the COVID-19 pandemic in caregivers of service members and veterans with traumatic brain injury. Qual Life Res 2023; 32:3463-3474. [PMID: 37572244 DOI: 10.1007/s11136-023-03491-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 08/14/2023]
Abstract
PURPOSE To examine change in health-related quality of life (HRQOL) during the COVID-19 pandemic in caregivers of service members/veterans (SMVs) with traumatic brain injury (TBI), by comparing HRQOL during the first year of the pandemic to HRQOL 12 months pre-pandemic. METHODS Caregivers (N = 246) were classified into three COVID-19 Pandemic Impact groups based on impact ratings of the pandemic on HRQOL: No Impact (n = 50), Mild Impact (n = 117), and Moderate-Severe Impact (n = 79). Caregivers completed 19 measures across physical, social, caregiving, and economic HRQOL domains, and a measure of SMV Adjustment. T-scores were used to determine individual symptom trajectories for each measure as follows: Asymptomatic (pre + during < 60 T); Developed (pre < 60 + during ≥ 60 T); Improved (pre ≥ 60 T + during < 60 T); and Persistent (pre + during ≥ 60 T). RESULTS Using ANOVA, during the pandemic, the Moderate-Severe Impact group reported worse scores on 19 measures (d = 0.41-0.89) compared to the No Impact group and 18 measures (d = 0.31-0.62) compared to the Mild Impact group (d = 0.31-0.38). The Mild Impact group reported worse scores on two measures compared to the No Impact group (d = 0.42-0.43). Using the entire sample, the majority of HRQOL measures were classified as Asymptomatic (47.2-94.7%), followed by Persistent (2.4-27.2%). Few were classified as Developed (0.4-12.6%) or Improved (2.4-13.8%). Using repeated measures ANOVA, no meaningful effects sizes were found for mean scores on all measures completed pre-pandemic compared to during the pandemic (d ≤ 0.17). CONCLUSION The vast majority of caregivers reported stability in HRQOL pre-pandemic compared to during the pandemic. The COVID-19 pandemic was not associated with a high prevalence of decline in caregiver HRQOL.
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Affiliation(s)
- Tracey A Brickell
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA.
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA.
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
- General Dynamics Information Technology, Silver Spring, MD, USA.
| | - Megan M Wright
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Ciconix, Annapolis, MD, USA
| | - Jamie K Sullivan
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- General Dynamics Information Technology, Silver Spring, MD, USA
| | - Nicole V Varbedian
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Ciconix, Annapolis, MD, USA
| | - Corie E Tippett
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Ciconix, Annapolis, MD, USA
| | - Anice M Byrd
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Ciconix, Annapolis, MD, USA
- Traumatic Brain Injury Center of Excellence, Naval Medical Center San Diego, San Diego, CA, USA
| | - Louis M French
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Rael T Lange
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- General Dynamics Information Technology, Silver Spring, MD, USA
- University of British Columbia, Vancouver, BC, Canada
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Duong A, Roberts L, Cramm H, Evans MB, Mayhew E, Latimer-Cheung AE, Aiken A, Shirazipour CH. I AM FAMILY: Understanding the adapted sport experiences of family members of military personnel with physical and psychological illnesses and injuries through the lens of the Invictus Games. PSYCHOLOGY OF SPORT AND EXERCISE 2023; 68:102457. [PMID: 37665901 DOI: 10.1016/j.psychsport.2023.102457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 04/28/2023] [Accepted: 05/03/2023] [Indexed: 09/06/2023]
Abstract
Family are influential actors in adapted sport participation. However, little is known about their experiences with adapted sport. The current study sought to explore the experiences of families in adapted sport through the context of the Invictus Games, an international adapted sport competition for military personnel with physical and psychological illnesses and injuries that is unique in its inclusion of family programming. Family members (n = 21; partners, parents, siblings, and children) of Invictus Games Toronto 2017 competitors participated in semi-structured interviews. Data were analyzed using reflexive thematic analysis. Three themes were identified: recognition of family experiences during service and after onset of disability; creating a sense of belonging; and improving family knowledge and perceptions. This study provides insight regarding how adapted sport events can support the well-being of both individuals with illnesses and injuries and their families.
