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Krch D, Lequerica AH, Arango-Lasprilla JC, Corrigan JD. Neurobehavioral Symptoms in Spanish-Speaking Individuals With Subconcussive Injuries. J Head Trauma Rehabil 2024:00001199-990000000-00127. [PMID: 38456793 DOI: 10.1097/htr.0000000000000939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
OBJECTIVE To examine whether exposure to high-risk events causing injury to the head or neck has an effect on neurobehavioral symptoms in the absence of an alteration of consciousness in Spanish-speakers. SETTING Web-based survey. PARTICIPANTS Seven hundred forty-eight individuals from Spain and Latin America, aged 18 to 65 years, with 10 years or more of education. Thirty-nine participants failed quality checks and were excluded. Seven hundred nine participants were included in the analyses. DESIGN Cross-sectional study. Subconcussive exposure was defined as endorsing exposure to one or more high-risk scenarios in the absence of any alteration of consciousness. Three injury groups were derived: No Head Injury, Subconcussive Exposure, and traumatic brain injury (TBI). The Subconcussive Exposure group was further divided into Single and Multiple Exposures. Two analyses were conducted: the effect of lifetime exposure to injury (No Head Injury, Subconcussive Exposure, TBI) on neurobehavioral symptoms; the effect of Subconcussive Exposure Frequency (No Head Injury, Single Exposure, Multiple Exposures) on neurobehavioral symptoms. MAIN MEASURES Spanish Ohio State University Traumatic Brain Injury Identification Method Self-Administered-Brief (OSU TBI-ID SAB); Neurobehavioral Symptom Inventory (NSI). RESULTS There was a significant effect for Injury group on the NSI partial eta-squared (ηp2 = 0.053) and a significant effect of Exposure Frequency group on the NSI (ηp2 = 0.40). Individuals with subconcussive exposures reported significantly more neurobehavioral symptoms than those with no history of head injury and significantly less symptoms than those with TBI. Individuals with multiple subconcussive exposures reported significantly more neurobehavioral symptoms than those with single and no exposure. CONCLUSION This research expands the utility of the OSU-TBI-ID SAB as a lifetime TBI history assessment tool to one capable of evaluating subconcussive exposure dosing effects in Spanish-speakers. Such an index may facilitate establishment of subconcussive exposure prevalence rates worldwide, leading to improved understanding of the chronic effects of high-risk exposures.
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Affiliation(s)
- Denise Krch
- Author Affiliations: Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, and Department of Physical Medicine and Rehabilitation, Rutgers, New Jersey Medical School, Newark, New Jersey (Drs Krch and Lequerica); Department of Psychology, Virginia Commonwealth University, Richmond, Virginia (Dr Arango-Lasprilla); and Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, Ohio (Dr Corrigan)
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Sander AM, Pappadis MR, Juengst SB, Leon-Novelo L, Ngan E, Corrigan JD, Dreer LE, Driver S, Lequerica AH. Characterizing Health Literacy and Its Correlates Among Individuals With Traumatic Brain Injury (TBI): A TBI Model Systems Study. J Head Trauma Rehabil 2024; 39:95-102. [PMID: 38529906 DOI: 10.1097/htr.0000000000000913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
OBJECTIVE To characterize health literacy among individuals with traumatic brain injury (TBI) at least a year postinjury and to explore its relationship to sociodemographic variables, injury severity, and cognition. SETTING Community following discharge from inpatient rehabilitation. PARTICIPANTS In total, 205 individuals with complicated mild to severe TBI who completed follow-up as part of a national longitudinal study of TBI and completed a web-based health literacy measure. DESIGN Multicenter, cross-sectional, observational study. MAIN MEASURES Health Literacy Assessment Using Talking Touchscreen Technology. RESULTS Thirty-one percent of the sample demonstrated marginal/inadequate health literacy; 69% demonstrated adequate health literacy. A higher proportion of non-Hispanic White adults had adequate health literacy than non-Hispanic Black and Hispanic adults. Individuals with greater than a high school education were more likely to have adequate health literacy than those with a high school education or less. Better executive functioning performance was related to adequate health literacy. Better episodic memory performance was related to adequate health literacy, but only for those with complicated mild to moderate injury. CONCLUSIONS A substantial proportion of individuals with TBI have marginal/inadequate health literacy, which may impact their understanding, appreciation, and use of health-related information and recommendations. While low health literacy may be preexisting, directly related to TBI, or a combination of both, it should be screened and considered by professionals when communicating with persons with TBI. Healthcare providers should tailor their communication approaches and presentation of health information, particularly for those with low health literacy.
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Affiliation(s)
- Angelle M Sander
- Author Affiliations: H. Ben Taub 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, Pappadis, and Juengst); Department of Population Health and Health Disparities, School of Public and Population Health, The University of Texas Medical Branch (UTMB) and Sealy Center on Aging, UTMB (Dr Pappadis), Galveston; Department of Physical Medicine and Rehabilitation, UTHealth, Houston, Texas (Dr Juengst); Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Sciences Center at Houston (Dr Leon-Novelo); Department of Radiology, Baylor College of Medicine, Houston, Texas (Dr Ngan); Department of Physical Medicine & Rehabilitation, The Ohio State University, Columbus (Dr Corrigan); Department of Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, Texas (Dr Driver); Baylor Scott and White Research Institute, Dallas, Texas (Dr Driver); Department of Physical Medicine & Rehabilitation, University of Alabama at Birmingham (Dr Dreer); Kessler Foundation, East Hanover, New Jersey; and Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark (Dr Lequerica)
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Pappadis MR, Sander AM, Juengst SB, Leon-Novelo L, Ngan E, Bell KR, Corrigan JD, Driver S, Dreer LE, Lequerica AH. The Relationship of Health Literacy to Health Outcomes Among Individuals With Traumatic Brain Injury: A Traumatic Brain Injury Model Systems Study. J Head Trauma Rehabil 2024; 39:103-114. [PMID: 37862139 PMCID: PMC10965390 DOI: 10.1097/htr.0000000000000912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
OBJECTIVE To examine the associations between health literacy and health outcomes among individuals with traumatic brain injury (TBI) at least a year post-injury. SETTING Community following discharge from inpatient rehabilitation. PARTICIPANTS A total of 205 individuals with complicated mild to severe TBI who completed a TBI Model Systems National Database follow-up interview and a web-based health literacy measure. DESIGN A multicenter, cross-sectional, observational study. MAIN MEASURES The Health Literacy Assessment Using Talking Touchscreen Technology (Health LiTT), number of comorbid conditions (Medical and Mental Health Comorbidities Interview [MMHCI]), perceived physical and mental health (PROMIS Global Physical and Mental Health subscales), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7). RESULTS After controlling for sociodemographic, injury, cognition, and time post-injury, adequate health literacy was associated with higher odds of greater perceived physical health compared with participants with marginal/inadequate health literacy (odds ratio = 4.10; CI = 1.52-11.70]. Participants with inadequate/marginal health literacy had 3.50 times greater odds of depression (PHQ-9 ≥ 10) compared with those with adequate health literacy. Participants 45 years and older reported a greater number of MMHCI physical health conditions, but fewer MMHCI mental health conditions and GAD-7 anxiety symptoms compared with those who were younger. Non-Hispanic White participants and those with mild/moderate TBI were more likely to report a greater number of MMHCI mental health conditions compared with non-Hispanic Black participants or those with severe TBI. Greater time post-injury was associated with greater number of chronic physical and mental health conditions, and less odds of good-to-excellent perceived global mental health. CONCLUSIONS Inadequate health literacy is associated with worse perceived physical health and greater depressive symptoms among adults with TBI. Greater efforts are needed to explore the mechanisms by which health literacy influences chronic disease management and mental health after TBI to improve postinjury health status and outcomes, particularly among those with limited health literacy skills.
