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Liou-Johnson V, Merced K, Klyce DW, Agtarap S, Finn JA, Chung JS, Campbell T, Harris OA, Perrin PB. Exploring racial/ethnic disparities in rehabilitation outcomes after TBI: A veterans affairs model systems study. NeuroRehabilitation 2023; 52:451-462. [PMID: 36806517 DOI: 10.3233/nre-220225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND Almost one-third of the U.S. military population is comprised of service members and veterans (SMVs) of color. Research suggests poorer functional and psychosocial outcomes among Black and Hispanic/Latine vs. White civilians following traumatic brain injury (TBI). OBJECTIVE This study examined racial/ethnic differences in 5-year functional independence and life satisfaction trajectories among SMVs who had undergone acute rehabilitation at one of five VA TBI Model Systems (TBIMS) Polytrauma Rehabilitation Centers (PRCs). METHODS Differences in demographic and injury-related factors were assessed during acute rehabilitation among White (n = 663), Black (n = 89) and Hispanic/Latine (n = 124) groups. Functional Independence Measure (FIM) Motor, FIM Cognitive, and Satisfaction with Life Scale (SWLS) scores were collected at 1, 2, and 5 years after injury. Racial/ethnic comparisons in these outcome trajectories were made using hierarchical linear modeling. RESULTS Black SMVs were less likely than White and Hispanic/Latine SMVs to have been deployed to a combat zone; there were no other racial/ethnic differences in any demographic or injury-related variable assessed. In terms of outcomes, no racial/ethnic differences emerged in FIM Motor, FIM cognitive, or SWLS trajectories. CONCLUSION The absence of observable racial/ethnic differences in 5-year outcome trajectories after TBI among SMVs from VA TBIMS PRCs contrasts sharply with previous research identifying disparities in these same outcomes and throughout the larger VA health care system. Individuals enrolled in VA PRCs are likely homogenized on key social determinants of health that would otherwise contribute to racial/ethnic disparities in outcome trajectories.
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Affiliation(s)
- Victoria Liou-Johnson
- Polytrauma Department, VA Palo Alto Healthcare Center, Palo Alto, CA, USA.,Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Kritzia Merced
- Central Virginia Veterans Affairs Health Care System, Richmond, VA, USA
| | - Daniel W Klyce
- Central Virginia Veterans Affairs Health Care System, Richmond, VA, USA.,Department of Physical Medicine and Rehabilitation, Virginia Common wealth University, Richmond, VA, USA.,Sheltering Arms Institute, Richmond, VA, USA
| | | | - Jacob A Finn
- Rehabilitation and Extended Care, Minneapolis VA Health Care System, Minneapolis, MN, USA.,Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Joyce S Chung
- Rehabilitation Department, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Thomas Campbell
- Central Virginia Veterans Affairs Health Care System, Richmond, VA, USA
| | - Odette A Harris
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA.,Rehabilitation Department, Traumatic Brain Injury Center of Excellence, VA Palo Alto Health Care System, PaloAlto, CA, USA
| | - Paul B Perrin
- Central Virginia Veterans Affairs Health Care System, Richmond, VA, USA.,Department of Psychology, School of Data Science, University of Virginia, Charlottesville, VA, USA
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Pk Bernstein J, Milberg WP, McGlinchey RE, Fortier CB. Associations between Post-Traumatic stress disorder symptoms and automobile driving behaviors: A review of the literature. ACCIDENT; ANALYSIS AND PREVENTION 2022; 170:106648. [PMID: 35367898 PMCID: PMC9022601 DOI: 10.1016/j.aap.2022.106648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/28/2022] [Accepted: 03/25/2022] [Indexed: 06/03/2023]
Abstract
Human factors are responsible for most motor vehicle accidents that occur on the road. Recent work suggests that symptoms of posttraumatic stress disorder (PTSD) are linked to reduced driving safety, yet none have provided a comprehensive review of this small, emerging literature. The present review identified twenty-two studies reporting associations between PTSD and driving behaviors. Among these, longitudinal designs (k = 3) and studies using objective driving performance measures (e.g., simulators) (k = 2) were rare. Most studies (k = 18) relied on brief screener measures of PTSD status/symptoms or a prior chart diagnosis, while few used a standardized structured interview measure to determine PTSD status (k = 4), and only a small number of studies assessed PTSD symptom clusters (k = 7). PTSD was most frequently associated with increased rates of hostile driving behaviors (e.g., cutting off others), unintentional driving errors (e.g., lapses in attention) and negative thoughts and emotions experienced behind the wheel. Findings regarding risk of motor vehicle accident and driving-related legal issues were variable, however relatively few studies (k = 5) explored these constructs. Future directions are discussed, including the need for work focused on concurrent PTSD symptom/driving-related changes, more comprehensive PTSD and driving assessment, and consideration of the contributions of comorbid traumatic brain injury history and other neurological and psychiatric conditions on driving outcomes.
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Affiliation(s)
- John Pk Bernstein
- Translational Research Center for TBI and Stress Disorders (TRACTS) & Geriatric Research, Educational and Clinical Center (GRECC), VA Boston Healthcare System, Boston MA.
| | - William P Milberg
- Translational Research Center for TBI and Stress Disorders (TRACTS) & Geriatric Research, Educational and Clinical Center (GRECC), VA Boston Healthcare System, Boston MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Regina E McGlinchey
- Translational Research Center for TBI and Stress Disorders (TRACTS) & Geriatric Research, Educational and Clinical Center (GRECC), VA Boston Healthcare System, Boston MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Catherine B Fortier
- Translational Research Center for TBI and Stress Disorders (TRACTS) & Geriatric Research, Educational and Clinical Center (GRECC), VA Boston Healthcare System, Boston MA; Department of Psychiatry, Harvard Medical School, Boston, MA
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