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Affiliation(s)
- Amber Duong
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, USA; School of Medicine, University of California Irvine, Irvine, USA
| | - Lauren Roberts
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Heidi Cramm
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - M Blair Evans
- Department of Psychology, Western University, London, Canada
| | - Emily Mayhew
- Department of Bioengineering, Imperial College London, London, UK
| | | | - Alice Aiken
- School of Physiotherapy, Dalhousie University, Halifax, Canada
| | - Celina H Shirazipour
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, USA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA.
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Is Traumatic Brain Injury Severity in Service Members and Veterans Related to Health-Related Quality of Life in Their Caregivers? J Head Trauma Rehabil 2022; 37:338-349. [PMID: 35862894 DOI: 10.1097/htr.0000000000000802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To examine the relationship between service member/veteran (SM/V) traumatic brain injury (TBI) severity with caregiver health-related quality of life (HRQOL). SETTING Military treatment facility. PARTICIPANTS Caregivers (N = 316) of SM/Vs following a TBI divided into 2 groups based on SM/V TBI severity: (1) caregivers of SM/Vs following an uncomplicated mild TBI (UnMTBI Caregiver group, n = 246), and (2) caregivers of SM//Vs following a complicated mild, moderate, severe, or penetrating TBI (STBI Caregiver group, n = 70). The STBI Caregiver group was further divided into 2 subgroups: Parent (n = 21) versus Intimate Partner (n = 49). The UnMTBI Caregiver group consisted of intimate partners. DESIGN Prospective cohort. MAIN MEASURES Caregivers completed 15 HRQOL measures. RESULTS Using analysis of variance and chi-square analysis, the UnMTBI Caregiver group reported worse scores on 12 HRQOL measures and more clinically elevated scores for 6 of 15 comparisons than the STBI Caregiver group. The UnMTBI Caregiver group also reported worse scores on 10 HRQOL measures than intimate partners in the STBI Caregiver group and 5 measures than parents in the STBI Caregiver group. Parents reported worse scores on 3 measures than intimate partners in the STBI Caregiver group. The UnMTBI Caregiver group reported more clinically elevated scores for 7 of 15 comparisons than intimate partners in the STBI Caregiver group. CONCLUSION Intimate partner caregivers of an SM/V following a remote uncomplicated MTBI reported worse HRQOL than intimate partners and parent caregivers of an SM/V following a more severe TBI, mostly likely due to SM/V physical and mental health comorbidities. Interventions that focus on the SM/V's TBI and other comorbidities, the caregiver's behavioral health problems, and the relationship and family factors that interact with each other will likely have the most success in improving individual and family outcomes for military families.
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Abstract
OBJECTIVE To describe the self-reported needs of family caregivers of service members and veterans (SMVs) who sustained a traumatic brain injury (TBI) and to identify predictors of the unmet family caregiver needs. SETTING Five Department of Veterans Affairs (VA) Polytrauma Rehabilitation Centers (PRCs). PARTICIPANTS Family caregivers of SMVs enrolled in the VA PRC TBI Model Systems (TBIMS) national database who were within their first 5 years post-TBI (n = 427). DESIGN Observational study. MAIN OUTCOME MEASURE The Family Needs Questionnaire-Revised (FNQ-R) was completed by each SMV's designated caregiver. ANALYSES Descriptive analyses were conducted on the FNQ-R responses at the item, domain, and total score levels. Unadjusted univariable and adjusted multivariable regression models were fitted to identify predictors of total unmet needs and unmet family need domains. RESULTS FNQ-R item-level and domain-level descriptive results indicated that health information was the most frequently met need domain. In contrast, emotional and instrumental support domains were the least often met. On average, family caregivers reported that 59.2% of the 37 FNQ-R needs were met at the time of the follow-up assessment. Regression models indicated that both the number of SMV-perceived environmental barriers and whether the SMV received mental health treatment within the past year predicted the number of unmet FNQ-R needs. SMV-reported environmental barriers predicted increased unmet needs in all 6 family caregiver domains, and SMV mental health treatment in the past year predicted more unmet family caregiver emotional support, community support, and professional support needs. CONCLUSIONS The current findings can be used to inform policy and programming for VA and Department of Defense to proactively address the specific needs of families and caregivers experienced in the first 5 years post-TBI.