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Affiliation(s)
- Monique R Pappadis
- Author Affiliations: Department of Population Health and Health Disparities School of Public and Population Health, The University of Texas Medical Branch (UTMB) and Sealy Center on Aging, UTMB, Galveston (Dr Pappadis); Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas (Drs Sander, Pappadis, and Juengst); H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine and Harris Health System, Houston, Texas (Dr Sander); Department of Physical Medicine and Rehabilitation, UTHealth, Houston, Texas (Dr Juengst); School of Public Health, Biostatistics and Data Science Department, University of Texas Health Sciences Center at Houston, Houston (Dr Leon-Novelo); Department of Radiology, Baylor College of Medicine, Houston, Texas (Dr Ngan); Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas (Dr Bell); Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus (Dr Corrigan); Department of Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, Texas (Dr Driver); Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham (Dr Dreer); and Kessler Foundation, East Hanover, New Jersey, and Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark (Dr Lequerica)
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Kalpakjian CZ, Hanks R, Quint EH, Millis S, Sander AM, Lequerica AH, Bushnik T, Brunner R, Rapport L. Assessing menopause symptoms in women with traumatic brain injury: the development and initial testing of a new scale. Women Health 2024; 64:51-64. [PMID: 38097958 DOI: 10.1080/03630242.2023.2294969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/09/2023] [Indexed: 12/30/2023]
Abstract
With greater survival rates after catastrophic injury, more women with traumatic brain injury (TBI) are living longer than ever. However, knowledge about this transition in these women is largely unexamined and there are no scales that have been developed to assess the experience of symptoms. To address this gap, we developed and tested a new scale of menopause symptoms in midlife women with TBI. We selected candidate items from two existing measures based on feedback from focus group discussions with seven women with TBI. Twenty candidate items were tested in cognitive interviews with six women with TBI/1 non-TBI. Then, these were field tested with 221 participants (TBI, n = 68; non-TBI, n = 153) recruited from registries. Rasch analysis and convergent validity testing were used to evaluate the new scale. Results of the Rasch analysis indicate that overall, the scale fits well the Rasch model with evidence for unidimensionality. Differential item functioning indicated that the scale performed equally well for women with and without TBI and distinguished pre- and post-menopausal states. Convergent validity was found in the expected directions. These findings support further development of the new scale to understand the experience of menopause symptoms among women with TBI.
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Affiliation(s)
- Claire Z Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Robin Hanks
- Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Elisabeth H Quint
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - Scott Millis
- Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Angelle M Sander
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine and the Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas, USA
| | - Anthony H Lequerica
- Center for Traumatic Brain Injury Research, Kessler Foundation, West Orange, New Jersey, USA
| | - Tamara Bushnik
- Rusk Rehabilitation, NYU Langone Health, New York, NY, USA
| | - Robert Brunner
- Department of Physical Medicine and Rehabilitation, University of Alabama, Birmingham, Alabama, USA
| | - Lisa Rapport
- Department of Psychology, Wayne State University, Detroit, Michigan, USA
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Arango-Lasprilla JC, Watson JD, Ertl MM, Morel Valdes GM, Lequerica AH, Perrin PB. Trajectories of life satisfaction in Hispanic individuals over the 10 years after traumatic brain injury: A model systems study. Brain Inj 2023; 37:697-705. [PMID: 37317533 DOI: 10.1080/02699052.2023.2216025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE To identify life satisfaction trajectories at 1-10 years post-traumatic brain injury (TBI) and examine which demographic and injury characteristics at the time of injury are associated with those trajectories. METHODS Participants included 1,051 Hispanic individuals from the multi-site, longitudinal TBI Model Systems (TBIMS) database. Individuals were enrolled after sustaining a TBI and while undergoing inpatient rehabilitation at a TBIMS site; they were included if they completed the Satisfaction with Life Scale during one or more follow-up data collections at 1, 2, 5, or 10 years after TBI. RESULTS A linear (straight-line) movement of life satisfaction trajectories was the best fit to the data. Across the overall sample, life satisfaction increased over time, with higher trajectories for Hispanic individuals who had been partnered at baseline, born outside the US and experienced a nonviolent injury cause. There were no significant interactions between time and any of these main effect predictors, suggesting no differential change over time in life satisfaction trajectories as a function of these characteristics. CONCLUSIONS Results revealed increases in life satisfaction over time among Hispanic individuals with TBI and shed light on critical risks and protective factors that may inform targeted rehabilitation services with this underserved group.
