Action Ethnography of Community Reintegration for Veterans and Military Service Members With Traumatic Brain Injury: Protocol for a Mixed Methods Study (Preprint)

BACKGROUND Numerous studies of community reintegration (CR) in traumatic brain injury (TBI) have been conducted in civilian populations, but research is limited in veteran and military service member populations. Little is known about how knowledge from civilian studies translates into veterans’ experiences and needs. The US Department of Veterans Health Administration (VHA) recognizes the distinctive health care needs of post-9/11 veteran and military service members, particularly with TBI, including the need to bridge health and rehabilitation-related services from acute care and inpatient settings to veteran and military service members’ homes and communities to facilitate CR. OBJECTIVE The goal of this study is to better understand the experiences of veterans with complicated mild, moderate, or severe TBI; their families; and CR workers as veterans and servicemembers transition to and sustain living in communities. This paper describes the rationale, design, and methods used to reach this goal. METHODS This five-year longitudinal mixed methods study uses both a community-engaged research (CEnR) approach and an ethnographic approach. The sample includes 30 veterans and service members with TBI, 13 family caregivers, 11 CR specialists, 16 key stakeholders, and 82 community events. Interviews and observations are coded and analyzed using hierarchical coding schemes and thematic analysis. Analyses include data from surveys, interviews, and participant observations. Content analysis is used to highlight the complex social context of reintegration and to triangulate quantitative data. Egocentric (personal) social network analysis is used to examine the support system a veteran or service member has in place to facilitate reintegration. RESULTS Study enrollment and data collection are completed. Data analyses are underway. CONCLUSIONS The results of this study may provide a heightened understanding of environmental factors affecting CR in complicated mild, moderate, or severe TBI. Veteran, servicemember and family voices and insights provide VHA clinicians and policy makers with an ecological view of CR that is grounded in the life experiences of veterans, military service members, and families. The results of this study provide a roadmap for designing and testing interventions to maximize CR in a variety of domains. The longitudinal ethnographic approach allows for capturing detailed experiences within the naturalistic context. CEnR allows collaborative assessment of the social context of reintegration with community members. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/14170

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Action Ethnography of Community Reintegration for Veterans and Military Service Members With Traumatic Brain Injury: Protocol for a Mixed Methods Study

JMIR Research Protocols ◽

10.2196/14170 ◽

2019 ◽

Vol 8 (11) ◽

pp. e14170

Author(s):

Christine Melillo ◽

Kiersten Downs ◽

Christina Dillahunt-Aspillaga ◽

Jason Lind ◽

Karen Besterman-Dahan ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Social Context ◽

Military Service ◽

Service Member ◽

Mixed Methods Study ◽

Service Members ◽

Ethnographic Approach ◽

Military Service Members ◽

Severe Tbi

Background Numerous studies of community reintegration (CR) in traumatic brain injury (TBI) have been conducted in civilian populations, but research is limited in veteran and military service member populations. Little is known about how knowledge from civilian studies translates into veterans’ experiences and needs. The US Department of Veterans Health Administration (VHA) recognizes the distinctive health care needs of post-9/11 veteran and military service members, particularly with TBI, including the need to bridge health and rehabilitation-related services from acute care and inpatient settings to veteran and military service members’ homes and communities to facilitate CR. Objective The goal of this study is to better understand the experiences of veterans with complicated mild, moderate, or severe TBI; their families; and CR workers as veterans and servicemembers transition to and sustain living in communities. This paper describes the rationale, design, and methods used to reach this goal. Methods This five-year longitudinal mixed methods study uses both a community-engaged research (CEnR) approach and an ethnographic approach. The sample includes 30 veterans and service members with TBI, 13 family caregivers, 11 CR specialists, 16 key stakeholders, and 82 community events. Interviews and observations are coded and analyzed using hierarchical coding schemes and thematic analysis. Analyses include data from surveys, interviews, and participant observations. Content analysis is used to highlight the complex social context of reintegration and to triangulate quantitative data. Egocentric (personal) social network analysis is used to examine the support system a veteran or service member has in place to facilitate reintegration. Results Study enrollment and data collection are completed. Data analyses are underway. Conclusions The results of this study may provide a heightened understanding of environmental factors affecting CR in complicated mild, moderate, or severe TBI. Veteran, servicemember and family voices and insights provide VHA clinicians and policy makers with an ecological view of CR that is grounded in the life experiences of veterans, military service members, and families. The results of this study provide a roadmap for designing and testing interventions to maximize CR in a variety of domains. The longitudinal ethnographic approach allows for capturing detailed experiences within the naturalistic context. CEnR allows collaborative assessment of the social context of reintegration with community members. International Registered Report Identifier (IRRID) DERR1-10.2196/14170

