Publications by authors named "Angelle M Sander"

100 Publications

Race/Ethnicity and Community Participation Among Veterans and Service Members With Traumatic Brain Injury: A VA Traumatic Brain Injury Model Systems Study.

J Head Trauma Rehabil 2021 Feb 22. Epub 2021 Feb 22.

Departments of Psychology and Physical Medicine and Rehabilitation, Virginia Commonwealth University, and Defense and Veterans Brain Injury Center (DVBIC), Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia (Dr Stevens); Research Department, Craig Hospital, Englewood, Colorado (Dr Ketchum); Research Services, James A. Haley Veterans Hospital, Tampa, Florida (Drs Ketchum and Dillahunt-Aspillaga); H. Ben Taub Department of Physical Medicine & Rehabilitation, Baylor College of Medicine and Harris Health System, and Brain Injury Research Center, TIRR Memorial Herman, Houston, Texas (Dr Sander); Baylor Research Institute at Baylor Institute for Rehabilitation, Dallas, Texas (Ms Callender); Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, Texas (Dr Juengst); Rehabilitation and Mental Health Counseling Program, Department of Child and Family Studies, College of Family and Community Sciences, University of South Florida, Tampa (Dr Dillahunt-Aspillaga); Departments of Physical Medicine and Rehabilitation and Ophthalmology and Visual Sciences, University of Alabama at Birmingham (Dr Dreer); Minneapolis Veterans Affairs Health Care System, and Department of Psychiatry, University of Minnesota-Twin Cities, Minneapolis (Dr Finn); Department of Rehabilitation Counseling, Virginia Commonwealth University, Richmond (Dr Gary); Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York City, New York (Drs Kajankova and Kolakowsky-Hayner); Kessler Foundation, East Hanover, New Jersey (Dr Lequerica); Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark (Dr Lequerica); and Moss Rehabilitation Research Institute, Elkins, Pennsylvania (Dr Rabinowitz).

Objective: To examine racial/ethnic disparities in community participation among veterans and active duty service members with traumatic brain injury (TBI).

Setting: Five Department of Veterans Affairs (VA) TBI Model Systems (TBIMS) Polytrauma Rehabilitation Centers (PRCs). Participants: Three hundred forty-two community-dwelling adults (251 White, 34 Black, and 57 Hispanic) with TBI enrolled in the VA TBIMS National Database who completed a 1-year follow-up interview. Mean age was 38.6 years (range, 19-84 years).

Design: Cross-sectional analysis of a prospective observational cohort study. Main Measures: Community participation at 1 year postinjury assessed by 3 domains of the Participation Assessment with Recombined Tools-Objective (PART-O): Out & About, Productivity, and Social Relations.

Results: Significant differences were observed among race/ethnicity groups in PART-O Productivity and Out & About domains without controlling for relevant participant characteristics; Productivity scores were significantly higher for non-Hispanic Black than for non-Hispanic White participants (t = 2.40, P = .0169). Out & About scores were significantly higher for Hispanic than for non-Hispanic White participants (t = 2.79, P = .0056). However, after controlling for demographic, injury severity, and 1-year follow-up characteristics, only differences in the Out & About domain remained statistically significant (t = 2.62, P = .0094), with scores being significantly higher for Hispanics than for non-Hispanic Whites.

Conclusions: The results, which differ from findings from studies conducted in non-VA healthcare settings where there are greater racial/ethnic disparities in participation outcomes, could reflect differences between military and civilian samples that may reduce disparities.
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http://dx.doi.org/10.1097/HTR.0000000000000657DOI Listing
February 2021

Primary Language and Participation Outcomes in Hispanics With Traumatic Brain Injury: A Traumatic Brain Injury Model Systems Study.

J Head Trauma Rehabil 2021 Feb 22. Epub 2021 Feb 22.

Department of Physical Medicine & Rehabilitation, Baylor College of Medicine and Harris Health System, Houston, Texas (Dr Sander); Brain Injury Research Center, TIRR Memorial Herman, Houston, Texas (Drs Sander and Pappadis); Research Department, Craig Hospital, Englewood, Colorado (Dr Ketchum and Mr Sevigny); Kessler Foundation, East Hanover, New Jersey, and Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark, New Jersey (Dr Lequerica); Division of Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch at Galveston, Galveston, Texas (Dr Pappadis); Rusk Rehabilitation and NYU Langone Health, New York, New York (Dr Bushnik); and Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana (Dr Hammond).

Objective: To examine the relationship between primary language and participation outcomes in English- and Spanish-speaking persons with complicated mild to severe traumatic brain injury (TBI) at 1 year post-injury.

Setting: Community following discharge from inpatient rehabilitation.

Participants: A total of 998 Hispanic participants with outcomes available at year 1 follow-up; 492 (49%) indicated English as their primary language and 506 (51%) indicated Spanish as their primary language.

Design: Prospective, multicenter, cross-sectional, observational cohort study.

Main Measures: Community participation at 1 year post-injury was assessed by 3 domains of the Participation Assessment with Recombined Tools-Objective (PART-O): Out and About, Productivity, and Social Relations.

Results: Unadjusted group comparisons showed better participation outcomes for English versus Spanish speakers for all PART-O domains and for the Balanced Total score. After controlling for relevant covariates, English-speaking participants had significantly better PART-O Balanced Total scores and better scores on the Social Relations domain, although effect sizes were small.

Conclusions: Hispanic persons with TBI whose primary language is Spanish may require greater assistance integrating socially back into their communities after TBI. However, potential cultural differences in value placed on various social activities must be considered. Potential cultural bias inherent in existing measures of participation should be investigated in future studies.
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http://dx.doi.org/10.1097/HTR.0000000000000655DOI Listing
February 2021

Pain anxiety and rehabilitation outcomes after acquired brain injury.

Brain Inj 2021 Jan 21;35(1):32-40. Epub 2020 Dec 21.

Department of Psychology, Wayne State University, Detroit, MI, USA.

: The purpose of this study was to examine pain anxiety after acquired brain injury (ABI) and its relationship to rehabilitation outcomes.: Participants consisted of 89 adults with an ABI participating in outpatient rehabilitation therapy. They completed a battery of neuropsychological tests at baseline along with surveys of mood, health-related self-efficacy, and pain anxiety. Separately, occupational therapists assessed basic and instrumental activities of daily living (ADLs) as well as therapy engagement across treatment after the sixth session.: Individuals who reported high pain anxiety had fewer years of formal education, lower self-efficacy, and more emotional distress than those with low pain anxiety. Although Blacks were about half (56%) of the study sample, they comprised the majority (73.1%) of individuals in the high pain anxiety group. Pain anxiety was negatively related to therapy engagement. Moderation analysis using linear regression indicated that pain anxiety moderated the influence of self-efficacy on basic ADLs.: Pain anxiety, particularly when high, is negatively associated with rehabilitation outcomes for individuals with ABI. Among those with high pain anxiety, health-related self-efficacy is an important resilience characteristic to improve functional outcomes. In rehabilitation therapy, pain anxiety provides a novel intervention target to enhance ABI recovery.
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http://dx.doi.org/10.1080/02699052.2020.1859614DOI Listing
January 2021

Evaluating Negative Attributions in Persons With Brain Injury: A Comparison of 2 Measures.