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Affiliation(s)
| | - Jack D Watson
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Melissa M Ertl
- Department of Psychiatry, HIV Center for Clinical and Behavioral Studies at Columbia University and New York State Psychiatric Institute, New York, New York, USA
| | - Gloria M Morel Valdes
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Anthony H Lequerica
- Department of Physical Medicine and Rehabilitation, Rutgers - New Jersey Medical School, Newark, New Jersey, USA
- Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, New Jersey, USA
| | - Paul B Perrin
- Departments of Psychology and Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
- Polytrauma Rehabilitation Center TBI Model Systems, Central Virginia Veterans Affairs Health Care System, Richmond, Virginia, USA
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Dams-O'Connor K, Juengst SB, Bogner J, Chiaravalloti ND, Corrigan JD, Giacino JT, Harrison-Felix CL, Hoffman JM, Ketchum JM, Lequerica AH, Marwitz JH, Miller AC, Nakase-Richardson R, Rabinowitz AR, Sander AM, Zafonte R, Hammond FM. Traumatic brain injury as a chronic disease: insights from the United States Traumatic Brain Injury Model Systems Research Program. Lancet Neurol 2023; 22:517-528. [PMID: 37086742 DOI: 10.1016/s1474-4422(23)00065-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/14/2022] [Accepted: 01/31/2023] [Indexed: 04/24/2023]
Abstract
Traumatic brain injury (TBI) is a global health priority, associated with substantial burden. Historically conceptualised as an injury event with finite recovery, TBI is now recognised as a chronic condition that can affect multiple domains of health and function, some of which might deteriorate over time. Many people who have had a TBI remain moderately to severely disabled at 5 years, are rehospitalised up to 10 years post-injury, and have a reduced lifespan relative to the general population. Understanding TBI as a chronic disease process can be highly informative for optimising care, which has traditionally focused on acute care. Chronic brain injury care models must be informed by a holistic understanding of long-term outcomes and the factors that can affect how care needs evolve over time. The United States Traumatic Brain Injury Model Systems of Care follows up individuals with moderate-to-severe TBI for over 30 years, allowing characterisation of the chronic (2-30 years or more post injury) functional, cognitive, behavioural, and social sequelae experienced by individuals who have had a moderate-to-severe TBI and the implications for their health and quality of life. Older age, social determinants of health, and lower acute functional status are associated with post-recovery deterioration, while younger age and greater functional independence are associated with risky health behaviours, including substance misuse and re-injury. Systematically collected data on long-term outcomes across multiple domains of health and function are needed worldwide to inform the development of models for chronic disease management, including the proactive surveillance of commonly experienced health and functional challenges.
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Affiliation(s)
- Kristen Dams-O'Connor
- Brain Injury Research Center, Department of Rehabilitation and Human Performance, Brain Injury Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. kristen.dams-o'
| | - Shannon B Juengst
- Brain Injury Research Center, TIRR Memorial Hermann, Houston, TX, USA; Department of Physical Medicine & Rehabilitation, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jennifer Bogner
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH, USA
| | - Nancy D Chiaravalloti
- Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, USA; Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - John D Corrigan
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH, USA
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | | | - Jeanne M Hoffman
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | | | - Anthony H Lequerica
- Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, USA
| | - Jennifer H Marwitz
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - A Cate Miller
- National Institute on Disability, Independent Living, and Rehabilitation Research, Administration for Community Living, US Department of Health and Human Services, Washington, DC, USA
| | - Risa Nakase-Richardson
- Research Service, James A Haley Veterans Hospital, Tampa, FL, USA; Department of Internal Medicine, Pulmonary and Sleep Medicine Division, University of South Florida, Tampa, FL, USA
| | - Amanda R Rabinowitz
- Department of Physical Medicine and Rehabilitation, Moss Rehabilitation Research Institute, Elkins Park, PA, USA; Department of Physical Medicine and Rehabilitation, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Angelle M Sander
- Brain Injury Research Center, TIRR Memorial Hermann, Houston, TX, USA; H Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, Brigham and Women's Hospital, Boston, MA, USA
| | - Flora M Hammond
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN, USA; Rehabilitation Hospital of Indiana, Indianapolis, IN, USA
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Lasprilla JCA, Watson JD, Merced K, Mascialino G, Lequerica AH, Perrin PB. Trajectories of Cognitive and Motor Functional Independence in Hispanic Individuals During the 10 yrs After Traumatic Brain Injury. Am J Phys Med Rehabil 2023; 102:308-315. [PMID: 36098351 DOI: 10.1097/phm.0000000000002092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study examined demographic and injury-related predictors of cognitive and motor functional independence in Hispanics with traumatic brain injury at years 1, 2, 5, and 10 after hospital discharge. DESIGN Hispanic participants ( n = 1360) from the TBI Model Systems Study were included if they had at least one Functional Independence Measure (FIM) Cognitive and Motor score at any time point (years 1, 2, 5, or 10). Hierarchical linear modeling was used to examine baseline predictors of FIM Cognitive and Motor trajectories across this period. RESULTS FIM Cognitive trajectories showed a quadratic movement (initial increase followed by a plateau or slight decrease), whereas FIM Motor trajectories showed a cubic movement (initial increase, followed by a plateau, then another increase). Higher FIM Cognitive trajectories were predicted by younger age, shorter length of posttraumatic amnesia, higher education, and having experienced a nonviolent mechanism of injury. Higher FIM Motor trajectories were predicted by younger age, shorter posttraumatic amnesia, and a nonviolent mechanism of injury. CONCLUSIONS The baseline predictors of functional trajectories identified may help create tailored, evidence-based rehabilitation interventions along the continuum of recovery during the first 10 yrs for Hispanics with traumatic brain injury at risk for reduced functional outcomes.
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Affiliation(s)
- Juan Carlos Arango Lasprilla
- From the Department of Psychology, Virginia Commonwealth University, Richmond, Virginia (JCAL, JDW); Central Virginia Veterans Affairs Health Care System, Department of Psychology, Virginia Commonwealth University, Richmond, Virginia (KM); Escuela de Psicología, Universidad de Las Américas, Quito, Ecuador (GM); Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, New Jersey (AHL); Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark, New Jersey (AHL); and Departments of Psychology and Physical Medicine and Rehabilitation, Virginia Commonwealth University, Central Virginia Veterans Affairs Health Care System, Richmond, Virginia (PBP)
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McNair KM, Zeitlin D, Slivka AM, Lequerica AH, Stubblefield MD. Translation of Karnofsky Performance Status (KPS) for use in inpatient cancer rehabilitation. PM R 2023; 15:65-68. [PMID: 34837660 DOI: 10.1002/pmrj.12741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 10/18/2021] [Accepted: 11/06/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Better tools are needed to predict functional decline and oncologic prognosis in inpatient cancer rehabilitation. The Karnofky Performance Status (KPS) is a widely used scale of functional performance in oncology, although the scale differs from current rehabilitation terminology. Use of the KPS in inpatient rehabilitation may support a shared method of communication between cancer rehabilitation providers and the primary oncology teams. OBJECTIVE To establish interrater reliability for translation of the KPS for use in inpatient cancer rehabilitation. DESIGN Retrospective interrater reliability review. SETTING A large inpatient rehabilitation hospital system. PARTICIPANTS Fifty randomized charts were chosen for review from a larger database of all patients admitted to an inpatient cancer rehabilitation program in 2020. INTERVENTION Not applicable. MAIN OUTCOME MEASURES The KPS scale was translated into common inpatient rehabilitation grading consistent with the Continuity and Assessment Record and Evaluation (CARE) Item Set to support its use in this specialty area. Additionally, a list of best practice guidelines and scoring instructions were created to assist raters in determining appropriate levels within the scale. Members of the inpatient cancer rehabilitation team scored all patients within the larger database (n = 424) throughout 2020. A blinded rater completed retrospective chart reviews to score the 50-chart sample. A two-way random effects model was used to calculate an intraclass correlation coefficient (ICC) for the KPS scores at each of three time points (premorbid, admission, and discharge). RESULTS The KPS interpretation for rehabilitation proved to be statistically reliable for the 50-chart sample. The premorbid KPS interrater reliability was acceptable (ICC = 0.67; 95% confidence interval [CI]: 0.40-0.82), admission KPS reliability was good (ICC = 0.88, 95% CI: 0.78-0.93), and discharge reliability was excellent (ICC = 0.96; 95% CI: 0.91-0.98). CONCLUSION The KPS translation at three time points (premorbid, admission, and discharge) during the inpatient rehabilitation continuum has acceptable interrater reliability.
