Suchergebnisse

The purpose of this study was to analyze quantitative diffusion tensor imaging measures across the spectrum of traumatic brain injury severity and evaluate their trajectories in military service members. Participants were 96 U.S. military service members and veterans who had sustained a mild traumatic brain injury [including complicated mild traumatic brain injury (n = 16) and uncomplicated mild traumatic brain injury (n = 68)], moderate-severe traumatic brain injury (n = 12), and controls (with or without orthopaedic injury, n = 39). All participants had been scanned at least twice, with some receiving up to five scans. Both whole brain voxel-wise analysis and tract-of-interest analysis were applied to assess the group differences of diffusion tensor imaging metrics, and their trajectories between time points of scans and days since injury. Linear mixed modelling was applied to evaluate cross-sectional and longitudinal diffusion tensor imaging metrics changes within and between groups using both tract-of-interest and voxel-wise analyses. Participants with moderate to severe traumatic brain injury had larger white matter disruption both in superficial subcortical and deep white matter, mainly over the anterior part of cerebrum, than those with mild traumatic brain injury, both complicated and uncomplicated, and there was no evidence of recovery over the period of follow-ups in moderate-severe traumatic brain injury, but deterioration was possible. Participants with mild traumatic brain injury had white matter microstructural changes, mainly in deep central white matter over the posterior part of cerebrum, with more spatial involvement in complicated mild traumatic brain injury than in uncomplicated mild traumatic brain injury and possible brain repair through neuroplasticity, e.g. astrocytosis with glial processes and glial scaring. Our results did not replicate 'V-shaped' trajectories in diffusion tensor imaging metrics, which were revealed in a previous study assessing the sub-acute stage of brain injury in ...

The aim of this study was to examine the relationship between plasma tau and amyloid beta-42 (Aβ42), neuropsychological functioning, and white matter integrity in U.S. military service members with (n = 155) and without (n = 42) a history of uncomplicated mild (n = 83), complicated mild (n = 26), or moderate, severe, or penetrating (n = 46) traumatic brain injury (TBI). We hypothesized that higher levels of tau and Aβ42 would be related to reduced neurocognitive performance and white matter integrity. Participants were enrolled prospectively from Walter Reed National Military Medical Center. Participants completed a blood draw, neuropsychological assessment, and diffusion tensor imaging (General Electric 3T) of the whole brain. From 20 neuropsychological test scores, five cognitive domain scores were computed. Measures of fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were generated for 18 regions of interest (ROIs). There was no relationship found between the plasma biomarkers and neurocognitive performance in any of the three TBI groups (all ps >0.05; all R(2) changes 0.15). Future investigation in larger samples of moderate, severe, and penetrating TBI are needed. Other plasma biomarkers, including phosphorylated tau, exosomal tau, and interleukin-10, may be more promising measures to use in the diagnosis, management, and treatment of TBI.

OBJECTIVE: To identify barriers and supports that caregivers of individuals with military-related traumatic brain injury (TBI) encounter when navigating the military healthcare system; this information will be used as the foundation of a new patient-reported outcome measure. SETTING: Community. PARTICIPANTS: Forty-five caregivers of service members and veterans (SMV) who sustained a medically documented mild, moderate, severe, or penetrating TBI. DESIGN: Latent content analysis. MAIN MEASURES: Nine focus group discussions of barriers and supports to navigating the military healthcare system and community resources. RESULTS: Latent content analysis indicated that caregivers discussed barriers (66%) and supports (34%) to obtaining care within the military healthcare system and the community. Caregivers most frequently discussed SMVs' interactions with healthcare, their own interactions with healthcare, family care, and community organizations. CONCLUSIONS: Caregivers confront numerous challenges while pursuing healthcare services. Although much of the discussion focused on barriers and perceived unmet needs within the military healthcare system, caregivers also recognized supports within the military healthcare system and general community. Increased attention to accessibility and quality of services, as well as reducing financial burden, can lead to improved health-related quality of life for caregivers and their SMVs.

