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Published on: November 29, 2024
Rates and Predictors of Completed Cognitive Rehabilitation Referrals Among Veterans With Traumatic Brain Injury
Adam R Kinney1, Molly E Penzenik, Jeri E Forster
1Author Affiliations: Veteran Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado (Kinney, Penzenik, Forster, and Bahraini); Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus, Aurora, Colorado (Kinney, Penzenik, and Forster); Department of Rehabilitation and Prosthetic Services, Veterans Health Administration, Washington, DC (O'Donnell); and Departments of Physical Medicine and Rehabilitation and Psychiatry, University of Colorado, Anschutz Medical Campus, Aurora, Colorado (Bahraini).
Most Veterans with traumatic brain injury (TBI) initiate cognitive rehabilitation, but completion rates vary. Nonclinical factors like age, marital status, and homelessness influence engagement, highlighting needs for improved TBI care strategies.
Area of Science:
- Neuroscience
- Rehabilitation Medicine
- Health Services Research
Background:
- Traumatic brain injury (TBI) is a significant concern among Veterans.
- Cognitive rehabilitation is a crucial service for TBI recovery.
- Understanding factors influencing referral completion is vital for optimizing care.
Purpose of the Study:
- To determine the completion rates of cognitive rehabilitation referrals among Veterans with TBI.
- To identify nonclinical factors associated with cognitive rehabilitation referral completion.
- To stratify analyses by TBI severity (mild TBI vs. moderate-severe TBI).
Main Methods:
- Retrospective cohort study using Veterans Health Administration (VHA) electronic medical record data.
- Included Veterans with clinician-confirmed TBI and a cognitive rehabilitation referral.
- Modified Poisson regression analyzed associations between nonclinical factors and referral completion.
Main Results:
- Referral completion rates were similar for mild TBI (69%) and moderate-severe TBI (68%).
- For mild TBI, older age, marriage, and non-employment status were linked to higher completion.
- For moderate-severe TBI, a history of homelessness was associated with lower completion.
Conclusions:
- A significant proportion of Veterans with TBI do not complete cognitive rehabilitation referrals, indicating missed care opportunities.
- Patient-specific factors (age, marital status, employment, homelessness history) impact referral completion.
- Findings support developing system-level strategies to enhance cognitive rehabilitation engagement for Veterans with TBI.