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Brickell TA, French LM, Wright MM, Lange RT. Aggression in Military Members With Mild Traumatic Brain Injury and Post-Traumatic Stress Disorder Is Associated With Intimate Partner Health-Related Quality of Life. Womens Health Issues 2022; 32:526-533. [PMID: 35643836 DOI: 10.1016/j.whi.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 02/08/2022] [Accepted: 04/11/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE We aimed to examine the relationship between service member/veteran (SMV) aggression and health-related quality of life (HRQOL) in their intimate partners. METHODS This prospective cohort study included 201 female intimate partner caregivers of post-9/11 male SMVs with a diagnosis of uncomplicated mild traumatic brain injury and post-traumatic stress disorder from a military treatment facility. Caregivers completed 17 HRQOL measures and rated the level the SMV experiences problems with verbal or physical expressions of irritability, anger, or aggression on the Mayo-Portland Adaptability Inventory, 4th edition. Caregivers were classified into three SMV Aggression groups: i) none or very mild (n = 53); ii) mild (n = 47); and iii) moderate or severe (n = 101). HRQOL scores were classified as clinically elevated using a cutoff of 60T or higher. RESULTS Using χ2 analysis, the moderate or severe group had a significantly higher proportion of clinically elevated scores on 15 HRQOL measures compared with the none or very mild group, and six measures compared with the mild group. The mild group had higher scores on two measures compared with the none or very mild group. Using analysis of covariance (and controlling for caregiver strain), the moderate or severe group had significantly higher scores on 11 HRQOL measures compared with the none or very mild group, and two measures compared with the mild group. The mild group had higher scores on five measures compared with the none or very mild group. CONCLUSIONS Many caregivers who report moderate to severe SMV aggression after a traumatic brain injury, report poor HRQOL beyond the strain of care provision. Traumatic brain injury and post-traumatic stress disorder programs should screen for and treat SMV aggression, and attend to the health needs of their caregivers.
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Affiliation(s)
- Tracey A Brickell
- Department of Research, Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland; Department of Research, National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland; F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Department of Research, General Dynamics Information Technology, Silver Spring, Maryland.
| | - Louis M French
- Department of Research, Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland; Department of Research, National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland; F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Megan M Wright
- Department of Research, Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland; Department of Research, National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland; Department of Research, General Dynamics Information Technology, Silver Spring, Maryland
| | - Rael T Lange
- Department of Research, Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland; Department of Research, National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland; Department of Research, General Dynamics Information Technology, Silver Spring, Maryland; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Brickell TA, Wright MM, Ferdosi H, French LM, Lange RT. Pain interference and health-related quality of life in caregivers of service members and veterans with traumatic brain injury and mental health comorbidity. Qual Life Res 2022; 31:3031-3039. [PMID: 35594013 DOI: 10.1007/s11136-022-03153-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To examine (1) the relationship between caregiver pain interference with caregiver health-related quality of life (HRQOL), caregiver age, and service member/veteran (SMV) functional ability, and (2) change in caregiver pain interference longitudinally over 5 years. METHOD Participants were 347 caregivers of SMVs diagnosed with traumatic brain injury (TBI). Caregivers completed the SF-12v2 Health Survey Bodily Pain scale at an initial baseline evaluation and up to four annual follow-up evaluations. Caregivers were divided into three pain interference groups: High Pain Interference (n = 104), Neutral Pain Interference (n = 117), and Low Pain Interference (n = 126). Caregivers also completed 15 HRQOL measures and a measure of SMV functional ability. RESULTS The High Pain Interference group reported more clinically elevated scores on 13 measures compared to the Low Pain Interference group, and seven measures compared to the Neutral Pain Interference group. The Neutral Pain Interference group had more clinically elevated scores on three measures compared to the Low Pain Interference group. The High and Neutral Pain Interference groups were older than the Low Pain Interference group. Parent caregivers were older than intimate partner/sibling caregivers, but did not report worse pain interference. Caregiver age, and measures of Fatigue, Strain, Perceived Rejection, and Economic QOL were the strongest predictors of pain interference (p < .001), accounting for 28.2% of the variance. There was minimal change in Bodily Pain scores over five years. The interaction of time and age was not significant (X2 = 2.7, p = .61). CONCLUSION It is important to examine pain in the context of HRQOL in caregivers, regardless of age.