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Affiliation(s)
- Keara M McNair
- Kessler Institute for Rehabilitation, West Orange, New Jersey, USA
| | - Dana Zeitlin
- Kessler Institute for Rehabilitation, Saddle Brook, New Jersey, USA
| | | | | | - Michael D Stubblefield
- Department of Physical Medicine and Rehabilitation, Rutgers, New Jersey Medical School, Newark, New Jersey, USA
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Lequerica AH, Sander AM, Pappadis MR, Ketchum JM, Jaross M, Kolakowsky-Hayner S, Rabinowitz A, Callender L, Smith M. The Association Between Payer Source and Traumatic Brain Injury Rehabilitation Outcomes: A TBI Model Systems Study. J Head Trauma Rehabil 2023; 38:E10-E17. [PMID: 35452026 PMCID: PMC10131079 DOI: 10.1097/htr.0000000000000781] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To examine the relationship between payer source for acute rehabilitation, residential median household income (MHI), and outcomes at rehabilitation discharge after traumatic brain injury (TBI). SETTING Acute inpatient rehabilitation facilities. PARTICIPANTS In total, 8558 individuals enrolled in the Traumatic Brain Injury Model Systems (TBIMS) National Database who were admitted to inpatient rehabilitation between 2006 and 2019 and were younger than 64 years. DESIGN Secondary data analysis from a multicenter longitudinal cohort study. MAIN MEASURES Payer source was divided into 4 categories: uninsured, public insurance, private insurance, and workers' compensation/auto. Relationships between payer source with residential MHI, rehabilitation length of stay (RLOS), and the FIM Instrument at discharge were examined. Covariates included age, injury severity, FIM at admission, and a number of sociodemographic characteristics including minority status, preinjury limitations, education level, and employment status. RESULTS Individuals with workers' compensation/auto or private insurance had longer RLOS than uninsured individuals or those with public insurance after controlling for demographics and injury characteristics. An adjusted model controlling for demographics and injury characteristics showed a significant main effect of payer source on FIM scores at discharge, with the highest scores noted among those with workers' compensation/auto insurance. The main effect of payer source on FIM at discharge became nonsignificant after RLOS was added to the model as a covariate, suggesting a mediating effect of RLOS. CONCLUSION Payer source was associated with preinjury residential MHI and predicted RLOS. While prior studies have demonstrated the effect of payer source on long-term outcomes due to lack of inpatient rehabilitation or quality follow-up care, this study demonstrated that individuals with TBI who are uninsured or have public insurance may be at risk for poorer functional status at the point of rehabilitation discharge than those with private insurance, particularly compared with those with workers' compensation/auto insurance. This effect may be largely driven by having a shorter length of stay in acute rehabilitation.
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Affiliation(s)
- Anthony H. Lequerica
- Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, New Jersey
- Department of Physical Medicine and Rehabilitation, Rutgers – New Jersey Medical School, Newark, NJ
| | - Angelle M. Sander
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine and Harris Health, Houston, TX
- Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas
| | - Monique R. Pappadis
- Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas
- Department of Nutrition, Metabolism, and Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch at Galveston, Galveston, TX
| | | | | | | | | | - Librada Callender
- Research Department, Baylor Scott and White Institute for Rehabilitation, Dallas, TX
| | - Michelle Smith
- Department of Research, NYU Grossman School of Medicine, New York, NY
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Perrin PB, Ramos-Usuga D, West SJ, Merced K, Klyce DW, Lequerica AH, Olabarrieta-Landa L, Alzueta E, Baker FC, Iacovides S, Cortes M, Arango-Lasprilla JC. Network Analysis of Neurobehavioral Symptom Patterns in an International Sample of Spanish-Speakers with a History of COVID-19 and Controls. Int J Environ Res Public Health 2022; 20:183. [PMID: 36612505 PMCID: PMC9819652 DOI: 10.3390/ijerph20010183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/08/2022] [Accepted: 12/10/2022] [Indexed: 06/17/2023]
Abstract
(1) Background: Psychometric network analysis provides a novel statistical approach allowing researchers to model clusters of related symptoms as a dynamic system. This study applied network analysis to investigate the patterns of somatic, cognitive, and affective neurobehavioral symptoms in an international sample of Spanish-speaking individuals with a history of COVID-19 positivity and non-COVID controls; (2) methods: the sample (n = 1093) included 650 adults from 26 countries who reported having previously tested positive for COVID-19 (COVID+) through a viral and/or antigen test (average of 147 days since diagnosis). The control group (COVID-) was comprised of 443 adults from 20 countries who had completed the survey prior to the COVID-19 pandemic; (3) results: relative to the COVID- network, the COVID+ network was very well-connected, such that each neurobehavioral symptom was positively connected to the network. The organize-to-headache and dizzy-to-balance connections in the COVID+ network were stronger than in the COVID- network. The hearing, numbness, and tense symptoms were more central to the COVID+ network with the latter connected to the sleep, fatigue, and frustrated symptoms. The COVID- network was largely disjointed, with most of the somatosensory symptoms forming their own cluster with no connections to other symptom groups and fatigue not being connected to any other symptom. The cognitive and affective symptoms in the COVID- network were also largely connected to symptoms from within their own groups; (4) conclusions: These findings suggest that many of the long-term neurobehavioral symptoms of COVID-19 form a discernable network and that headaches, frustration, hearing problems, forgetfulness, and tension are the most central symptoms. Cognitive and behavioral rehabilitation strategies targeting these central symptom network features may hold promise to help fracture the lingering symptom network of COVID-19.