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A-116 Predicting Chronic Neurobehavioral Symptoms based on Acute Injury Characteristics and Symptoms in U.S. Military Service Members with and without history of TBI

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acaa068.116 ◽

2020 ◽

Vol 35 (6) ◽

pp. 909-909

Author(s):

Lippa S ◽

Bailie J ◽

Brickell T ◽

French L ◽

Hungerford L ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Military Service ◽

Service Members ◽

Injury Characteristics ◽

Military Service Members ◽

History Of ◽

Neurobehavioral Symptoms ◽

Severe Tbi

Abstract Objective Recovery following traumatic brain injury (TBI) is complex. Often following mild TBI, recovery occurs within days or weeks, though this is not always the case. Following more severe TBI, some recover quickly, while many never fully recover. This study examines acute predictors of chronic neurobehavioral symptoms in U.S. military service members (Age: M = 33.9 years, SD = 10.2) without injury (n = 86), or with history of uncomplicated mild traumatic brain injury (TBI; n = 56), complicated mild, moderate, or severe TBI (mod-sev TBI; n = 43), or bodily injury (n = 25). Method Participants completed the Neurobehavioral Symptom Inventory (NSI), Posttraumatic Stress Disorder Checklist, Alcohol Use Disorder Checklist, Combat Exposure Scale, and TBI Quality of Life and passed symptom validity tests at 0–8 months and ≥ 2 years post-injury. Forward stepwise logistic regression included 26 potential predictors (demographics, injury characteristics, military characteristics, and self-report measures at baseline) of International Statistical Classification of Diseases and Related Health Problems-10 Postconcussional Syndrome (PCSy) at follow-up. Results Cognitive Concerns (Exp(B) = .896, p = .001), Sleep (Exp(B) = 1.874, p < .001), Somatosensory Symptoms (Exp(B) = 1.194, p = .012), and mod-sev TBI (Exp(B) = 2.959, p = .045) significantly predicted follow-up PCSy. When baseline NSI symptoms were removed from the model, Cognitive Concerns (Exp(B) = .902, p < .001), Post-traumatic stress (Exp(B) = 1.173, p = .001), and Resilience (Exp(B) = .950, p < .031) significantly predicted PCSy. For all included measures in both models, higher symptoms at baseline predicted increased likelihood of follow-up PCSy. Both models correctly classified 81.3% of participants. Conclusion Findings suggest patients reporting psychological distress and cognitive concerns acutely should be targeted for treatment to mitigate prolonged neurobehavioral symptoms.

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P111 Sleep disturbances are associated with poor neurobehavioural outcomes following traumatic brain injury: A study of military service members and veterans

SLEEP Advances ◽

10.1093/sleepadvances/zpab014.154 ◽

2021 ◽

Vol 2 (Supplement_1) ◽

pp. A57-A57

Author(s):

C Pattinson ◽

T Brickell ◽

J Bailie ◽

L Hungerford ◽

S Lippa ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Military Service ◽

Sleep Disturbances ◽

Tissue Injury ◽

Soft Tissue Injury ◽

Service Member ◽

Service Members ◽

Poor Sleep ◽

Military Service Members

Abstract Introduction Sleep disturbances are pervasively reported in military service members and veterans, especially following traumatic brain injury (TBI). The purpose of this study was to examine the association between sleep disturbances and neurobehavioural outcomes in a large group of U.S. military service members and veterans, with and without a history of TBI. Methods Participants were enrolled into the Defense and Veterans Brain Injury Center/Traumatic Brain Injury Center of Excellence, 15-Year Longitudinal TBI study (N = 606). Participants self-reported sleep disturbances (PROMIS 8A) and neurobehavioral symptoms. Data were analyzed using analysis of variance with post-hoc comparisons. Four groups were analyzed separately: uncomplicated mild TBI (MTBI; n=218); complicated mild, moderate, severe, or penetrating - combined TBI (CTBI; n=118); injured controls (IC, i.e., orthopedic or soft-tissue injury without TBI; n=162); and non-injured controls (NIC; n=108). Results Participants in the MTBI group reported the highest proportion of moderate-severe sleep disturbances (66.5%) compared to the IC (54.9%), CTBI (47.5%), and NIC groups (34.3%). Participants classified as having Poor Sleep reported significantly worse scores on almost all TBI-QOL scales compared to those classified as having Good Sleep, regardless of TBI severity or even the presence of TBI (ps<.05, Cohen’s ds>.3). Discussion This study demonstrates that sleep disturbances remain a prevalent and debilitating concern in service member and veteran populations. Regardless of group (injured or NIC), sleep disturbances were common and were associated with significantly worse neurobehavioral functioning. When assessing and treating neurobehavioural symptoms, it is important to assess sleep, especially in service member and veteran populations.

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