Identifying mTBI Subtypes and their Implications for Recovery and Reintegration

识别 mTBI 亚型及其对康复和重返社会的影响

• 批准号: 8273525
• 负责人: Mark Meterko
• 金额: --
• 依托单位: VA BOSTON HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-01 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8273525
• 关键词: Accounting; Achievement; Affect; Affective; Area; Brain Concussion; Build-it; Caring; Characteristics; Clinical; Closed head injuries; Cognitive; Collection; Communities; Comorbidity; Data; Diagnosis; Dimensions; Early Intervention; Elements; Equipment and supply inventories; Etiology; Evaluation; Family; Freedom; Friends; Funding; Gender; Goals; Hand; Healthcare; Individual; Injury; Interpersonal Relations; Knowledge; Mandatory Testing; Measures; Mediating; Medical; Mental Health; Multiple Trauma; Nature; Outcome; Paper; Patients; Pattern; Physical Examination; Population; Post-Concussion Syndrome; Post-Traumatic Stress Disorders; Process; Property; Psychometrics; Recording of previous events; Recovery; Reporting; Research; Research Personnel; Resources; Self Care; Sensory; Services; Severities; Societies; Structure; Symptoms; Syndrome; Taxonomy; Time; Traumatic Brain Injury; Variant; Veterans; Women' s Health; Work; base; behavioral health; civil society; cohort; combat; community reintegration; cost; demographics; design; effective therapy; follow-up; improved; instrument; interest; neurobehavioral; open wound; operation; outcome forecast; screening; social; treatment planning

DESCRIPTION (provided by applicant): Traumatic brain injury (TBI) is a signature condition of combat among returnees from Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF). VA's goals regarding TBI are to (1) screen every OEF/OIF Veteran for the possibility of TBI; (2) evaluate each Veteran who screens positive, using the 22-item Neurobehavioral Symptom Inventory (NSI-22) in combination with a comprehensive history and physical examination; and then (3) develop a treatment plan including recommended referrals to appropriate services based on the assessment. The latter two elements constitute the comprehensive TBI evaluation (CTE). This proposal builds on a recently-completed study (SDR 08-405) in which the present researchers were funded to examine the impact of patient and medical facility factors affecting differential rates of progression to the CTE among Veterans with a positive initial screening for TBI, and assess differential rates of TBI diagnosis and participation in post-CTE follow-up care. We also examined the structure of persistent post-concussive symptoms by assessing the dimensionality and psychometric properties of the NSI-22. The present proposal's overall aim is to move beyond screening and evaluation to examine the course of persistent PCS and impacts on Veterans' functioning at personal, family and broader community levels. Within this overarching aim, we propose three research objectives: Objective 1: Identify clusters of persistent post-concussive symptoms (syndromes) and their associated demographic, co-morbidity and etiological factors among Veterans with a CTE. Objective 2: Identify VA utilization and costs related to each syndrome. Objective 3: Assess the course of symptom severity within syndromes over time and relationships to short- and long-term reintegration in multiple domains, controlling for utilization. Objective 1 uses analysis of national CTE data combined with data from other VA files. It builds on our extensive prior use of the files to identify the dimensional structure of persistent PCS assessed by the NSI-22. Based on prior work, we expect to identify distinct patterns of symptom severity (syndromes) across the four dimensions of the NSI-22: somato-sensory, vestibular, affective and cognitive. We expect to use these syndromes for analyses of recovery and reintegration over time, but if there are no distinct syndromes, we will track symptom severity on the four NSI-22 dimensions independently for Objectives 2 and 3. For Objective 1 we will also examine the relationship between Veteran characteristics in three domains - demographics, injury etiology, and mental health co-morbidities - and their neurobehavioral symptoms. A key point is that we can study the relationships using the four NSI-22 dimensions separately or as symptom clusters (syndromes). Hereafter we refer to syndromes as convenient short-hand for either clusters of symptoms (if discovered) or alternatively the individual NSI-22 symptom dimensions. Our ultimate interest in the identification of syndromes under Objective 1 is to understand their relationship to meaningful clinical, personal and social outcomes in both the short and long term. To adequately pursue this objective will require the collection of new data. We therefore propose to administer a comprehensive measure of community reintegration along with the NSI-22 to a cohort of OEF/OIF Veterans at 6 and 18 months following their CTE. The reintegration measure developed by Sayer and colleagues was specifically designed for the Veteran population and assesses reintegration problems in 24 specific areas within the broader domains of self-care, interpersonal relations with family, friends and others, work, and participation in civil society more generally.

描述（由申请人提供）： 创伤性脑损伤 (TBI) 是持久自由行动和伊拉克自由行动 (OEF/OIF) 返回者战斗中的标志性病症。 VA 关于 TBI 的目标是 (1) 筛查每位 OEF/OIF 退伍军人是否有 TBI 的可能性； (2) 使用 22 项神经行为症状量表 (NSI-22) 结合全面的病史和体检，对每位筛查呈阳性的退伍军人进行评估；然后 (3) 制定治疗计划，包括根据评估推荐转诊至适当的服务机构。后两个要素构成了综合 TBI 评估（CTE）。该提案以最近完成的一项研究 (SDR 08-405) 为基础，其中目前的研究人员获得资助，研究患者和医疗机构因素对 TBI 初步筛查呈阳性的退伍军人中 CTE 进展率差异的影响，并评估 TBI 诊断率和参与 CTE 后随访护理的差异率。我们还通过评估 NSI-22 的维度和心理测量特性来检查持续性脑震荡后症状的结构。 本提案的总体目标是超越筛查和评估，审查持续性 PCS 的病程以及对退伍军人在个人、家庭和更广泛的社区层面的功能的影响。在这一总体目标中，我们提出了三个研究目标： 目标 1：确定患有 CTE 的退伍军人中持续存在的脑震荡后症状（综合征）及其相关的人口统计、共病和病因因素。 目标 2：确定与每种综合征相关的 VA 利用率和成本。 目标 3：评估综合征内症状严重程度随时间的变化，以及与多个领域的短期和长期重新融入的关系，控制利用。 目标 1 使用国家 CTE 数据结合其他 VA 文件的数据进行分析。它建立在我们之前广泛使用文件来识别由 NSI-22 评估的持久 PCS 的维度结构的基础上。根据之前的工作，我们期望在 NSI-22 的四个维度（躯体感觉、前庭、情感和认知）中识别症状严重程度（综合症）的不同模式。我们希望使用这些综合征来分析随着时间的推移恢复和重新融入社会，但如果没有明显的综合征，我们将独立跟踪目标 2 和 3 的四个 NSI-22 维度的症状严重程度。对于目标 1，我们还将检查退伍军人在三个领域的特征（人口统计、伤害病因和心理健康共病）与其神经行为症状之间的关系。关键是我们可以单独使用 NSI-22 的四个维度或作为症状群（综合症）来研究这些关系。此后，我们将综合症称为症状群（如果发现）或单个 NSI-22 症状维度的方便简写。 我们对目标 1 下的综合征识别的最终兴趣是了解它们与短期和长期有意义的临床、个人和社会结果的关系。为了充分实现这一目标需要收集新数据。因此，我们建议在 CTE 后 6 个月和 18 个月时对 OEF/OIF 退伍军人群体实施一项全面的社区重新融入措施以及 NSI-22。 Sayer 及其同事制定的重返社会措施是专门为退伍军人群体设计的，评估了更广泛的自我保健、与家人、朋友和其他人的人际关系、工作以及更广泛的公民社会参与等 24 个特定领域的重返社会问题。