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 METHODS/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 three 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 three 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 seven 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 to the other two 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.

OBJECTIVE: Identify biomarkers in peripheral blood that relate to chronic post-concussive and behavioural symptoms following traumatic brain injuries (TBIs) to ultimately improve clinical management. RESEARCH DESIGN: We compared military personnel with mild TBIs (mTBIs) (n = 42) to those without TBIs (n = 22) in concentrations of tau, amyloid-beta (Aβ42) and cytokines (tumour necrosis factor alpha (TNFα, interleukin (IL)-6 and −10) in neuronal-derived exosomes from the peripheral blood. We utilized nanosight technology coupled with ultra-sensitivity immunoassay methods. We also examined the impact of post-concussive and behavioural symptoms including depression and post-traumatic stress disorder (PTSD) on these neuronal-derived markers. RESULTS: We report that concentrations of exosomal tau (F(1, 62) = 10.50), Aβ42 (F(1, 61) = 5.32) and IL-10 (F(1, 59) = 4.32) were elevated in the mTBI group compared to the controls. Within the mTBI group, regression models show that post-concussive symptoms were most related to exosomal tau elevations, whereas exosomal IL-10 levels were related to PTSD symptoms. CONCLUSIONS: These findings suggest that chronic post-concussive symptoms following an mTBI relate to altered exosomal activity, and that greater tau pathology may underlie chronic post-concussive symptoms that develop following mTBIs. It also suggests that central inflammatory activity contributes to PTSD symptoms following an mTBI, providing necessary insights into the role of inflammation in chronic PTSD symptoms.

OBJECTIVE: To provide important reliability and validity data to support the use of the PROMIS Mental Health measures in caregivers of civilians or service members/veterans with traumatic brain injury (TBI). DESIGN: Patient-reported outcomes surveys administered through an electronic data collection platform. SETTING: Three TBI Model Systems rehabilitation hospitals, an academic medical center, and a military medical treatment facility. PARTICIPANTS: 560 caregivers of individuals with a documented TBI (344 civilians and 216 military) INTERVENTION: Not Applicable MAIN OUTCOME MEASURES: PROMIS Anxiety, Depression, and Anger Item Banks RESULTS: Internal consistency for all of the PROMIS Mental Health item banks was very good (all α > .86) and three-week test retest reliability was good to adequate (ranged from .65 to .85). Convergent validity and discriminant validity of the PROMIS measures was also supported. Caregivers of individuals that were low functioning had worse emotional HRQOL (as measured by the three PROMIS measures) than caregivers of high functioning individuals, supporting known groups validity. Finally, levels of distress, as measured by the PROMIS measures, were elevated for those caring for low-functioning individuals in both samples (rates ranged from 26.2% to 43.6% for caregivers of low-functioning individuals). CONCLUSIONS: Results support the reliability and validity of the PROMIS Anxiety, Depression, and Anger item banks in caregivers of civilians and service members/veterans with TBI. Ultimately, these measures can be used to provide a standardized assessment of HRQOL as it relates to mental health in these caregivers.

OBJECTIVE: To design a new measure of caregiver-specific anxiety for use in caregivers of individuals with TBI, the TBI-CareQOL Caregiver Specific-Anxiety item bank. DESIGN: Cross-sectional survey study. SETTING: Three TBI Model Systems rehabilitation hospitals, an academic medical center, and a military medical treatment facility. PARTICIPANTS: 344 caregivers of civilians with TBI and 216 caregivers of service members/veterans with TBI. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: TBI-CareQOL Caregiver-Specific Anxiety Item Bank RESULTS: The retention of 40 caregiver-specific anxiety items was supported by exploratory and confirmatory factor analyses. Graded response model (GRM) and differential item functioning analyses supported the retention of 33 items in the final measure. Expert review and GRM calibration data was used to select a 6-item static short form, and GRM calibration data was used to program the TBI-CareQOL Caregiver-Specific Anxiety computer adaptive test (CAT). CONCLUSIONS: Established, rigorous measurement development standards were used to develop the new TBI-CareQOL Caregiver-Specific Anxiety CAT and corresponding 6-item short form. This measure is the first patient-reported outcome measure (PRO) designed to assess caregiver-specific anxiety in caregivers of individuals with TBI. The measure exhibits strong psychometric properties.