J Head Trauma Rehabil 2021 May-Jun 01;36(3):E170-E177

Departments of Physical Medicine and Rehabilitation (Drs Neumann and Hammond) and Biostatistics (Dr Jang and Ms Bhamidipalli), Indiana University School of Medicine (Dr Witwer), Indianapolis; Rehabilitation Hospital of Indiana, Indianapolis (Drs Neumann and Hammond); Division of Clinical Neuropsychology and Rehabilitation Psychology, H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine and Harris Health System, Houston, Texas (Dr Sander); and Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas (Dr Sander).

Objectives: To compare construct and predictive validity, readability, and time-to-administer of 2 negative attribution measures in participants with traumatic brain injury (TBI).

Setting: Two TBI rehabilitation hospitals.

Participants: Eighty-five adults with complicated mild to severe TBI.

Main Measures: Negative attributions (intent, hostility, and blame) and anger responses to hypothetical scenarios were measured with the Epps scenarios and the Ambiguous Intention Hostility Questionnaire (AIHQ). Trait aggression was measured with the Buss-Perry Aggression Questionnaire (BPAQ).

Results: Associations between attributions and anger responses (ie, construct validity) within each measure were significant (Epps: r = 0.61-0.74; AIHQ: r = 0.39-0.71); however, associations were stronger for Epps (Ps < .001). Receiver operating characteristics (ROC) revealed attributions from both measures predicted BPAQ scores (area under the ROC curves = 0.6-0.8); predictive validity did not statistically differ between the 2 measures. Both had comparable readability (fifth- to sixth-grade levels), but Epps required longer administration times.

Conclusion: Negative attributions affect anger and aggression after TBI, making it important to identify suitable assessments for the TBI population. While psychometric properties of the AIHQ and Epps scenarios should be further explored, this study offers early support for the use of either instrument in persons with TBI. Advantages and disadvantages of the AIHQ and Epps scenarios are highlighted.
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http://dx.doi.org/10.1097/HTR.0000000000000635DOI Listing
November 2020

Relationship of medical comorbidities to psychological health at 2 and 5 years following traumatic brain injury (TBI).

Rehabil Psychol 2020 Oct 29. Epub 2020 Oct 29.

Mental Health and Behavioral Sciences, James A. Haley Veterans' Hospital.

To examine the relationship between medical comorbidities and psychological health outcomes at 2 and 5 years following traumatic brain injury (TBI). Veterans Affairs (VA) TBI Model System participants who completed a 2-year ( = 225) and/or 5-year ( = 283) follow-up with a comorbidities interview were included in the current study. Psychological health outcomes were assessed using the Patient Global Impression of Change (PGIC), Patient Health Questionnaire-9 (PHQ-9), and Satisfaction with Life Scale (SWLS). While controlling for known predictors of outcome, the relationship of overall comorbidity burden to psychological outcomes was examined cross-sectionally using generalized linear regression at 2 and 5 years post-TBI. Lasso regularization was used to examine relationships of specific comorbid conditions to outcome. Greater comorbidity burden was significantly associated with lower satisfaction with life at 2 and 5 years post-TBI and was associated with greater depressive symptomatology at 5 years post-TBI. Chronic pain was associated with lower satisfaction with life and greater depressive symptoms at both 2- and 5-year follow-up. Sleep apnea was associated with lower satisfaction with life and greater depressive symptoms at 5-year follow-up. Rheumatoid arthritis was associated with lower satisfaction with life and lower levels of perceived improvement in health and well-being at the 5-year follow-up. Results suggest that medical comorbidities may have a cumulative impact on adverse psychological health outcomes in chronic stages of TBI. This study further highlights the complexity of patients with TBI and the importance of identifying medical comorbidities as they provide potential targets for intervention. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/rep0000366DOI Listing
October 2020

: a qualitative study on the perceptions of recovery following traumatic brain injury among Spanish-speaking U.S. immigrants.

Disabil Rehabil 2020 Oct 27:1-10. Epub 2020 Oct 27.

TIRR Memorial Hermann Brain Injury Research Center, Houston, TX, USA.

Purpose: To explore the impact of traumatic brain injury (TBI) on the quality of life (QoL) and self-concept of Spanish-speaking U.S. Hispanic immigrants with TBI.

Materials And Methods: A prospective, qualitative study conducted in a county level I trauma center and community. Semi-structured interviews on QoL and self-concept following TBI were conducted with 24 Spanish-speaking U.S. Hispanic immigrants with TBI living in the community at least 6 months following injury.

Results: Perceived facilitators of QoL included faith, hopefulness in recovery, empathy for others, and support from others. Perceived barriers to QoL mentioned were symptoms/consequences of injury, employment/financial changes, loss of independence, fear/uncertainty, stigma/shame, lack of medical care, and decreased social integration. Participants described their self-concept after TBI as either a maintained self or loss of self. Those who viewed themselves differently reported physical and emotional changes, gender role conflict, loss of self-worth, and total loss due to the TBI.

Conclusions: Spanish-speaking U.S. Hispanic immigrants held a strong faith and positive outlook after TBI in spite of the significant barriers to recovery. A need exists for programs to support creatively the recovery of Spanish-speaking U.S. Hispanic immigrants with limited access to care and resources.IMPLICATIONS FOR REHABILITATIONSpanish-speaking U.S. Hispanic immigrants may experience significant barriers to care following traumatic brain injury (TBI), such as access to rehabilitation services and follow-up care.Rehabilitation professionals should consider the importance of faith and encourage positive thinking and social support when working with Spanish-speaking U.S. Hispanic immigrants on how to cope with TBI-related challenges.Access to Spanish-speaking rehabilitation professionals, translators and Spanish language educational materials could help reduce language-related barriers to recovery among Spanish-speaking U.S. immigrants with TBI.Rehabilitation facilities should develop partnerships with community-based organizations serving the uninsured or underinsured to address the access to rehabilitation and medical needs of Spanish-speaking U.S. immigrants with TBI.
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http://dx.doi.org/10.1080/09638288.2020.1836045DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8109840PMC
October 2020

Sleep impairment is related to health-related quality of life among caregivers of lower-functioning traumatic brain injury survivors.

Rehabil Psychol 2020 Aug 10. Epub 2020 Aug 10.

Nursing Services.

