Date Presented 4/8/2016
This retrospective study explored the rate of return to productivity (RTP) in Operation Enduring Freedom/Operation Iraqi Freedom veterans who screened positive on the Veterans Affairs Comprehensive Traumatic Brain Injury Evaluation. Results showed depression and race were associated with RTP. Further prospective study is needed to explore predictors of RTP.
Primary Author and Speaker: Marianne Mortera
Additional Authors and Speakers: Heidi Klingbeil, Jessie Simantov, Stacy Kinirons
Contributing Authors: Stacy Kinirons, Jessie Simantov, Heidi Klingbeil
BACKGROUND: Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans with blast-related traumatic brain injury (TBI) account for 22% of combat injuries. For veterans to be directed toward optimal services to maximize their functional potential, an understanding of their current functional status is prerequisite.
PURPOSE: To determine the rate of return to productivity (RTP) in veterans of OEF/OIF who screen positive on the Veterans Affairs (VA) Comprehensive Traumatic Brain Injury Evaluation (CTBIE)
RESEARCH DESIGN: Retrospective medical record review at the outpatient clinic of the VA Medical Center Polytrauma Network Site
PARTICIPANTS: Medical records of 236 OEF/OIF veterans who underwent a CTBIE between 2009 and 2013 were included in this study.
DATA COLLECTION: Deidentified data that were collected from the medical records included patient demographics, injury history, symptoms, TBI diagnosis, and current employment status.
ANALYSIS: All deidentified data were entered into an SPSS statistical spreadsheet, and chi-square analysis using SPSS statistical software was used to determine significance.
RESULTS: Of the 236 veterans, 90.7% were male, 45.3% were White, 34.7% were Black, 47.9% were non-Hispanic, and 49.2% were Hispanic, with a mean age of 33.24 yr (standard deviation [SD] = 6.97). Most veterans had some college (46.9%). Two hundred thirty veterans reported number of injuries, with 56.5% reporting one and 30.5% reporting more than one. One hundred forty-five veterans reported time since most serious injury, with a mean of 48.75 mo (SD = 31.76 mo). Two hundred twelve veterans reported cause of injuries, with 59.0% reporting blast and 24.5% reporting nonblast. More than 90% of veterans reported anxiousness, irritability, sleep difficulty, forgetfulness, and headaches; 95.8% reported pain in the past 30 days; 89.5% (n = 219) of veterans had psychiatric symptoms; 69.1% of veterans were diagnosed with TBI. Return to productivity (part-time or full-time employment status or student) was 60.6% for the total population. On the basis of chi-square analysis, factors associated with return to productivity included race (p = .007) and feeling depressed (p = .017).
RESULTS: Veterans reported a substantial number of symptoms and a considerable amount of time since most serious injury. The majority of veterans were diagnosed with TBI.
DISCUSSION: RTP was problematic for many of the veterans and was associated with race and feeling depressed. Further prospective study is needed to explore self-identified factors affecting RTP.
IMPACT: There is a critical need for occupational therapy practitioners to understand the unique needs of the veteran with TBI in order to provide best practice and optimal rehabilitation services.
References
Lippa, S. M., Pastorek, N. J., Benge, J. F., & Thornton, G. M. (2010). Postconcussive symptoms after blast and nonblast-related mild traumatic brain injuries in Afghanistan and Iraq war veterans. Journal of the International Neuropsychological Society, 16, 856–866. http://dx.doi.org/10.1017/S135561771000074
O’Neil, E., Carlson, K. F., Storzbach, D., Brenner, L. A., Freeman, M., Quinones, A. R., . . . Kansagara, D. (2014). Factors associated with mild traumatic brain injury in veterans and military personnel: A systematic review. Journal of the International Neuropsychological Society. Advance online publication.
U.S. Department of Veterans Affairs/U.S. Department of Defense. (2009). Clinical practice guidelines: Management of concussion—Mild traumatic brain injury (mTBI). Retrieved April 2013 from http://www.healthquality.va.gov/guidelines/Rehab/mtbi/
Vanderploeg, R. D., Belanger, H. G., & Horner, R. D. (2012). Health outcomes associated with military deployment: Mild traumatic brain injury, blast, trauma, and combat associations in the Florida National Guard. Archives of Physical Medicine and Rehabilitation, 93, 1887–1895. http://dx.doi.org/10.1016/j.apmr.2012.05.024