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Affiliation(s)
- Tracey A Brickell
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA. .,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA. .,Uniformed Services University of the Health Sciences, Bethesda, MD, USA. .,General Dynamics Information Technology, Silver Spring, MD, USA.
| | - Megan M Wright
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA.,General Dynamics Information Technology, Silver Spring, MD, USA
| | - Hamid Ferdosi
- General Dynamics Information Technology, Silver Spring, MD, USA.,Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA.,The George Washington University, Washington, DC, USA
| | - Louis M French
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA.,Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Rael T Lange
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA.,General Dynamics Information Technology, Silver Spring, MD, USA.,University of British Columbia, Vancouver, BC, Canada
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10
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Borgen IMH, Hauger SL, Forslund MV, Kleffelgård I, Brunborg C, Andelic N, Sveen U, Søberg HL, Sigurdardottir S, Røe C, Løvstad M. Goal Attainment in an Individually Tailored and Home-Based Intervention in the Chronic Phase after Traumatic Brain Injury. J Clin Med 2022; 11:958. [PMID: 35207231 PMCID: PMC8875324 DOI: 10.3390/jcm11040958] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/04/2022] [Accepted: 02/10/2022] [Indexed: 12/04/2022] Open
Abstract
Traumatic brain injury (TBI) is a heterogeneous condition with long-term consequences for individuals and families. Goal-oriented rehabilitation is often applied, but there is scarce knowledge regarding types of goals and goal attainment. This study describes goal attainment in persons in the chronic phase of TBI who have received an individualized, SMART goal-oriented and home-based intervention, compares goal attainment in different functional domains, and examines indicators of goal attainment. Goal attainment scaling (GAS) was recorded in the intervention group (n = 59) at the final session. The goal attainment was high, with 93.3% increased goal attainment across all goals at the final session. The level of goal attainment was comparable across domains (cognitive, physical/somatic, emotional, social). Gender, anxiety symptoms, self-reported executive dysfunction, and therapy expectations were indicators of goal attainment. These results indicate a potential for the high level of goal attainment in the chronic phase of TBI. Tailoring of rehabilitation to address individual needs for home-dwelling persons with TBI in the chronic phase represents an important area of future research.
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Affiliation(s)
- Ida M. H. Borgen
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (M.V.F.); (I.K.); (N.A.); (U.S.); (H.L.S.); (C.R.)
- Department of Psychology, Faculty of Social Sciences, University of Oslo, 0316 Oslo, Norway; (S.L.H.); (M.L.)
| | - Solveig L. Hauger
- Department of Psychology, Faculty of Social Sciences, University of Oslo, 0316 Oslo, Norway; (S.L.H.); (M.L.)
- Department of Research, Sunnaas Rehabilitation Hospital, 1453 Nesoddtangen, Norway
| | - Marit V. Forslund
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (M.V.F.); (I.K.); (N.A.); (U.S.); (H.L.S.); (C.R.)
| | - Ingerid Kleffelgård
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (M.V.F.); (I.K.); (N.A.); (U.S.); (H.L.S.); (C.R.)
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, 0424 Oslo, Norway;
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (M.V.F.); (I.K.); (N.A.); (U.S.); (H.L.S.); (C.R.)
- Center for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, Faculty of Medicine, University of Oslo, 0316 Oslo, Norway
| | - Unni Sveen
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (M.V.F.); (I.K.); (N.A.); (U.S.); (H.L.S.); (C.R.)
- Department for Occupational Therapy Prosthetics and Orthotics, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway
| | - Helene L. Søberg
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (M.V.F.); (I.K.); (N.A.); (U.S.); (H.L.S.); (C.R.)
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway
| | | | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (M.V.F.); (I.K.); (N.A.); (U.S.); (H.L.S.); (C.R.)
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0316 Oslo, Norway
| | - Marianne Løvstad
- Department of Psychology, Faculty of Social Sciences, University of Oslo, 0316 Oslo, Norway; (S.L.H.); (M.L.)