The purpose of this study was to examine perceived sleep-related impairment in caregivers of individuals with traumatic brain injury (TBI). Specifically, we examined the relationship between caregiver-perceived sleep-related impairment and different aspects of health-related quality of life (HRQOL) and explored whether these relationships were moderated by the perceived level of everyday function in the person with TBI. Three hundred forty-one caregivers of individuals with TBI completed surveys to determine whether the association between sleep-related impairment and HRQOL was moderated by caregiver-perceived functional impairment of the person with injury. Participants completed measures from the Patient-Reported Outcomes Measurement Information System and the TBI-CareQOL. These measures were used to examine different aspects of HRQOL: caregiver-specific HRQOL, mental HRQOL, social HRQOL, and fatigue. The Mayo-Portland Adaptability Inventory-4 was used to measure caregiver perceptions of the level of everyday function in the person with injury. Results indicated that caregiver-perceived sleep-related impairment was associated with each of the four HRQOL scores. This relationship was moderated by the caregiver-reported level of everyday function in the person with TBI for both caregiver-specific HRQOL and fatigue but not mental or social HRQOL. For caregiver-specific HRQOL and fatigue, caregiver-perceived sleep-related impairment was associated with worse HRQOL for those caring for individuals with lower perceived levels of everyday function, but not for those caring for individuals with higher levels of everyday function. Interventions to improve caregiver sleep and HRQOL should consider both psychosocial and environmental factors (i.e., factors related to the person with the TBI). (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/rep0000334DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7873168PMC
August 2020

Negative Attribution Bias and Related Risk Factors After Brain Injury.

J Head Trauma Rehabil 2021 Jan-Feb 01;36(1):E61-E70

Departments of Physical Medicine and Rehabilitation (Drs Neumann and Hammond) and Biostatistics (Dr Perkins and Ms Bhamidipalli), Indiana University School of Medicine, Indianapolis; Rehabilitation Hospital of Indiana, Indianapolis (Drs Neumann and Hammond); Division of Clinical Neuropsychology and Rehabilitation Psychology, H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine and Harris Health System, Houston, Texas (Dr Sander); and Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas (Dr Sander).

Objective: In participants with traumatic brain injury (TBI) and peer controls, examine (1) differences in negative attributions (interpret ambiguous behaviors negatively); (2) cognitive and emotional factors associated with negative attributions; and (3) negative attribution associations with anger responses, life satisfaction, and participation.

Setting: Two TBI outpatient rehabilitation centers.

Participants: Participants with complicated mild to severe TBI (n = 105) and peer controls (n = 105).

Design: Cross-sectional survey study.

Main Measures: Hypothetical scenarios describing ambiguous behaviors were used to assess situational anger and attributions of intent, hostility, and blame. Executive functioning, perspective taking, emotion perception and social inference, alexithymia, aggression, anxiety, depression, participation, and life satisfaction were also assessed.

Results: Compared with peer controls, participants with TBI rated behaviors significantly more intentional, hostile, and blameworthy. Regression models explained a significant amount of attribution variance (25%-43%). Aggression was a significant predictor in all models; social inference was also a significant predictor of intent and hostility attributions. Negative attributions were associated with anger responses and lower life satisfaction.

Conclusion: People with TBI who have higher trait aggression and poor social inferencing skills may be prone to negative interpretations of people's ambiguous actions. Negative attributions and social inferencing skills should be considered when treating anger problems after TBI.
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http://dx.doi.org/10.1097/HTR.0000000000000600DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7769858PMC
January 2022

Assessing Negative Attributions After Brain Injury With the Ambiguous Intentions Hostility Questionnaire.

J Head Trauma Rehabil 2020 Sep/Oct;35(5):E450-E457

Departments of Physical Medicine and Rehabilitation (Drs Neumann and Hammond) and Biostatistics (Dr Perkins and Ms Bhamidipalli), Indiana University School of Medicine, Indianapolis; Rehabilitation Hospital of Indiana, Indianapolis (Drs Neumann and Hammond); Division of Clinical Neuropsychology and Rehabilitation Psychology, H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine and Harris Health System, Houston, Texas; Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas (Dr Sander); Indiana University School of Medicine, Indianapolis (Ms Witwer); and Department of Psychology, University of Texas at Tyler, Tyler (Dr Combs).

Objectives: (1) To explore the construct validity of the Ambiguous Intentions Hostility Questionnaire (AIHQ) in participants with traumatic brain injury (TBI) (ie, confirm negative attributions are associated with anger and aggression); and (2) use the AIHQ to examine negative attribution differences between participants with and without TBI.

Setting: Two rehabilitation hospitals.

Participants: Eighty-five adults with TBI and 86 healthy controls (HCs).

Design: Cross-sectional survey.

Main Measures: The AIHQ, a measure of negative attributions (intent, hostility, and blame), anger, and aggressive responses to hypothetical scenarios.

Results: Attributions were significantly correlated with anticipated anger and aggressive responses to AIHQ scenarios. Compared with HCs, participants with TBI reported stronger negative attributions (P ≤ .001), anger (P = .021), and aggressive responses (P = .002) to the scenarios.

Conclusion: Negative attributions were associated with anger and aggression responses, demonstrating construct validity of the AIHQ in the TBI population. Participants with TBI judged others' behaviors more severely than HCs, similar to prior research using a different attribution measure. The AIHQ has promise as a practical instrument for assessing negative attributions after TBI.
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http://dx.doi.org/10.1097/HTR.0000000000000581DOI Listing
May 2020

Health literacy, health outcomes, and the caregiver role in traumatic brain injury.

Rehabil Psychol 2020 May 28. Epub 2020 May 28.

Center for Clinical Outcomes Development and Application (CODA), Department of Physical Medicine and Rehabilitation, University of Michigan.

The purpose of this study is to estimate the occurrence of low health literacy among caregivers of people with traumatic brain injury (TBI), and to evaluate associations of health literacy with caregiver health-related quality of life (HRQOL) and perceptions of the caregiving role. Research The TBI-CareQOL measurement system assesses important self-reported outcomes for caregivers of civilians or service members/veterans (SMVs) with TBI. The validation phase included the Health Literacy Assessment Using Talking Touchscreen Technology (Health LiTT) measure. Multivariable regression evaluated the impact of low health literacy on generic and TBI-specific HRQOL and appraisals of the caregiving role, adjusted for caregiver gender, race/ethnicity and education, and the functional status of the TBI care recipient. Among 131 caregivers, 28 (21%) had low health literacy. Compared with the high health literacy group, the group with low health literacy had fewer women, more racial/ethnic minorities, and lower education (all < .05). The low health literacy group reported more subjective caregiving burden, less satisfaction with their relationship with the TBI recipient, less caregiving mastery, and poorer physical health (all < .05). There were no differences between health literacy groups in caregiving ideology, caregiver-specific HRQOL or general mental health. A better understanding of the links between health literacy and caregiver HRQOL and the caregiving role can help identify strategies to meet the needs of this underserved population. Tailored interventions for caregivers with low health literacy could improve outcomes for both the caregiver and the care recipient. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/rep0000330DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7704789PMC
May 2020

Patterns of Cognitive Test Scores and Symptom Complaints in Persons with TBI Who Failed Performance Validity Testing.