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Affiliation(s)
- Paul B. Perrin
- School of Data Science, University of Virginia, 400 Brandon Ave., Charlottesville, VA 22903, USA
- Department of Psychology, University of Virginia, 485 McCormick Rd., Charlottesville, VA 22903, USA
- Central Virginia Veterans Affairs Health Care System, 1201 Broad Rock Blvd, Richmond, VA 23249, USA
| | - Daniela Ramos-Usuga
- Biomedical Research Doctorate Program, University of the Basque Country, Barrio Sarriena, s/n, 48940 Leioa, Spain
- Biocruces Bizkaia Health Research Institute, Cruces Plaza, 48903 Barakaldo, Spain
| | - Samuel J. West
- Department of Psychology, Virginia State University, 1 Hayden St., Petersburg, VA 23803, USA
| | - Kritzia Merced
- Central Virginia Veterans Affairs Health Care System, 1201 Broad Rock Blvd, Richmond, VA 23249, USA
- Departments of Psychology and Physical Medicine and Rehabilitation, Virginia Commonwealth University, 907 Floyd Ave., Richmond, VA 23284, USA
| | - Daniel W. Klyce
- Central Virginia Veterans Affairs Health Care System, 1201 Broad Rock Blvd, Richmond, VA 23249, USA
- Departments of Psychology and Physical Medicine and Rehabilitation, Virginia Commonwealth University, 907 Floyd Ave., Richmond, VA 23284, USA
| | - Anthony H. Lequerica
- Center for Traumatic Brain Injury Research, Kessler Foundation, 120 Eagle Rock Avenue, East Hanover, NJ 07936, USA
| | - Laiene Olabarrieta-Landa
- Health Sciences Department, Public University of Navarre (UPNA), Cataluña, s/n, 31006 Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
| | - Elisabet Alzueta
- Center for Health Sciences, SRI International, 333 Ravenswood Ave, Menlo Park, CA 94025, USA
| | - Fiona C. Baker
- Center for Health Sciences, SRI International, 333 Ravenswood Ave, Menlo Park, CA 94025, USA
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Stella Iacovides
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Mar Cortes
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, USA
| | - Juan Carlos Arango-Lasprilla
- Departments of Psychology and Physical Medicine and Rehabilitation, Virginia Commonwealth University, 907 Floyd Ave., Richmond, VA 23284, USA
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11
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Lequerica AH, Watson E, Dijkers MP, Goldin Y, Hoffman JM, Niemeier JP, Silva MA, Rabinowitz A, Chiaravalloti ND. The Utility of the Patient Health Questionnaire (PHQ-9) Sleep Disturbance Item as a Screener for Insomnia in Individuals With Moderate to Severe Traumatic Brain Injury. J Head Trauma Rehabil 2022; 37:E383-E389. [PMID: 35125428 PMCID: PMC10165877 DOI: 10.1097/htr.0000000000000746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the utility of the sleep disturbance item of the Patient Health Questionnaire-9 (PHQ-9) as a screening tool for insomnia among individuals with moderate to severe traumatic brain injury (TBI). SETTING Telephone interview. PARTICIPANTS A sample of 248 individuals with a history of moderate to severe TBI participated in an interview within 2 years of their injury. DESIGN Observational, cross-sectional analysis. MAIN MEASURES The PHQ-9 was administered along with the Insomnia Severity Index, Pittsburgh Sleep Quality Index, Sleep Hygiene Index, Epworth Sleepiness Scale, and the Insomnia Interview Schedule. RESULTS Receiver operating characteristic curve analysis was conducted for the PHQ-9 sleep item rating against a set of insomnia criteria to determine an optimal cutoff score. A cutoff of 2 on the PHQ-9 sleep item maximized sensitivity (76%) and specificity (79%), with an area under the curve of 0.79 (95% CI, 0.70-0.88). The 2 groups formed using this cutoff differed significantly on all sleep measures except the Epworth Sleepiness Scale. CONCLUSIONS The PHQ-9 sleep item may serve as a useful screener to allow for detection of potential sleep disturbance among individuals with moderate to severe TBI. Those who screen positive using this item included in a commonly used measure of depression can be prioritized for further and more comprehensive assessment of sleep disorders.
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Affiliation(s)
- Anthony H. Lequerica
- Center for Brain Injury Research, Kessler Foundation, East Hanover, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Eric Watson
- Brain Injury Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Yelena Goldin
- Cognitive Rehabilitation Department, JFK Johnson Rehabilitation Institute, Edison, NJ, USA
| | - Jeanne M. Hoffman
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Janet P. Niemeier
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Marc A. Silva
- Mental Health and Behavioral Sciences Service, James A. Haley Veterans’ Hospital, Tampa, FL, USA
| | - Amanda Rabinowitz
- Brain Injury Neuropsychology Laboratory, Moss Rehabilitation Research Institute, Elkins Park, PA, USA
| | - Nancy D. Chiaravalloti
- Center for Brain Injury Research, Kessler Foundation, East Hanover, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark, NJ, USA
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12
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Lequerica AH, Houston M, Chen MH, Arango-Lasprilla JC. Preliminary construct validity of a memory concerns scale derived from a PROMIS® item bank in a spanish-speaking sample. Neuropsychol Rehabil 2022:1-13. [PMID: 35362366 DOI: 10.1080/09602011.2022.2058965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study examined preliminary evidence of construct validity in a stand-alone memory concerns scale constructed from the Patient-Reported Outcomes Measurement Information System (PROMIS®) Cognitive Function item bank. A sample of 396 individuals, ages 18-75 (M = 33.7, SD = 12.7), from Spain and Latin America completed an online survey regarding lifetime exposure to factors associated with neurological compromise. The sample was 69.4% female. Respondents completed 8 items from the PROMIS® Cognitive Function item bank v1.0 dealing with memory concerns (MCS-8) along with the PROMIS® 8-item short form reflecting general cognitive concerns (CCS-8). The MCS-8 had high internal consistency reliability (Cronbach's alpha = 0.90), and represented a factor distinct from general cognitive concerns items on the CCS-8 in confirmatory factor analysis. Analysis of covariance controlling for sex, age, and education, showed that individuals endorsing history of exposure to sources of neurological compromise scored significantly lower T-scores on the MCS-8 than those who did not report any such history, F(1,390) = 6.4, p = 0.012. Older age was significantly associated with greater memory concerns, a relationship with age not observed with the CCS-8. As a stand-alone self-report measure, the MCS-8 appears to measure a construct distinct from general cognitive concerns that may be of interest for further research in clinical populations.