OBJECTIVE: To develop a new measure of caregiver strain for use in caregivers of individuals with TBI, TBI-CareQOL Caregiver Strain. DESIGN: Qualitative data, literature reviews, and cross-sectional survey study. SETTING: Three TBI Model Systems rehabilitation hospitals, an academic medical center, and a military medical treatment facility. PARTICIPANTS: Five-hundred-sixty caregivers of civilians (n=344) or service members/veterans (SMVs) with TBI (n=216). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: TBI-CareQOL Caregiver Strain Item Bank RESULTS: Exploratory and confirmatory factor analyses, a graded response model (GRM) and differential item functioning supported the retention of 33 items in the final measure. GRM calibration data was used to inform the selection of a 6-item static short form, and to program the TBI-CareQOL Caregiver Strain computer-adaptive test (CAT). CAT simulation analyses indicated a 0.97 correlation between the CAT scores and the full item-bank. Three-week test-retest reliability was strong (r = 0.83). CONCLUSIONS: The new TBI-CareQOL Caregiver Strain CAT and corresponding 6-item short form were developed using established rigorous measurement development standards; this is the first self-reported measure developed to evaluate caregiver strain in caregivers of individuals with TBI.

OBJECTIVES: To establish the reliability and validity of the newly developed TBI-CareQOL patient reported outcomes measures in caregivers of civilians and service members/veterans (SMVs) with traumatic brain injury (TBI) so that they can be used with confidence in clinical research and practice. DESIGN: Computer-based surveys delivered through an on-line data capture platform. SETTING: Three TBI Model Systems rehabilitation hospitals, an academic medical center, and a military medical treatment facility. PARTICIPANTS: Five hundred and sixty caregivers of individuals with TBI; this included two different study samples: 344 caregivers of civilians with TBI and 216 caregivers of SMVs with TBI. INTERVENTION: Not Applicable MAIN OUTCOME MEASURES: 5 TBI-CareQOL item banks RESULTS: Reliabilities for the TBI-CareQOL measures were excellent (all Cronbach's α > .88); three-week test-retest reliability ranged from .75 to .90 across the two samples. Convergent validity was supported by moderate to high associations among the TBI-CareQOL measures and moderate correlations between the TBI-CareQOL measures and other measures of health-related quality of life (HRQOL) and caregiver burden. Discriminant validity was supported by low correlations between the TBI-CareQOL measures and less-related constructs (e.g., caregiver satisfaction). Known groups validity was supported: caregivers of individuals that were low functioning had worse HRQOL than caregivers of high functioning individuals. CONCLUSIONS: Results provide psychometric support for the new TBI-CareQOL item banks. As such, these measures fill a significant gap in the caregiver literature where sensitive patient-reported outcomes (PRO) measures that capture changes in HRQOL are needed to detect improvements for interventions designed to assist family caregivers.