J Int Neuropsychol Soc 2020 10 27;26(9):932-938. Epub 2020 May 27.

Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center, Houston, TX, USA.

Objective: To determine clinically meaningful subgroups of persons with traumatic brain injury (TBI) who have failed performance validity testing.

Method: Study participants were selected from a cohort of 674 participants with definitive medical evidence of TBI. Participants were those who failed performance validity testing (the Word Memory Test, using the standard cutoffs). Participants were administered cognitive tests and self-report questionnaires. Test and questionnaire results were summarized as 12 dimension scores. Cluster analysis using the k-means method was performed.

Results: Cluster analysis for the 143 retained participants indicated three subgroups. These subgroups differed on patterns of scores. Subgroup 1 was impaired for memory and had no excessive complaints. Subgroup 2 had impaired memory and processing speed as well as concern regarding cognition function. Subgroup 3 showed impairment on all cognitive tests and excess complaints in multiple areas.

Conclusions: These results provide a preliminary basis for improved understanding of poor performance validity.
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http://dx.doi.org/10.1017/S1355617720000351DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7554049PMC
October 2020

A randomized controlled trial of acceptance and commitment therapy for psychological distress among persons with traumatic brain injury.

Neuropsychol Rehabil 2020 May 15:1-25. Epub 2020 May 15.

National Center for Posttraumatic Stress Disorder, Palo Alto, CA, USA.

Psychological distress is common in persons with traumatic brain injury (TBI) but treatments remain underdeveloped. This randomized controlled trial of Acceptance and Commitment Therapy (ACT) was designed to address this gap. Ninety-three persons with medically-documented complicated mild to severe TBI, normal-to-mildly impaired memory, and clinically significant psychological distress in the chronic phase of recovery were randomized to receive eight weeks of ACT (manualized with adaptations to address TBI-related cognitive impairments) or a single session of needs assessment, brief counseling/education, and referral. The ACT group showed significantly greater reduction of psychological distress (Brief Symptom Inventory 18) and demonstrated improvements in psychological flexibility and commitment to action (Acceptance and Action Questionnaire-II (AAQ-II) scores). The number of treatment responders (post-treatment BSI 18 GSI T scores <63) was larger in the ACT group than in the control group. Entry of AAQ-II scores into the model of between-group differences in BSI 18 GSI T scores indicated that core ACT processes explained the variance in treatment group outcomes. Provision of ACT reduces psychological distress in persons with TBI in the chronic phase of recovery when adaptations are made to accommodate TBI-related cognitive impairments. Additional clinical trials with a structurally equivalent control group are needed.
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http://dx.doi.org/10.1080/09602011.2020.1762670DOI Listing
May 2020

Do emotional distress and functional problems in persons with traumatic brain injury contribute to perceived sleep-related impairment in caregivers?

Rehabil Psychol 2020 May 14. Epub 2020 May 14.

Department of Physical Medicine and Rehabilitation.

Objective: The goal of this study was to examine the association between characteristics of persons with traumatic brain injury (PwTBI) and perceived sleep-related impairment of the caregivers.

Method: Fifty-two dyads ( = 23 civilians, = 29 service members/veterans [SMVs]) were enrolled. Caregivers completed the Patient-Reported Outcomes Measurement Information System Sleep-Related Impairment computer adaptive test, and PwTBI completed Quality of Life in Neurological Disorders measures of depression, anxiety, anger, cognitive functioning, and upper and lower extremity functioning. Hierarchical linear regression models, stratified by civilian/SMV group, were employed to assess prediction of caregiver-perceived sleep-related impairment from emotional distress of the PwTBI (anxiety, depressed mood, and anger) and perceived functional status of the PwTBI (cognitive, upper extremity, lower extremity functioning).

Results: Compared with caregivers of civilians, caregivers of SMVs reported higher perceived sleep-related impairment. Regression results showed that characteristics of the PwTBI accounted for moderate amounts of variance in the sleep-related impairment of caregivers of both civilians and SMVs. Within-group analyses showed that the strongest predictor of sleep-related impairment of caregivers of civilians was self-reported cognitive function of the PwTBI (β = -0.82, = .08); the strongest predictor of sleep-related impairment of caregivers of SMVs was self-reported anger of the PwTBI (β = 0.54, = .07).

Conclusions: In both caregivers of civilians and SMVs with TBI, characteristics of the PwTBI were related to perceived caregiver sleep-related impairment. These preliminary data can inform future research with larger samples that examine the impact of multiple characteristics of the caregiver and care recipient on caregiver sleep. Findings highlight the potential importance of considering the dynamics of the dyad in rehabilitation programming not only for the PwTBI but for caregivers as well. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/rep0000327DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7665992PMC
May 2020

Establishing the Factor Structure of a Health-Related Quality of Life Measurement System for Caregivers of Persons Living With Traumatic Brain Injury.

Arch Phys Med Rehabil 2020 07 18;101(7):1220-1232. Epub 2020 Apr 18.

Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI. Electronic address:

Objectives: To understand the factor structure of health-related quality of life specific to caregivers of people living with traumatic brain injury (TBI).

Design: Prospective, cross-sectional data collection.

Setting: Three TBI Model Systems rehabilitation hospitals, an academic medical center, and a military medical treatment facility.

Participants: Caregivers (N=558) of people who have sustained a TBI (344 caregivers of civilians and 214 caregivers of service members or veterans; 85% women; 58% spouses; mean age, 46.12±14.07y) who have provided care for an average of 5.82±5.40 years.

Interventions: Not applicable.

Main Outcomes Measures: The Traumatic Brain Injury Caregiver Quality of Life (TBI-CareQOL) measurement system including 10 Patient-Reported Outcomes Measurement Information System item banks (anger, anxiety, depression, social isolation, sleep disturbance, fatigue, ability to participate in social roles and activities, satisfaction with social roles and activities, emotional support, informational support) and 5 TBI-CareQOL banks (feelings of loss-self, feelings of loss-person with TBI, feeling trapped, caregiver-specific anxiety, caregiver strain).

Results: Confirmatory factor analysis model fit indices were compared for 14 empirically derived and 5 theoretically derived models. Confirmatory factor analysis results indicated that the best model fit was for a 6-factor model with dimensions that included mental health, social support, social participation, social isolation, physical health, and caregiver emotion.

Conclusions: Results indicated that a 6-factor model provided the best model fit for health-related quality of life in caregivers of individuals with TBI. These results have utility for both research and clinical applications. Establishing the TBI-CareQOL's factor structure provides preliminary evidence of the measurement system's construct validity, helps inform the selection of measures for specific research or clinical interventions, and informs the development of composite scores.
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http://dx.doi.org/10.1016/j.apmr.2020.03.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7311311PMC
July 2020

The Association Between Community Participation and Social Internet Use Among Adults With Traumatic Brain Injury.