- Department of Research, Sunnaas Rehabilitation Hospital, 1453 Nesoddtangen, Norway
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Oyesanya TO, Harris G, Yang Q, Byom L, Cary MP, Zhao AT, Bettger JP. Inpatient rehabilitation facility discharge destination among younger adults with traumatic brain injury: differences by race and ethnicity. Brain Inj 2021; 35:661-674. [PMID: 33779428 PMCID: PMC8122065 DOI: 10.1080/02699052.2021.1895317] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 02/21/2021] [Accepted: 02/22/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE : To determine the association of race and ethnicity with discharge destination among patients with traumatic brain injury (TBI) receiving inpatient rehabilitation facility (IRF) care. DESIGN Secondary analysis using Uniform Data System for Medical Rehabilitation data. METHODS : Patients (N = 99,614) diagnosed with TBI, age 18-64, admitted for IRF care between 2002 and 2018. Logistic regression was used to analyze data. OUTCOME : Discharge destination (home/community vs. subacute settings). RESULTS : Most younger adults (age 18-64) with TBI were discharged home (89.24%) after IRF care vs. subacute (10.76%). Of those discharged home, 63.16% were white, 10.42% Black, 8.94% Hispanic/Latino, and 6.72% other races/ethnicities. After adjusting for covariates, patients who were Hispanic/Latino [OR = 1.26; 95% CI: 1.15, 1.37] and other race/ethnicities [OR = 1.10; 95% CI: 1.00, 1.21] (vs. White) had higher odds of discharge home vs. subacute. There was no difference in discharge destination for Black patients (vs. white). Predictors of discharge destination for groups stratified by race/ethnicity varied. CONCLUSIONS : Younger patients with TBI who were Hispanic/Latino or other races/ethnicities (vs. white) were more likely to go home vs. subacute. Findings can be used to inform IRF planning, resource allocation, and transitional care planning.
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Affiliation(s)
| | | | | | - Lindsey Byom
- University of North Carolina-Chapel Hill, Department of Allied Health Sciences
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12
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Carlozzi NE, Kallen MA, Brickell TA, Lange RT, Boileau NR, Tulsky D, Hanks RA, Massengale JP, Nakase-Richardson R, Ianni PA, Miner JA, French LM, Sander AM. Measuring emotional suppression in caregivers of adults with traumatic brain injury. Rehabil Psychol 2020; 65:455-470. [PMID: 31580109 PMCID: PMC7117989 DOI: 10.1037/rep0000291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Caregivers of individuals with traumatic brain injury (TBI) often feel pressure to maintain the appearance that they are emotionally well adjusted, despite feelings to the contrary. Because there are currently no measures examining this construct, this article focuses on the development of a new measure that is specific to caregivers of people with TBI. DESIGN A total of 533 caregivers of civilians with TBI (n = 218) or service members/veterans (SMVs) with TBI (n = 315) completed 43 emotional suppression items, as well as other patient-reported outcomes and an estimate of the functional ability of the person with TBI. RESULTS Exploratory and confirmatory factor analyses supported the retention of 25 items. Graded response model (GRM) analyses and differential item functioning (DIF) studies supported the retention of 21 items in the final measure. Expert review and GRM calibration data were used to develop a 6-item static short form (SF) and program a computer adaptive test (CAT). Internal consistency was excellent for both the CAT and SF (reliabilities ≥ 0.91); 3-week test-retest stability was good (all intraclass correlations ≥ 0.89). Convergent validity was supported by moderate associations between TBI-CareQOL Emotional Suppression and related measures (rs from 0.47 to 0.59); discriminant validity was supported by small correlations between Emotional Suppression and positive aspects of caregiving and physical health (rs from 0.14 to 0.28). Known-groups validity was also supported. CONCLUSIONS The new TBI-CareQOL Emotional Suppression CAT and 6-item short form is the first self-report measure of this construct in this population. Our findings suggest this new measure has strong psychometric properties. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Noelle E. Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Michael A. Kallen
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Tracey A. Brickell
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD
- Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Rael T. Lange
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicholas R. Boileau
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - David Tulsky
- Center for Health Assessment Research and Translation, and Departments of Physical Therapy and Psychological Brain Sciences, University of Delaware, Newark, DE
| | - Robin A. Hanks
- Department of Psychology and Neuropsychology, Rehabilitation Institute of Michigan, Detroit, MI
- Department of Physical Medicine and Rehabilitation, Wayne State University, Detroit, MI
| | | | - Risa Nakase-Richardson
- MHBS, James A. Haley Veterans’ Hospital, Tampa, FL
- Defense and Veterans Brain Injury Center, James A. Haley Veterans’ Hospital, Tampa, FL
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Phillip A. Ianni
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, MI
| | - Jennifer A. Miner
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Louis M. French
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD
- Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Angelle M. Sander
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine/Harris Health System, Houston, TX
- Brain Injury Research Center, TIRR Memorial Hermann, Houston, TX
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Brickell TA, French LM, Lippa SM, Wright MM, Lange RT. Caring for a service member or Veteran following traumatic brain injury influences caregiver mental health. MILITARY PSYCHOLOGY 2020; 32:341-351. [PMID: 38536254 PMCID: PMC10013226 DOI: 10.1080/08995605.2020.1754149] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 04/06/2020] [Indexed: 10/23/2022]
Abstract
This study examined factors related to poor mental health in caregivers assisting service members and Veterans (SMV) following traumatic brain injury (TBI). Participants were 201 military caregivers (96.0% female; Age: M = 39.2 years, SD = 10.2) of SMVs following a mild, moderate, severe, or penetrating TBI. The SF-36v2 Health Survey, Caregiver Appraisal Scale, Mayo-Portland Adaptability Inventory-4, and Caregiver Questionnaire were completed. Caregivers were divided into two mental health groups: Poor Mental Health (n = 108) and Good Mental Health (n = 93). Factors related to poor caregiver mental health were worse general health and stress appraisal, less personal time, unmet needs, and greater financial and employment strain. Factors also related to poor caregiver mental health included assisting a SMV who had sustained a mild TBI, did not have significant hospital care, had post-traumatic stress disorder, depression, and/or anxiety, was experiencing greater functional disability, and was experiencing physical expressions of irritability, anger, and aggression (all p's<.05; d =.29 to d =.64; OR = 1.911 to OR = 4.984). For many military caregivers, poor mental health may be related to the SMVs ongoing comorbid mental health symptoms and less so neurological impairment related to the brain injury. TBI treatment programs require a holistic approach that addresses the behavioral health concerns of both SMVs and their caregivers.
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Affiliation(s)
- Tracey A. Brickell
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, Maryland
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
- Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Louis M. French
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, Maryland
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
- Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Sara M. Lippa
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, Maryland
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Megan M. Wright
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, Maryland
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Rael T. Lange
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, Maryland
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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14
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Wang S, Cheung DSK, Leung AYM, Davidson PM. Factors associated with caregiving appraisal of informal caregivers: A systematic review. J Clin Nurs 2020; 29:3201-3221. [DOI: 10.1111/jocn.15394] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 05/23/2020] [Accepted: 06/21/2020] [Indexed: 12/25/2022]
Affiliation(s)
- Shanshan Wang
- Center for Gerontological Nursing School of Nursing The Hong Kong Polytechnic University Hong Kong China
- School of Nursing and Health Zhengzhou University Zhengzhou China
| | - Daphne Sze Ki Cheung
- Center for Gerontological Nursing School of Nursing The Hong Kong Polytechnic University Hong Kong China
| | - Angela Yee Man Leung
- Center for Gerontological Nursing School of Nursing The Hong Kong Polytechnic University Hong Kong China
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15
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Brickell TA, Wright MM, Lippa SM, Sullivan JK, Bailie JM, French LM, Lange RT. Resilience is associated with health-related quality of life in caregivers of service members and veterans following traumatic brain injury. Qual Life Res 2020; 29:2781-2792. [DOI: 10.1007/s11136-020-02529-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2020] [Indexed: 11/30/2022]
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Brickell TA, Cotner BA, French LM, Carlozzi NE, O’Connor DR, Nakase-Richardson R, Lange RT. Severity of military traumatic brain injury influences caregiver health-related quality of life. Rehabil Psychol 2020; 65:2020-04060-001. [PMID: 31971431 PMCID: PMC7375900 DOI: 10.1037/rep0000306] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE/OBJECTIVE To examine the influence of traumatic brain injury (TBI) severity on the health-related quality of life of caregivers providing care to service members/veterans (SMV) following a TBI. Research Method/Design: Thirty caregivers (90.0% female; 70.0% spouse; age: M = 39.5 years, SD = 10.7) of SMVs who sustained a mild, moderate, severe, or penetrating TBI were recruited from Walter Reed National Military Medical Center and via community outreach to participate in one of six focus groups. Caregivers were classified into 3 TBI severity/caregiver groups: (a) moderate/severe/penetrating TBI caregiver group (n = 11); (b) mild TBI caregiver group (n = 10); and (c) equivocal TBI caregiver group (n = 9). Thematic analysis using a constant comparative approach was conducted with qualitative analysis software to identify common themes across the 3 severity/caregiver groups. RESULTS Eleven themes emerged: no time for self/needs last (83.3%), poor physical health (80.0%), increased