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Affiliation(s)
- Anthony H Lequerica
- Kessler Foundation, East Hanover, NJ, USA.,Rutgers - New Jersey Medical School, Newark, NJ, USA
| | | | - Michelle H Chen
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, NJ, USA.,Robert Wood Johnson Medical School, Rutgers University, NJ, USA
| | - Juan Carlos Arango-Lasprilla
- BioCruces Bizkaia Health Research Institute. Barakaldo, Bizkaia, Spain.,IKERBASQUE. Basque Foundation for Science, Bilbao, Spain
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13
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Rivera D, Usuga DR, Mendoza EMF, Arelis AA, Barajas BVR, Islas MÁM, Krch D, Lequerica AH, Arango-Lasprilla JC. Validation of the Norma Latina neuropsychological assessment battery in individuals with multiple sclerosis in Mexico. Mult Scler Relat Disord 2022; 59:103685. [DOI: 10.1016/j.msard.2022.103685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/23/2022] [Accepted: 02/11/2022] [Indexed: 10/19/2022]
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14
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Lequerica AH, Shoval HA, Yalamanchi K, Lengenfelder J, Marchetta C, Ace J, DeLuca J. Examining the Use of a Rest-Activity Ratio in a Pediatric Rehabilitation Setting. Arch Phys Med Rehabil 2022; 103:1766-1770. [PMID: 35093333 DOI: 10.1016/j.apmr.2021.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/22/2021] [Accepted: 12/26/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To examine the relationship between an estimate of sleep/wake regulation derived from actigraphy would be sensitive to neurocognitive dysfunction associated with acquired brain injury (ABI) in a pediatric rehabilitation sample. DESIGN cross-sectional design SETTING: Inpatient pediatric rehabilitation facility PARTICIPANTS: A sample of 31 males (72.1%) and 12 females (27.9%) admitted to a pediatric rehabilitation hospital wore an actigraph (wrist accelerometer) for one week. Ages ranged from 8 to 17 years (M=13.1, SD=2.7). INTERVENTIONS not applicable MAIN OUTCOME MEASURE(S): Raw actigraphy activity counts in 1-minute epochs were used to derive a rest-activity ratio over each 24-hour period and a 5-day average value was calculated covering Monday through Friday. Brain injury status was derived through medical record review and three groups were formed: traumatic brain injury (n=14), non-traumatic brain injury (n=16), and a non-ABI control group (n=13). Functional status was measured using WeeFIM Cognitive and Motor scores extracted from the medical records. RESULTS Unadjusted models showed a significant main group effect for brain injury status (p=0.012). Compared with controls, the rest-activity ratio was significantly lower in both the traumatic brain injury (p = 0.005), and non-traumatic brain injury (p = 0.023) groups. However, the main group effect was no longer significant in an adjusted model controlling for WeeFIM Cognitive and WeeFIM Motor scores at admission. In the context of the adjusted model, there was a significant relationship between the rest-activity ratio and WeeFIM Cognitive scores at admission. CONCLUSIONS Individuals with lower functional status at admission, especially in the cognitive domain, had lower rest-activity ratios, suggesting poorer sleep/wake regulation. Similar to findings in adults with acquired brain injury, this ratio may have utility in tracking sleep/wake regulation in the pediatric rehabilitation setting. Future studies should investigate sensitivity to change over the course of recovery and responsiveness to clinical interventions to improve sleep.
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Affiliation(s)
- Anthony H Lequerica
- Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, USA; Department of Physical Medicine and Rehabilitation, Rutgers - New Jersey Medical School, Newark, NJ, USA.
| | - Hannah Aura Shoval
- Physiatry Section (Medical), Children's Specialized Hospital, Mountainside, NJ, USA
| | - Krishan Yalamanchi
- Inpatient Rehabilitation Unit, Children's Specialized Hospital, New Brunswick, NJ, USA
| | - Jean Lengenfelder
- Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, USA; Department of Physical Medicine and Rehabilitation, Rutgers - New Jersey Medical School, Newark, NJ, USA
| | - Claire Marchetta
- Children's Specialized Hospital Research Center, New Brunswick, NJ, USA
| | - Jessica Ace
- JFK-Johnson Rehabilitation Institute, Edison, NJ, USA
| | - John DeLuca
- Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, USA; Department of Physical Medicine and Rehabilitation, Rutgers - New Jersey Medical School, Newark, NJ, USA
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15
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Ward-Sutton C, Manyibe EO, Lewis AN, Lequerica AH, Fyffe D, Moore CL, Kwan N, Wang N, O'Neil J. Assistive Technology Workplace Accommodation and Employment among Diverse Populations with Disabilities: Does Race/Ethnicity Matter? J Rehabil 2022; 88:23-25. [PMID: 38528876 PMCID: PMC10961985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
The purpose of this study was to examine the relationship between assistive technology workplace accommodation (AT-WA) usage and employment status among racial/ethnic populations with disabilities. Chi-square tests and logistic regression were used to analyze secondary data from the 2015 Kessler Foundation National Employment and Disability Survey (KFNEDS). Results indicated that significantly more consumers who used AT-WA were currently working, and a significantly greater proportion of them were White. Moreover, a significantly lower proportion of those who did not use AT-WA had less expected odds of being currently employed. Specific implications are discussed to inform practices, policy, and/or future research.
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16
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Stevens LF, Ketchum JM, Sander AM, Callender L, Dillahunt-Aspillaga C, Dreer LE, Finn JA, Gary KW, Graham KM, Juengst SB, Kajankova M, Kolakowsky-Hayner S, Lequerica AH, Rabinowitz AR. 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; 36:408-417. [PMID: 33656479 DOI: 10.1097/htr.0000000000000657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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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Affiliation(s)
- Lillian Flores Stevens
- 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)
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17
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Sander AM, Ketchum JM, Lequerica AH, Pappadis MR, Bushnik T, Hammond FM, Sevigny M. Primary Language and Participation Outcomes in Hispanics With Traumatic Brain Injury: A Traumatic Brain Injury Model Systems Study. J Head Trauma Rehabil 2021; 36:E218-E225. [PMID: 33656477 PMCID: PMC8249338 DOI: 10.1097/htr.0000000000000655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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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Affiliation(s)
- Angelle M Sander
- 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)
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18
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O'Neil-Pirozzi TM, Lequerica AH, Chiaravalloti ND, Juengst SB, Newman JK. Cognitive-Communication Predictors of Employment Outcomes 1 and 5 Years Posttraumatic Brain Injury. J Head Trauma Rehabil 2021; 36:196-204. [PMID: 33528176 PMCID: PMC8327472 DOI: 10.1097/htr.0000000000000641] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine changes in functional memory, problem solving, comprehension, expression, and social communication over the first 2 years posttraumatic brain injury (TBI) and the ability of each to predict return to work (RTW) outcomes at 1 year and 5 years postinjury. DESIGN Secondary analysis of data from a multicenter longitudinal cohort study. SETTING Acute inpatient rehabilitation facilities and community follow-up. PARTICIPANTS A total of 3543 individuals between 16 and 60 years of age who were competitively employed at the time of TBI and had completed year 1, year 2, and year 5 postinjury follow-ups. MAIN OUTCOME MEASURES Year 1 and year 5 RTW status (± competitively employed) at the time of study completion. RESULTS Greater function across each of the 5 cognitive-communication abilities was associated with RTW success at 1 year and 5 years post-TBI. At discharge, these 5 abilities showed comparable odds of predicting later employment. At year 1 and year 2 follow-ups, independence with problem solving was the most predictive of employment 5 years post-TBI, followed by social interaction, memory, expression, and comprehension. CONCLUSIONS An increased rehabilitation focus on functional memory, problem solving, comprehension, expression, and social interaction post-TBI has the potential to improve RTW outcomes.