J Head Trauma Rehabil 2020 Jul/Aug;35(4):254-261

Research Department, Craig Hospital, Englewood, Colorado (Drs Ketchum and Whiteneck and Mr Sevigny); Traumatic Brain Injury Model Systems National Data and Statistical Center, Englewood, Colorado (Drs Ketchum and Whiteneck and Mr Sevigny); Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania (Dr Hart); Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts (O'Neil-Pirozzi); Department of Communication Sciences and Disorders, Northeastern University, Boston, Massachusetts (O'Neil-Pirozzi); H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine and Harris Health System, Houston, Texas (Dr Sander); Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas (Dr Sander); Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas (Dr Juengst); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota (Dr Bergquist); and Departments of Ophthalmology & Visual Sciences and Physical Medicine & Rehabilitation, The University of Alabama at Birmingham (Dr Dreer).

Objective: To examine the association between social Internet use and real-world societal participation in survivors of moderate-severe traumatic brain injury.

Design: Prospective cross-sectional observational study.

Setting: Ten Traumatic Brain Injury Model Systems Centers.

Participants: A total of 331 participants in the Traumatic Brain Injury Model Systems, interviewed at any follow-up year between April 2014 and March 2015.

Main Measures: Survey on Internet use, including social media and other online socialization; Participation Assessment with Recombined Tools-Objective with separate analyses of Productivity, Social Relations, Out and About subscales; covariates included demographics, injury variables, and functional and emotional status at follow-up.

Results: Participants were classified as social Internet users (N = 232) or nonusers (N = 99). Users had significantly higher Participation Assessment with Recombined Tools-Objective Social Relations scores than nonusers. A similar finding pertained to Out and About scores, with the between-group difference significantly greater for those with greater depressive symptoms severity. Users and nonusers did not differ significantly on Productivity subscale.

Conclusions: The positive association between social Internet use and real-world social participation suggests that people with traumatic brain injury do not use social media as an alternative to real-world socialization. Rather, it is likely that similar barriers and facilitators affect both online and real-world social participation following traumatic brain injury. Emotional function should be considered as a moderating factor in further studies.
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http://dx.doi.org/10.1097/HTR.0000000000000566DOI Listing
February 2020

Assessing vigilance in caregivers after traumatic brain injury: TBI-CareQOL Caregiver Vigilance.

Rehabil Psychol 2020 Nov 23;65(4):418-431. Epub 2020 Jan 23.

Defense and Veterans Brain Injury Center.

Objective: Caregivers of individuals with traumatic brain injury (TBI) frequently experience anxiety related to the caregiver role. Often this is due to a caregiver's perceived need to avoid people and situations that might upset or "trigger" the care recipient. There are currently no self-report measures that capture these feelings; thus, this article describes the development and preliminary validation efforts for the TBI-Caregiver Quality of Life (CareQOL) Caregiver Vigilance item bank.

Design: A sample of 532 caregivers of civilians ( = 218) or service members/veterans (SMVs; = 314) with TBI completed 32 caregiver vigilance items, other measures of health-related quality of life (RAND-12, Patient-Reported Outcomes Measurement Information System [PROMIS] Depression, PROMIS Social Isolation, Caregiver Appraisal Scale), and the Mayo-Portland Adaptability Inventory-4.

Results: The final item bank contains 18 items, as supported by exploratory and confirmatory factor analysis, item response theory graded response modeling (GRM), and differential item functioning investigations. Expert review and GRM calibration data informed the selection of a 6-item short form and programming of a computer adaptive test. Internal consistency reliability for the different administration formats were excellent (reliability coefficients ≥ .90). Three-week test-retest stability was supported (i.e., ≥ .78). Correlations between vigilance and other self-report measures supported convergent and discriminant validity (0.01 ≤ ≤ .69). Known-groups validity was also supported.

Conclusions: The new TBI-CareQOL Caregiver Vigilance computer adaptive test and corresponding 6-item short form were developed using established rigorous measurement development standards, providing the first self-report measure to evaluate caregiver vigilance. This development work indicates that this measure exhibits strong psychometric properties. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/rep0000302DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7375946PMC
November 2020

TBI-CareQOL military health care frustration in caregivers of service members/veterans with traumatic brain injury.

Rehabil Psychol 2020 Nov 9;65(4):360-376. Epub 2020 Jan 9.

Defense and Veterans Brain Injury Center.

Purpose: Caregivers of service members/veterans (SMVs) encounter a number of barriers when navigating the military health care system. The purpose of this study was to develop a new measure to assess potential caregiver frustration with the systems of care and benefits in the United States Departments of Defense and Veterans Affairs.

Method: The TBI-CareQOL Military Health Care Frustration measure was developed using data from 317 caregivers of SMVs with TBI who completed an item pool comprised of 64 questions pertaining to anger or frustration with accessing military health care services.

Results: Exploratory and confirmatory factor analyses supported the retention of 58 items. Constrained graded response model (GRM) overall fit and item fit analyses and differential item functioning investigations of age and education factors supported the retention of 43 items in the final measure. Expert review and GRM item calibration products were used to inform the selection of two 6-item static short forms (TBI-CareQOL Military Health Care Frustration-Self; TBI-CareQOL Military Health Care Frustration-Person with TBI) and to program the TBI-CareQOL Military Health Care Frustration computer adaptive test (CAT). Preliminary data supported the reliability (i.e., internal consistency and test-retest reliability) as well as the validity (i.e., convergent, discriminant, and known-groups) of the new measure.

Conclusions: The new TBI-CareQOL Military Health Care Frustration measure can be used to examine caregiver perceptions of and experience with the military health care system, to target improvements. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/rep0000305DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7343601PMC
November 2020

TBI-CareQOL family disruption: Family disruption in caregivers of persons with TBI.

Rehabil Psychol 2020 Nov 16;65(4):390-400. Epub 2019 Dec 16.

Defense and Veterans Brain Injury Center.

Purpose: Family disruption is often an indirect consequence of providing care for a person with traumatic brain injury (TBI). This article describes the development and preliminary validation of a Family Disruption scale designed for inclusion within the TBI-CareQOL measurement system.

Method/design: Five hundred thirty-four caregivers of persons with TBI (service member/veteran = 316; civilian = 218) completed the Family Disruption scale, alongside several other measures of caregiver strain and health-related quality of life. Classical test theory and item response theory (IRT)-based analyses were conducted to develop, and establish reliability and validity of, this scale.

Results: Exploratory and confirmatory factor analysis, as well as Samejima's graded response model-related IRT fit analyses, supported the development of a 3-item scale. This final scale is scored on a T score metric ( = 50; = 10); higher scores are indicative of more family disruption. Reliability (internal consistency; test-retest stability) was supported for both caregiver groups, and average administration times were under 10 s. Convergent and discriminant validity were supported by strong correlations between Family Disruption and measures of caregiver burden, and smaller correlations with positive aspects of caregiving. As evidence of known-groups validity, caregivers of lower-functioning persons with TBI experienced more family disruption than caregivers of higher functioning individuals.

