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Characteristics of Responders and Nonresponders in a Military Postconcussion Rehabilitation Program
Caitlyn A Nix1, Latiba D Cummings, Lisa H Lu
1Brain Injury Rehabilitation Service, Department of Rehabilitation Medicine, Brooke Army Medical Center (Mss Nix and Cummings and Drs Lu and Bowles), and Traumatic Brain Injury Center of Excellence, Defense Health Agency (Dr Lu), JBSA Fort Sam Houston, San Antonio, Texas; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland (Ms Nix); and General Dynamic Information Technology, Falls Church, Virginia (Dr Lu).
Objective:
To characterize treatment responders and nonresponders as measured by the Neurobehavioral Symptom Inventory (NSI) in order to understand whether certain traits in our patient population would characterize favorable response.
Setting:
Brain Injury Rehabilitation Service at Brooke Army Medical Center, Fort Sam Houston, San Antonio, Texas.
Patients:
In total, 655 active duty military patients with a diagnosis of mild traumatic brain injury (mTBI) who received treatment between 2007 and 2020 and completed self-report measures as part of routine care.
Design:
Observational retrospective analysis of outpatient clinical outcomes data.
Main Measures:
The primary outcome measure was the NSI, divided into the responder and nonresponder groups. Responders were defined by reliable change in NSI total score (decrease of ≥8 points from intake to discharge).
Findings:
Responders ( n = 395) reported a higher level of symptom burden at intake on the NSI. Women responded proportionally more (70%) than men (58%). After treatment, responders reported improvements on all measures evaluated while nonresponders reported no change or slightly worse symptoms. Logistic regression analysis showed that posttraumatic stress symptoms at intake decreased odds of favorable treatment response while satisfaction with social relationships increased odds of favorable treatment response.
Conclusion:
The results from this process improvement project suggested that posttraumatic symptoms warrant programmatic attention in TBI clinics while social relationships may be a protective factor that can be capitalized to enhance troop readiness. Systematic examination of these characteristics should be conducted on a larger population within the military health system.