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Affiliation(s)
- Therese M O'Neil-Pirozzi
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts (Dr O'Neil-Pirozzi); Department of Communication Sciences and Disorders, Northeastern University, Boston, Massachusetts (Dr O'Neil-Pirozzi); Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, New Jersey (Drs Lequerica and Chiaravalloti); Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark (Drs Lequerica and Chiaravalloti); Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas (Dr Juengst); and Research Department, Craig Hospital, Englewood, Colorado (Ms Newman)
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19
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Lequerica AH, Arango-Lasprilla JC, Krch D, Corrigan JD. Assessing lifetime exposure to traumatic brain injury among an international sample of Spanish speakers. NeuroRehabilitation 2021; 48:109-117. [PMID: 33361616 DOI: 10.3233/nre-201539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND With structured interviews being an established method for assessing one's exposure to traumatic brain injury across their lifetime, effective assessment tools are needed to serve the large population of Spanish speakers in the U.S. and abroad. OBJECTIVE To obtain preliminary evidence of validity for a Spanish version of a web-based, structured interview designed to assess lifetime exposure to TBI. METHODS A sample of 720 Spanish-speaking individuals between the ages of 18 through 65 from the continental U.S. (34.3%), South America (30.8%), the Caribbean (12.6%), Spain (12.4%), and Mexico and Central America (9.9%) completed an online survey containing the Ohio State University Traumatic Brain Injury Identification Method (Self-Administered-Brief; OSU TBI-ID SAB), Neurobehavioral Symptom Inventory, and PROMIS Cognitive Concerns Scale. RESULTS Indices of severity of worst TBI, time since most recent TBI, and multiple injuries demonstrated expected relationships with neurobehavioral symptoms such that greater symptom reporting was observed among those who had more severe injuries, more recent injuries, and multiple injuries over a period of time. CONCLUSIONS Findings provide preliminary evidence of validity for three of the indices derived from OSU TBI-ID SAB among Spanish-speaking individuals. Further study is needed to assess other aspects of this instrument to pave the way for further epidemiological studies involving lifetime exposure to TBI among Spanish-speaking individuals across the U.S., Spain, and Latin America.
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Affiliation(s)
- Anthony H Lequerica
- Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, USA.,Department of Physical Medicine and Rehabilitation, Rutgers - New Jersey Medical School, Newark, NJ, USA
| | - Juan Carlos Arango-Lasprilla
- BioCruces Bizkaia Health Research Institute. Barakaldo, Bizkaia, Spain.,IKERBASQUE. Basque Foundation for Science, Bilbao, Spain
| | - Denise Krch
- Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, USA.,Department of Physical Medicine and Rehabilitation, Rutgers - New Jersey Medical School, Newark, NJ, USA
| | - John D Corrigan
- Department of Physical Medicine & Rehabilitation, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
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20
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Fyffe DC, Lequerica AH, Ward-Sutton C, Williams NF, Sundar V, O’Neill J. Understanding Persons With Disabilities’ Reasons for Not Seeking Employment. Rehabilitation Counseling Bulletin 2021. [DOI: 10.1177/00343552211006773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Unemployment is common for persons with disabilities but little is known about the different reasons why people with disabilities may not be seeking employment. This study identified the reasons that people living with disabilities report for not seeking employment, from the 2015 Kessler Foundation National Employment and Disability Survey (KFNEDS) and variation of reasons by demographic, socioeconomic, and disability characteristics. We conducted a content analysis of responses to an open-ended question on the KFNEDS. The analytic sample ( n = 1,254) included adults (ages 18–64) living with disabilities, who self-identified as either unemployed or not seeking employment. Team coding used a hybrid inductive/deductive approach to identify nine meaningful reasons why people with disabilities may not seek employment. Overall, medical conditions, functional limitations, or their disability were more likely to be reported as reasons for not seeking work, rather than situational reasons associated with workplace engagement, such as “lack of job opportunities.” Bivariate comparisons of codes across demographic, socioeconomic, and disability characteristics noted variability in reasons reported by respondents by sex, race/ethnicity, age, household income, and disability. These findings provide an understanding of diverse reasons for not seeking employment, which can inform programs and policies that promote labor force participation of people with disabilities.
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Affiliation(s)
- Denise C. Fyffe
- Kessler Foundation, West Orange, NJ, USA
- Rutgers—New Jersey Medical School, Newark, USA
| | - Anthony H. Lequerica
- Kessler Foundation, West Orange, NJ, USA
- Rutgers—New Jersey Medical School, Newark, USA
| | | | | | | | - John O’Neill
- Kessler Foundation, West Orange, NJ, USA
- Rutgers—New Jersey Medical School, Newark, USA
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21
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Lequerica AH, Arango-Lasprilla JC, Krch D. Factor analysis of the Neurobehavioral Symptom Inventory among a sample of Spanish-speakers. Neuropsychol Rehabil 2020; 32:165-178. [PMID: 32867569 DOI: 10.1080/09602011.2020.1809464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ABSTRACTA study was conducted to examine the factor structure of the Neurobehavioral Symptom Inventory (NSI) among a large community sample of 729 Spanish-speakers from the Continental United States (n = 174, 23.9%), Latin America (n = 465, 63.8%), and Spain (n = 90, 12.3%) The sample was 62.1% female, had at least 10 years of formal education, and ranged in age from 18 to 65 years (M = 36.7, SD = 12.5). The sample was randomly split into two groups with comparable demographics for a sequential analysis that consisted of an exploratory factor analysis on the first subsample followed by a confirmatory factor analysis within a second validation subsample. Results demonstrated a high internal consistency reliability for the Spanish version of the NSI, and a three-factor solution was supported with somatic, affective, and cognitive factors. Findings were comparable to prior studies with the English version of the NSI providing preliminary support for the construct validity of this measure among a large sample of Spanish-speakers. Further study is needed to determine the criterion-related validity of the individual factors as separate subscales and to examine the appropriateness of this measure for individuals with lower levels of education.