Conclusions: The TBI-CareQOL Family Disruption scale is a brief, reliable, and valid assessment of caregiver perceptions of how caring for an individual with a TBI interferes with family life. This measure is well-suited for inclusion in studies seeking to support family functioning in persons with TBI. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/rep0000297DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7295660PMC
November 2020

Reliability and validity data to support the clinical utility of the Traumatic Brain Injury Caregiver Quality of Life (TBI-CareQOL).

Rehabil Psychol 2020 Nov 12;65(4):323-336. Epub 2019 Dec 12.

H. Ben Taub Department of Physical Medicine and Rehabilitation.

Objective: The Traumatic Brain Injury Caregiver Quality of Life (TBI-CareQOL) is a patient-reported outcome measurement system that is specific to caregivers of civilians and service members/veterans (SMVs) with traumatic brain injury (TBI). This measurement system includes 26 item banks that represent both generic (i.e., borrowed from existing measurement systems) and caregiver-specific components of health-related quality of life (HRQOL). This report provides reliability and validity data for measures within the TBI-CareQOL that have not previously been reported (i.e., 4 caregiver-specific and 7 generic measures of HRQOL).

Design: Three hundred eighty-five caregivers of persons with TBI completed caregiver-specific computer adaptive tests (CATs) for Feelings of Loss-Self, Caregiver Strain, Caregiver-Specific Anxiety, and Feeling Trapped, as well as generic measures of HRQOL from complementary measurement systems (i.e., Neuro-QoL Positive Affect and Well-Being; PROMIS Sleep-Related Impairment; NIH Toolbox Perceived Stress, General Life Satisfaction, and Self Efficacy; TBI-QOL Resilience and Grief/Loss). Caregivers also completed several additional measures to establish convergent and discriminant validity, as well as the Mayo Portland Adaptability Index, 4th ed.

Results: Findings support the internal consistency reliability (all alphas > .85) and test-retest stability (all alphas >.73) of the TBI-CareQOL measures. Convergent validity was supported by moderate to high correlations between the TBI-CareQOL measures and related measures, whereas discriminant validity was supported by low correlations between the TBI-CareQOL measures and unrelated constructs. Known-groups validity was also supported.

Conclusions: Findings support the reliability and validity of the item banks that comprise the TBI-CareQOL Measurement System. These measures should be considered for any standardized assessment of HRQOL in caregivers of civilians and SMVs with TBI. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/rep0000295DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7357718PMC
November 2020

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

JMIR Res Protoc 2019 Nov 22;8(11):e14170. Epub 2019 Nov 22.

Research and Development Service, James A Haley Veterans' Hospital, Veterans Health Administration, Tampa, FL, United States.

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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http://dx.doi.org/10.2196/14170DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6898887PMC
November 2019

Measuring emotional suppression in caregivers of adults with traumatic brain injury.

Rehabil Psychol 2020 Nov 3;65(4):455-470. Epub 2019 Oct 3.

H. Ben Taub Department of Physical Medicine and Rehabilitation.

Objective: Caregivers of individuals with traumatic brain injury (TBI) often feel pressure to maintain the appearance that they are emotionally well adjusted, despite feelings to the contrary. Because there are currently no measures examining this construct, this article focuses on the development of a new measure that is specific to caregivers of people with TBI.

Design: A total of 533 caregivers of civilians with TBI ( = 218) or service members/veterans (SMVs) with TBI ( = 315) completed 43 emotional suppression items, as well as other patient-reported outcomes and an estimate of the functional ability of the person with TBI.

Results: Exploratory and confirmatory factor analyses supported the retention of 25 items. Graded response model (GRM) analyses and differential item functioning (DIF) studies supported the retention of 21 items in the final measure. Expert review and GRM calibration data were used to develop a 6-item static short form (SF) and program a computer adaptive test (CAT). Internal consistency was excellent for both the CAT and SF (reliabilities ≥ 0.91); 3-week test-retest stability was good (all intraclass correlations ≥ 0.89). Convergent validity was supported by moderate associations between TBI-CareQOL Emotional Suppression and related measures (s from 0.47 to 0.59); discriminant validity was supported by small correlations between Emotional Suppression and positive aspects of caregiving and physical health (s from 0.14 to 0.28). Known-groups validity was also supported.

Conclusions: The new TBI-CareQOL Emotional Suppression CAT and 6-item short form is the first self-report measure of this construct in this population. Our findings suggest this new measure has strong psychometric properties. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/rep0000291DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7117989PMC
November 2020

Measuring Pain in TBI: Development of the TBI-QOL Pain Interference Item Bank and Short Form.

Arch Phys Med Rehabil 2020 01 25;101(1):11-19. Epub 2019 Sep 25.

Center for Health Assessment Research and Translation, University of Delaware College of Health Sciences, Newark, Delaware, United States; Departments of Physical Therapy and Psychological & Brain Sciences, University of Delaware, Newark, Delaware, United States. Electronic address:

Objective: To develop a pain interference item bank, computer adaptive test (CAT), and short form for use by individuals with traumatic brain injury (TBI).

Design: Cross-sectional survey study.

Setting: Five TBI Model Systems rehabilitation hospitals.

Participants: Individuals with TBI (N=590).

Interventions: Not applicable.

Outcome Measures: Traumatic Brain Injury-Quality of Life (TBI-QOL) Pain Interference item bank.

Results: Confirmatory factor analysis provided evidence of a single underlying trait (χ [740]=3254.030; P<.001; Comparative Fix Index=0.988; Tucker-Lewis Index=0.980; Root Mean Square Error of Approximation=0.076) and a graded response model (GRM) supported item fit of 40 Pain Interference items. Items did not exhibit differential item functioning or local item dependence. GRM calibration data were used to inform the selection of a 10-item static short form and to program a TBI-QOL Pain Interference CAT. Comparative analyses indicated excellent comparability and reliability across test administration formats.

Conclusion: The 40-item TBI-QOL Pain Interference item bank demonstrated strong psychometric properties. End users can administer this measure as either a 10-item short form or CAT.
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http://dx.doi.org/10.1016/j.apmr.2019.07.019DOI Listing
January 2020

Linking the GAD-7 and PHQ-9 to the TBI-QOL Anxiety and Depression Item Banks.

J Head Trauma Rehabil 2019 Sep/Oct;34(5):353-363

Center for Health Assessment Research and Translation, College of Health Sciences (Drs Boulton, Tyner, and Tulsky and Ms Kisala) and Departments of Physical Therapy and Psychological & Brain Sciences (Dr Tulsky), University of Delaware, Newark; Educational Psychology Department, The University of Texas at Austin (Dr Choi); H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine and Harris Health System, Houston, Texas (Dr Sander); TIRR Memorial Hermann, Houston, Texas (Drs Sander and Sherer); Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Dr Heinemann); Shirley Ryan AbilityLab, Chicago, Illinois (Dr Heinemann); Rusk Rehabilitation, NYU Langone Health, New York, New York (Dr Bushnik); Kessler Foundation, East Hanover, New Jersey (Dr Chiaravalloti); and Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark (Dr Chiaravalloti).