OBJECTIVE: To understand the factor structure of Health-Related Quality of Life (HRQOL) specific to caregivers of people living with Traumatic Brain Injury (TBI). DESIGN: Prospective, cross-sectional data collection. SETTING: Three TBI Model Systems rehabilitation hospitals, an academic medical center, and a military medical treatment facility. PARTICIPANTS: 558 caregivers of people who have sustained a TBI (344 caregivers of civilians and 214 caregivers of service member/veterans; 85% female; 58% spouses; mean age = 46.12, SD =14.07 years) who have provided care for an average of 5.82 (SD = 5.40) years. INTERVENTIONS: Not Applicable. MAIN OUTCOMES MEASURE: The Traumatic Brain Injury Caregiver Quality of Life (TBI-CareQOL) measurement system including 10 Patient-Reported Outcomes Measurement Information System (PROMIS) item banks (Anger, Anxiety, Depression, Social Isolation, Sleep Disturbance, Fatigue, Ability to Participate in Social Roles and Activities, Satisfaction with Social Roles and Activities, Emotional Support, Informational Support) and five TBI-CareQOL banks (Feelings of Loss–Self, Feelings of Loss–Person with TBI, Feeling Trapped, Caregiver-Specific Anxiety and Caregiver Strain). RESULTS: Confirmatory Factor Analysis (CFA) model fit indices were compared for 14 empirically and five theoretically derived models. CFA results indicated that the best model fit was for a six-factor model with dimensions that included: Mental Health, Social Support, Social Participation, Social Isolation, Physical Health, and Caregiver Emotion. CONCLUSION: Results indicated a six-factor model provided the best model fit for HRQOL in caregivers of individuals with TBI. These results have utility for both research and clinical applications. Establishing the TBI-CareQOL's factor structure provides preliminary evidence of the measurement system's construct validity, helps inform the selection of measures for specific research or clinical interventions, and informs the development of composite scores.

OBJECTIVE: To develop new patient-reported outcome (PRO) measures to better understand feelings of loss in caregivers of individuals with traumatic brain injury (TBI). DESIGN: Cross-sectional survey study. SETTING: Three TBI Model Systems rehabilitation hospitals, an academic medical center, and a military medical treatment facility. PARTICIPANTS: Five-hundred-sixty caregivers of civilians with TBI (n=344) or service members/veterans (SMVs) with TBI (n=216). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: TBI-CareQOL Feelings of Loss-Self and TBI-CareQOL Feelings of Loss-Person with Traumatic Brain Injury Item banks RESULTS: While the initial exploratory and confirmatory factor analyses of the Feelings of Loss item pool (98 items) potentially supported a unidimensional set of items, further analysis indicated two different factors: Feelings of Loss-Self (43 items) and Feelings of Loss-Person with TBI (20 items). For Feelings of Loss-Self, an additional 13 items were deleted due to item-response theory based item misfit; the remaining 30 items had good overall model fit (Confirmatory Fit Index [CFI]=0.96, Tucker Lewis Index [TLI]=.96, Root Mean Squared Error [RMSEA]=.10). For Feelings of Loss-Other, 1 additional item was deleted due to an associated high correlated error modification index value; the final 19 items evidenced good overall model fit (CFI=0.97, TLI=.97, RMSEA=.095). The final item banks were developed to be administered as either a CAT or a short-form. Clinical experts approved the content of the 6-item short forms of the two measures (three-week test-retest was r=.87 for Feelings of Loss-self and r=.85 for Feelings of Loss-Person with TBI) CONCLUSIONS: The findings from this study resulted in the development of two new PROs to assess feelings of loss in caregivers of individuals with TBI; TBI-CareQOL Feelings of Loss-Self and TBI-CareQOL Feelings of Loss-Person with TBI. Good psychometric properties were established and a short-form was developed for ease of use in clinical situations. ...