stress/anxiety (76.7%), social isolation/loneliness (66.7%), lack of access to services (50.0%), impact on family life (46.7%), sleep issues (46.7%), finances/employment (36.7%), depression (30.0%), exhaustion (30.0%), and anger (16.7%). Exploratory pairwise comparisons revealed a higher proportion of the moderate/severe/penetrating TBI group endorsed 7 of the 11 themes (no time for self/needs last, increased stress/anxiety, impact on family life, sleep issues, finances/employment, exhaustion, anger, and increased stress/anxiety) compared with the other 2 groups. CONCLUSIONS/IMPLICATIONS It is important that caregivers of SMVs receive long-term support in their caregiving and parenting roles. Further work is required to understand the challenges caregivers experience in accessing services they need and how to effectively meet their needs across the care continuum. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Tracey A. Brickell
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Bridget A. Cotner
- Rehabilitation Outcomes Research Section, Research Service, James A Haley Veterans Hospital, Tampa, Florida, USA
- Defense and Veterans Brain Injury Center, James A. Haley Veterans Hospital, Tampa, Florida, USA
| | - Louis M. French
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Noelle E. Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Danielle R. O’Connor
- Rehabilitation Outcomes Research Section, Research Service, James A Haley Veterans Hospital, Tampa, Florida, USA
- Defense and Veterans Brain Injury Center, James A. Haley Veterans Hospital, Tampa, Florida, USA
| | - Risa Nakase-Richardson
- Mental Health Behavioral Sciences, James A. Haley Veterans Hospital, Tampa, Florida, USA
- Morsani College of Medicine, Department of Internal Medicine, Division of Pulmonary and Sleep Medicine, University of South Florida, Tampa, Florida USA
| | - Rael T. Lange
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA
- University of British Columbia, Vancouver, British Columbia, Canada
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Rylee TL, Sarkar S, Reed SC, Rafizadeh E, Bell JF. Unmet Needs for Information and Support Among Military Caregivers. Mil Med 2019; 184:e922-e928. [PMID: 31067305 DOI: 10.1093/milmed/usz109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/03/2019] [Accepted: 04/17/2019] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION In the United States, there are 5.5 million military caregivers, defined as family members, friends, or other acquaintances who provide essential care and support to current or former military service members. This study describes the prevalence and predictors of unmet information and support needs in this unique group of caregivers. Until recently, little research has focused on military caregivers. In 2014, a comprehensive RAND report underscored the specific challenges experienced by military caregivers including greater physical, financial, and emotional strain when compared with civilian caregivers. Of note, compared to civilian caregivers, military caregivers provide care and support for care recipients who are more likely to have complex illness. While this recent research improved our understanding of the increased burden associated with military caregiving, it also identified gaps for future work, including the need for additional studies to better understand unmet information and support needs to inform future interventions. The current study was designed to address this gap. MATERIALS AND METHODS We examined data collected in the Caregiving in the U.S. Survey, a cross-sectional online survey fielded in 2014, by the National Alliance for Caregiving and the American Association of Retired Persons (AARP) for primary caregivers who had been in the role for at least six months. Four outcomes representing unmet caregiver needs were examined measuring caregiver report of needing more help or information to: (1) keep the care recipient safe at home; (2) manage challenging behaviors such as wandering; (3) manage their own emotional and physical stress; and (4) make end-of-life decisions. Survey-weighted logistic regression was used to test associations between military caregiver status (military/civilian) and unmet needs while controlling for key socio-demographic, caregiving and care recipient health variables, with nationally generalizable results. RESULTS Compared to their civilian counterparts, military caregivers had significantly higher odds of reporting need for information or support to make end-of-life decisions (OR = 2.22; 95% CI: 1.24, 3.97; p = 0.01) and marginally higher odds of reporting need for more information or support to manage physical and emotional stress (OR = 1.64; 95% CI: 0.93, 2.88; p = 0.08). In contrast, military caregivers had significantly lower odds of reporting need for more information or support to keep the care recipient safe compared to civilian caregivers (OR = 0.54; 95% CI: 0.30, 0.95; p = 0.03). Reports of unmet needs related to managing challenging behaviors were similar between military and civilian caregivers. CONCLUSIONS Needs for information and support differ for civilian and military caregivers and may reflect direct or indirect impacts on caregivers arising from differences in TRICARE and Veterans Affairs health insurance coverage and related benefits, services and systems or access to resources that address the unique needs of military populations. Future research is needed to better understand the unique concerns of military caregivers and inform interventions that support end-of-life care decision-making for military service members and their caregivers.