Objective: To link scores on commonly used measures of anxiety (7-item Generalized Anxiety Disorder Scale; GAD-7) and depression (9-item Patient Health Questionnaire; PHQ-9) to the Traumatic Brain Injury Quality of Life (TBI-QOL) measurement system.

Setting: 5 Traumatic Brain Injury Model Systems.

Participants: A total of 385 individuals with traumatic brain injury (TBI) (31% complicated mild; 14% moderate; and 54% severe).

Design: Observational cohort.

Main Measures: GAD-7, PHQ-9, TBI-QOL Anxiety v1.0 and TBI-QOL Depression v1.0.

Results: Item response theory-based linking methods were used to create crosswalk tables that convert scores on the GAD-7 to the TBI-QOL Anxiety metric and scores on the PHQ-9 to the TBI-QOL Depression metric. Comparisons between actual and crosswalked scores suggest that the linkages were successful and are appropriate for group-level analysis. Linking functions closely mirror crosswalks between the GAD-7/PHQ-9 and the Patient-Reported Outcomes Measurement Information System (PROMIS), suggesting that general population linkages are similar to those from a TBI sample.

Conclusion: Researchers and clinicians can use the crosswalk tables to transform scores on the GAD-7 and the PHQ-9 to the TBI-QOL metric for group-level analyses.
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http://dx.doi.org/10.1097/HTR.0000000000000529DOI Listing
October 2020

Development and Calibration of the TBI-QOL Ability to Participate in Social Roles and Activities and TBI-QOL Satisfaction With Social Roles and Activities Item Banks and Short Forms.

Arch Phys Med Rehabil 2020 01 29;101(1):20-32. Epub 2019 Aug 29.

Center for Health Assessment Research and Translation, University of Delaware, Newark, Delaware; Departments of Physical Therapy and Psychological & Brain Sciences, University of Delaware, Newark, Delaware. Electronic address:

Objective: To develop traumatic brain injury (TBI)-optimized versions of the Quality of Life in Neurological Disorders (Neuro-QoL) Ability to Participate in Social Roles and Activities and Satisfaction with Social Roles and Activities item banks, evaluate the psychometric properties of the item banks developed for adults with TBI, develop short form and computer adaptive test (CAT) versions, and report information to facilitate research and clinical applications.

Design: We used a mixed methods design to develop and evaluate Ability to Participate in Social Roles and Activities and Satisfaction with Social Roles and Activities items. Focus groups defined the constructs, cognitive interviews guided item revisions, and confirmatory factor analysis and item response theory methods helped calibrate item banks and evaluate differential item functioning related to demographic and injury characteristics.

Setting: Five TBI Model Systems centers in the United States.

Participants: Community-dwelling adults with TBI (N=556).

Interventions: None.

Outcome Measures: Traumatic Brain Injury-Quality of Life (TBI-QOL) Ability to Participate in Social Roles and Activities and TBI-QOL Satisfaction with Social Roles and Activities item banks.

Results: Forty-five Ability to Participate in Social Roles and Activities and 41 Satisfaction with Social Roles and Activities items demonstrated good psychometric properties. Although some of the items are new, most were drawn from analogous banks in the Neuro-QoL measurement system. Consequently, the 2 TBI-QOL item banks were linked to the Neuro-QoL metric, and scores are comparable with the general population. All CAT and short forms correlated highly (>0.90) with the full item banks and demonstrate comparable construct coverage and measurement error.

Conclusion: The TBI-QOL Ability to Participate in Social Roles and Activities and TBI-QOL Satisfaction with Social Roles and Activities item banks are TBI-optimized versions of the Neuro-QoL Ability to Participate in Social Roles and Activities and Satisfaction with Social Roles and Activities item banks and demonstrate excellent measurement properties in individuals with TBI. These measures, particularly in CAT or short form format, are suitable for efficient and precise measurement of social outcomes in clinical and research applications.
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http://dx.doi.org/10.1016/j.apmr.2019.07.015DOI Listing
January 2020

Development and Psychometric Characteristics of the TBI-QOL Independence Item Bank and Short Form and the TBI-QOL Asking for Help Scale.

Arch Phys Med Rehabil 2020 01 29;101(1):33-42. Epub 2019 Aug 29.

Department of Physical Medicine & Rehabilitation, Wayne State University, Detroit, Michigan, United States.

Objective: To develop an item response theory (IRT)-calibrated, patient-reported outcome measure of subjective independence for individuals with traumatic brain injury (TBI).

Design: Large-scale item calibration field testing; confirmatory factor analysis (CFA) and graded response model IRT analyses.

Setting: Five TBI Model System centers across the United States.

Participants: Adults with complicated mild, moderate, or severe TBI (N=556).

Outcome Measures: Traumatic Brain Injury-Quality of Life (TBI-QOL) Independence item bank and the TBI-QOL Asking for Help scale.

Results: A total of 556 individuals completed 44 items in the Independence item pool. Initial factor analyses indicated that items related to the idea of "asking for help" were measuring a different construct from other items in the pool. These 9 items were set aside. Twenty-two other items were removed because of bimodal distributions and/or low item-total correlations. CFA supported unidimensionality of the remaining Independence items. Graded response model IRT analysis was used to estimate slopes and thresholds for the final 13 Independence items. An 8-item fixed-length short form was also developed. The 9 Asking for Help items were analyzed separately. One misfitting item was deleted, and the final 8 items became a fixed-length IRT-calibrated scale. Reliability was high for both measures.

Conclusions: The IRT-calibrated TBI-QOL Independence item bank and short form and TBI-QOL Asking for Help scale may be used to measure important issues for individuals with TBI in research and clinical applications.
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http://dx.doi.org/10.1016/j.apmr.2019.08.469DOI Listing
January 2020

Emotional Suppression and Hypervigilance in Military Caregivers: Relationship to Negative and Positive Affect.

J Head Trauma Rehabil 2020 Jan/Feb;35(1):E10-E20

H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine/Harris Health System and Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas (Dr Sander); Department of Physical Medicine and Rehabilitation, University of Michigan (Mr Boileau and Dr Carlozzi); Department of Physical Medicine and Rehabilitation, School of Medicine, Wayne State University, Detroit, Michigan (Dr Hanks); and Center for Health Assessment Research and Translation, and Departments of Physical Therapy and Psychological and Brain Sciences, University of Delaware, Newark (Dr Tulsky).