OBJECTIVE: To examine the reliability and validity of the short form (SF) and computer adaptive test (CAT) versions of the Patient Reported Outcomes Measurement Information System (PROMIS) measures of social health of caregivers of civilians and service members/veterans (SMVs) with traumatic brain injury (TBI). DESIGN: Self-report questionnaires administered through an on-line data collection platform. SETTING: Hospital and community-based outreach at three TBI Model Systems rehabilitation hospitals, an academic medical center, and a military medical treatment facility PARTICIPANTS: 560 (344 civilians and 216 military) caregivers of individuals with a documented TBI INTERVENTION: N/A MAIN OUTCOME MEASURES: 5 PROMIS Social Health Measures RESULTS: All five PROMIS social health measures exceeded the a priori criterion for internal consistency reliability (≥ 0.70); most PROMIS measures met the criterion for test-retest reliability (≥ 0.70) in the civilian sample; in the SMV sample, test-retest reliability was generally below this criterion, except for Social Isolation. For both samples, convergent validity was supported by moderate correlations between the 5 PROMIS social health measures and related measures, and discriminant validity was supported by low correlations between PROMIS social health measures and measures of dissimilar constructs. Most PROMIS scores indicated significantly worse social health in both samples of those caring for individuals who were low functioning. Finally, impairment rates in social health were elevated for those caring for low functioning individuals, especially in the SMV sample. CONCLUSIONS: The PROMIS computer adaptive test and short form social health measures have potential clinical utility for use in caregivers of civilians and SMVs with TBI.

OBJECTIVE: To examine the reliability and validity of Patient Reported Outcomes Measurement Information System (PROMIS) measures of sleep disturbance and fatigue in TBI caregivers and to determine the severity of fatigue and sleep disturbance in these caregivers. DESIGN: Cross-sectional survey data collected through an online data capture platform. SETTING: Four rehabilitation hospitals and Walter Reed National Military Medical Center. PARTICIPANTS: Caregivers (N=560) of civilians (n=344) and service member/veterans (n=216) with TBI. INTERVENTION: Not Applicable MAIN OUTCOME MEASURES: PROMIS sleep and fatigue measures administered as both computerized adaptive tests (CATs) and 4-item short forms (SFs). RESULTS: For both samples, floor and ceiling effects for the PROMIS measures were low (<11%), internal consistency was very good (all alphas ≥0.80), and test-retest reliability was acceptable (all r≥0.70 except for the fatigue CAT in the service member/veteran sample r=0.63). Convergent validity was supported by moderate correlations between the PROMIS and related measures. Discriminant validity was supported by low correlations between PROMIS measures and measures of dissimilar constructs. PROMIS scores indicated significantly worse sleep and fatigue for those caring for someone with high levels versus low levels of impairment. CONCLUSIONS: Findings support the reliability and validity of the PROMIS CAT and SF measures of sleep disturbance and fatigue in caregivers of civilians and service members/veterans with TBI.

OBJECTIVE: To develop a new patient-reported outcome measure that captures feelings of being trapped that are commonly experienced by caregivers of individuals with traumatic brain injury (TBI). DESIGN: Cross-sectional SETTING: Three TBI Model Systems rehabilitation hospitals, an academic medical center, and a military medical treatment facility. PARTICIPANTS: Caregivers of civilians with TBI (n=344) and caregivers of service members/veterans with TBI (n=216). INTERVENTIONS: Not applicable. OUTCOME MEASURES: TBI-CareQOL Feeling Trapped Item Bank RESULTS: From an initial item pool of 28 items, exploratory and confirmatory factor analyses supported the retention of 16 items. After graded response model (GRM) and differential item functioning (DIF) analyses were conducted, 15 items were retained in the final measure. GRM calibration data, along with clinical expert input, was used to choose a 6-item, static short form, and the calibration data was utilized for programming of the TBI-CareQOL Feeling Trapped computer adaptive test (CAT). CAT simulation analyses produced an r = 0.99 correlation between CAT scores and the full item-bank. Three-week short form test-retest reliability was very good (r = 0.84). CONCLUSIONS: The new TBI-CareQOL Feeling Trapped item bank was developed to provide a sensitive and efficient examination of the impact that feelings of being trapped, due to the caregiver role, have on health-related quality of life (HRQOL) for caregivers of individuals with TBI. Both the CAT and corresponding 6-item short form demonstrate excellent psychometric properties. Future work is needed to establish the responsiveness of this measure to clinical interventions for these caregivers.