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Affiliation(s)
- Tina L Rylee
- University of California, Davis, Betty Irene Moore School of Nursing, 2450 48th Street, Suite 2600, Sacramento, CA
| | - Sayantani Sarkar
- University of California, Davis, Betty Irene Moore School of Nursing, 2450 48th Street, Suite 2600, Sacramento, CA
| | - Sarah C Reed
- University of California, Davis, Betty Irene Moore School of Nursing, 2450 48th Street, Suite 2600, Sacramento, CA
| | - Elbina Rafizadeh
- University of California, Davis, Betty Irene Moore School of Nursing, 2450 48th Street, Suite 2600, Sacramento, CA
| | - Janice F Bell
- University of California, Davis, Betty Irene Moore School of Nursing, 2450 48th Street, Suite 2600, Sacramento, CA
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Dreer LE, Cox MK, McBrayer A, Neumeier WH, Herman C, Malone LA. Resilience Among Caregivers of Injured Service Members: Finding the Strengths in Caregiving. Arch Phys Med Rehabil 2019; 100:S76-S84. [PMID: 30684488 DOI: 10.1016/j.apmr.2018.12.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 12/07/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the relationships between caregiver resilience and a comprehensive set of sociodemographic and health-related quality of life (HRQOL) predictors among both caregivers and injured service members. DESIGN Cross-sectional analysis of an observational cohort. SETTING Community dwelling. PARTICIPANTS Caregivers (n=87) who provide instrumental or emotional support to injured service members (n=73)(N=160). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE The Connor-Davidson Resilience Scale 25-item version. RESULTS Higher caregiver resilience scores were related to lower depressive symptom severity, greater health responsibility, physical activity, nutrition, spiritual growth, interpersonal relations, stress management, and problem-solving orientation. A multivariable regression model showed that spiritual growth and aspects of problem-solving orientation were significantly related to resilience. CONCLUSIONS Results highlight the relationships between resilience and spirituality, problem-solving orientation, and aspects of HRQOL among caregivers of injured service members. These findings have important implications for caregiver behavioral health programs designed to promote resilience and draw upon caregiver strengths when taking on a caregiver role. Approaches that include a more integrative medicine or strengths-based emphasis may be particularly beneficial when working with families of injured military.
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Affiliation(s)
- Laura E Dreer
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Alabama, the United States.
| | - Molly K Cox
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Alabama, the United States
| | - Alexandra McBrayer
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Alabama, the United States
| | - William H Neumeier
- School of Health Professions, UAB-Lakeshore Research Collaborative, University of Alabama at Birmingham, Birmingham, Alabama, the United States
| | - Cassandra Herman
- School of Health Professions, UAB-Lakeshore Research Collaborative, University of Alabama at Birmingham, Birmingham, Alabama, the United States; Department of Health Behavior, University of Alabama at Birmingham, Birmingham, Alabama, the United States
| | - Laurie A Malone
- School of Health Professions, UAB-Lakeshore Research Collaborative, University of Alabama at Birmingham, Birmingham, Alabama, the United States
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Niu F, Sharma A, Feng L, Ozkizilcik A, Muresanu DF, Lafuente JV, Tian ZR, Nozari A, Sharma HS. Nanowired delivery of DL-3-n-butylphthalide induces superior neuroprotection in concussive head injury. PROGRESS IN BRAIN RESEARCH 2019; 245:89-118. [DOI: 10.1016/bs.pbr.2019.03.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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