Objective: To investigate the relationship of 2 health-related quality-of-life (QOL) item banks (Emotional Suppression and Caregiver Vigilance), developed for caregivers of service members/veterans with traumatic brain injury (TBI), to caregivers' positive and negative affect.

Setting: Community.

Participants: One hundred sixty-five caregivers of service members/veterans with TBI.

Design: Retrospective database analysis.

Main Measures: TBI-CareQOL Emotional Suppression; TBI-CareQOL Caregiver Vigilance; measures of negative (Patient-Reported Outcomes Measurement Information System [PROMIS] Depression, PROMIS Anger, TBI-CareQOL Caregiver-Specific Anxiety, National Institutes of Health Toolbox [NIHTB] Perceived Stress, GAD-7) and positive affect (Neuro-QOL Positive Affect and Well-being, NIHTB Self-efficacy, NIHTB General Life Satisfaction, Family Resilience Scale for Veterans, TBI-QOL Resilience).

Results: When considered separately, linear regression showed that higher levels of Emotional Suppression and greater Caregiver Vigilance were individually associated with more negative affect and less positive affect. When considered together, the pattern of findings was generally consistent for both Emotional Suppression and Caregiver Vigilance with regard to negative affect and for Emotional Suppression with regard to positive affect. However, when considered together, Caregiver Vigilance was no longer related to positive affect.

Conclusions: Caregivers with high emotional suppression and/or vigilance are more likely to show emotional distress and less likely to have positive affect than caregivers with lower levels of emotional suppression and vigilance. A combination of education and individual counseling targeting coping with negative emotions and TBI-related problems may be beneficial.
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http://dx.doi.org/10.1097/HTR.0000000000000507DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7643713PMC
August 2019

The Impact of One's Sex and Social Living Situation on Rehabilitation Outcomes After a Stroke.

Am J Phys Med Rehabil 2020 01;99(1):48-55

From the University of Texas Medical Branch, Division of Rehabilitation Science, Galveston, Texas (CCH, JG, MRP); H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas (AMS); and University of Texas Medical Branch School of Occupational Therapy, Galveston, Texas (IH, TR).

Objective: The aim of the study was to investigate sex differences and the impact of social living situation on individual functional independence measure outcomes after stroke rehabilitation.

Design: A retrospective observational study using Medicare fee-for-service beneficiaries (N = 125,548) who were discharged from inpatient rehabilitation facilities in 2013 and 2014 after a stroke. Discharge individual functional independence measure score, dichotomized as ≥5 and <5, was the primary outcome measure. A two-step generalized linear mixed model was used to measure the effect of sex on each functional independence measure item while controlling for many clinical and sociodemographic covariates.

Results: After adjusting for sociodemographic and clinical factors, females had higher odds of reaching a supervision level for 14 of 18 functional independence measure items. Males had higher odds of reaching a supervision level on 2 of 18 functional independence measure items. Individuals who lived alone before their stroke had higher odds of reaching a supervision level than individuals who lived with a caregiver or with family for all functional independence measure items.

Conclusions: When sociodemographic and clinical factors are controlled, females are more likely to discharge from inpatient rehabilitation at a supervision level or better for most functional independence measure items. Individuals who live alone before their stroke have higher odds of discharging at a supervision level or better.
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http://dx.doi.org/10.1097/PHM.0000000000001276DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6920562PMC
January 2020

Group Differences Among Caregivers of Civilians and Service Members or Veterans With Traumatic Brain Injury.

Arch Phys Med Rehabil 2019 04 8;100(4S):S52-S57. Epub 2018 Dec 8.

Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI.

Objective: To examine group differences among caregivers of service members or veterans (SMVs) and civilians with traumatic brain injury (TBI).

Design: An observational research study examining the group differences between caregivers of SMVs and civilians with TBI. The data presented was collected as part of a larger study that calibrated and validated the Traumatic Brain Injury-Care Quality of Life (TBI-CareQOL) item banks.

Setting: Participants in this multicenter study completed an online survey via a study-specific website. Surveys were completed at the study site, at home, or via phone interview. Civilian caregivers were recruited from 4 rehabilitation hospitals and caregivers of SMVs were recruited through community outreach and collaboration with the Hearts of Valor.

Participants: Participants (N=473) consisted of 344 caregivers of civilians with TBI and 129 caregivers of SMVs with TBI.

Interventions: Not applicable.

Main Outcome Measures: Zarit Burden Interview Scale, TBI-CareQOL, and Mayo Portland Adaptability Inventory, 4th revision (MPAI-4).

Results: Of the independent variables included in the logistic regression model that classified military-affiliated vs civilian caregivers, 5 were statistically significant: age, spousal status, time since injury, MPAI-4 Adjustment, and TBI-CareQOL Feeling Trapped.

Conclusions: The results indicate that caregivers of SMVs were more likely to report worse emotional and social adjustment among the individuals with TBI and caregivers of SMVs were more likely to report greater levels of feeling trapped by their caregiving duties.
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http://dx.doi.org/10.1016/j.apmr.2018.11.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6528672PMC
April 2019

Lived experiences of chronic cognitive and mood symptoms among community-dwelling adults following stroke: a mixed-methods analysis.

Aging Ment Health 2019 09 27;23(9):1227-1233. Epub 2018 Oct 27.

a Division of Rehabilitation Sciences, School of Health Professions , University of Texas Medical Branch at Galveston (UTMB) , Galveston , TX , USA.

Few studies have explored the lived experiences of chronic cognitive and mood symptoms following stroke using a racially/ethnically diverse sample. Therefore, we aimed to explore the perceptions of chronic post-stroke cognition and mood symptoms and goals among a racially/ethnically diverse sample of community-dwelling adults aging with stroke. This qualitative study using mixed-methods analysis included semi-structured interviews regarding perceived post-stroke cognitive and mood symptoms among community-dwelling stroke survivors at least one-year post stroke. Transcripts were subjected to thematic content analysis, and differences in theme usage patterns by age, gender, race/ethnicity, and post-acute rehabilitation setting were assessed using an inferential clustering technique. The majority of participants (93%) reported cognition-related themes, including language and communication, memory, thinking abilities, comprehension, visual-spatial processing, and cognitive assessments and training. Nearly half of participants mentioned mood-related themes, including depression, aggression and anger, mood fluctuations, anxiety, and psychological services and medication. Nearly half reported an unmet need for cognition or mood-related treatment. Inferential clustering analysis revealed that older participants reported a different pattern of cognitive and mood symptoms than those aged younger than 65 ( = 0.02). Older adults were more likely to describe post-stroke language/communication changes, while younger adults described post-stroke mood changes. Stroke survivors experienced cognitive and mood-related symptoms beyond one-year post stroke, which has implications for long-term assessment and management. Incorporation of continued symptom monitoring into existing community-based services is needed to address chronic cognitive and mood symptoms affecting the quality of life of persons with stroke.
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http://dx.doi.org/10.1080/13607863.2018.1481927DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6486878PMC
September 2019