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Supervision Needs Following Veteran and Service Member Moderate to Severe Traumatic Brain Injury: A VA TBI Model
Erin K Bailey1, Risa Nakase-Richardson, Nitin Patel
1Department of Mental Health and Behavioral Sciences, James A. Haley Veterans' Hospital, Tampa, Florida (Drs Bailey, Nakase-Richardson, and Dillahunt-Aspillaga); Department of Internal Medicine, University of South Florida, Tampa, Florida (Drs Nakase-Richardson and Dillahunt-Aspillaga); HSR&D Center of Innovation in Disability & Rehabilitation Research (CINDRR), Tampa, Florida (Drs Nakase-Richardson and Dillahunt-Aspillaga and Mr Patel); Defense and Veterans Brain Injury Center (DVBIC), Tampa, Florida (Dr Nakase-Richardson); Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California (Dr Ropacki); Polytrauma Systems of Care, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Dr Ropacki); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas (Dr Sander); Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas (Dr Sander); Department of Physical Medicine and Rehabilitation, Harris Health System, Houston, Texas (Dr Sander); Department of Mental Health, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia (Dr Stevens); Departments of Psychology & Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia (Dr Stevens); Defense and Veterans Brain Injury Center (DVBIC), Richmond, Virginia (Dr Stevens); and Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas (Dr Tang).
Objective:
To characterize supervision levels across residential settings at 1 year post-TBI and explore predictors of supervision in a Veteran and Service-member population.
Setting:
Five VA Polytrauma Rehabilitation Centers.
Participants:
A total of 302 individuals enrolled in the VA TBI Model Systems (TBIMS) research program.
Design:
Prospective, longitudinal, multisite.
Main Measures:
Primary residence and supervision levels measured via scores on the Supervision Rating Scale. For predictive modeling, scores were dichotomized into 2 groups: those that were fully independent/living alone or required only some supervision during the day (independent group, n = 195) and those that required overnight supervision, full-time indirect supervision, and full-time direct supervision (dependent group, n = 107).
Results:
Thirty-five percent were receiving supervision at 1 year post-TBI across residential settings and 28% were living in alternative settings. Multivariate modeling indicated that older age and longer posttraumatic amnesia (PTA) were predictive of having a need for supervision at 1 year postinjury.
Conclusions:
Supervision needs are long-term features of moderate and severe TBI. Results of this study lend support to the shift toward conceptualizing TBI as a chronic disease.