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Affiliation(s)
- Anthony H Lequerica
- Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, USA.,Department of Physical Medicine and Rehabilitation, Rutgers - New Jersey Medical School, Newark, NJ, USA
| | - Juan Carlos Arango-Lasprilla
- BioCruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain.,IKERBASQUE, Basque Foundation for Science, Bilbao, Spain.,Department of Cell Biology and Histology, University of the Basque Country UPV/EHU, Leioa, Spain
| | - Denise Krch
- Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, USA.,Department of Physical Medicine and Rehabilitation, Rutgers - New Jersey Medical School, Newark, NJ, USA
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Juliano AC, Lequerica AH, Marino C, Marchetta C, DeLuca J. Inpatient length of stay moderates the relationship between payer source and functional outcomes in pediatric brain injury. Brain Inj 2020; 34:1395-1400. [PMID: 32755417 DOI: 10.1080/02699052.2020.1802666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To examine the extent to which race/ethnicity, length of rehabilitation hospital stay (LOS), and payer source contribute to functional status following inpatient rehabilitation in children with acquired brain injury (ABI). DESIGN Retrospective cohort study from a pediatric rehabilitation hospital including 485 individuals with ABI. METHODS Functional Independence Measure for Children (WeeFIM) scores were transformed into age-corrected Developmental Functional Quotients (DFQ) to examine the effects of race/ethnicity, LOS, and payer source (public insurance vs. private) on functional outcomes while controlling for year of admission, admission DFQ, time to rehabilitation, age, and brain injury aetiology. RESULTS Discharge DFQ scores tended to be lower for children with public insurance as well as those with longer LOS. There was no main effect of race/ethnicity, but a significant interaction effect for payer source×LOS (p < .001) was found. Further breakdown of the interaction showed lower discharge DFQ scores for children with public insurance primarily when LOS exceeded 28 days (p = .001). CONCLUSION Children with ABI who have both public insurance and LOS beyond 4 weeks tend to have poorer functional outcomes after inpatient rehabilitation. Because all children were receiving services at the same facility, payer source may be functioning as a proxy for other sociodemographic factors.
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Affiliation(s)
- Anthony C Juliano
- Center for Neuroscience and Neuropsychology Research, Kessler Foundation , West Orange, New Jersey, USA.,Children's Specialized Hospital Research Center , New Brunswick, New Jersey, USA.,Department of Physical Medicine and Rehabilitation, Rutgers University, New Jersey Medical School , Newark, New Jersey, USA
| | - Anthony H Lequerica
- Department of Physical Medicine and Rehabilitation, Rutgers University, New Jersey Medical School , Newark, New Jersey, USA.,Center for Traumatic Brain Injury Research, Kessler Foundation , West Orange, New Jersey, USA
| | - Cherylynn Marino
- Center for Neuroscience and Neuropsychology Research, Kessler Foundation , West Orange, New Jersey, USA.,Children's Specialized Hospital Research Center , New Brunswick, New Jersey, USA
| | - Claire Marchetta
- Children's Specialized Hospital Research Center , New Brunswick, New Jersey, USA
| | - John DeLuca
- Center for Neuroscience and Neuropsychology Research, Kessler Foundation , West Orange, New Jersey, USA.,Children's Specialized Hospital Research Center , New Brunswick, New Jersey, USA.,Department of Physical Medicine and Rehabilitation, Rutgers University, New Jersey Medical School , Newark, New Jersey, USA.,Department of Neurology, Rutgers University, New Jersey Medical School , Newark, New Jersey, USA
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Lequerica AH, Weber E, Dijkers MP, Dams-O'Connor K, Kolakowsky-Hayner SA, Bell KR, Bushnik T, Goldin Y, Hammond FM. Factors associated with the remission of insomnia after traumatic brain injury: a traumatic brain injury model systems study. Brain Inj 2019; 34:187-194. [PMID: 31640430 DOI: 10.1080/02699052.2019.1682193] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To examine the factors associated with the remission of insomnia by examining a sample of individuals who had insomnia within the first two years after traumatic brain injury (TBI) and assessing their status at a secondary time point.Design and Methods: Secondary data analysis from a multicenter longitudinal cohort study. A sample of 40 individuals meeting inclusion criteria completed a number of self-report scales measuring sleep/wake characteristics (Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Insomnia Severity Index, Sleep Hygiene Index), fatigue and depression (Multidimensional Assessment of Fatigue, Patient Health Questionnaire-9), and community participation (Participation Assessment with Recombined Tools-Objective). One cohort was followed at 1 and 2 years post-injury (n = 19) while a second cohort was followed at 2 and 5 years post-injury (n = 21).Results: Remission of insomnia was noted in 60% of the sample. Those with persistent insomnia had significantly higher levels of fatigue and depression at their final follow-up and poorer sleep hygiene across both follow-up time-points. A trend toward reduced community participation among those with persistent insomnia was also found.Conclusion: Individuals with persistent post-TBI insomnia had poorer psychosocial outcomes. The chronicity of post-TBI insomnia may be associated with sleep-related behaviors that serve as perpetuating factors.
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Affiliation(s)
- Anthony H Lequerica
- Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, USA.,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Erica Weber
- Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, USA.,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Marcel P Dijkers
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kristen Dams-O'Connor
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Kathleen R Bell
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, TX, USA
| | - Tamara Bushnik
- Rusk Rehabilitation, NYU Langone Health, New York, NY, USA
| | - Yelena Goldin
- Cognitive Rehabilitation Department, JFK-Johnson Rehabilitation Institute, Edison, NJ, USA.,Department of Physical Medicine and Rehabilitation, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Flora M Hammond
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, West Lafayette, IN, USA.,Rehabilitation Hospital of Indiana, Indianapolis, IN, USA
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Bell KR, Bushnik T, Dams-O'Connor K, Goldin Y, Hoffman JM, Lequerica AH, Nakase-Richardson R, Zumsteg JM. Sleep after TBI: How the TBI Model Systems have advanced the field. NeuroRehabilitation 2019; 43:287-296. [PMID: 30347631 DOI: 10.3233/nre-182538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Identification and management of comorbidities in TBI has become an increasing focus for optimizing TBI outcomes. Recent meta-analyses highlight sleep disturbance and sleep disorders following TBI (Mathias & Alvaro, 2012). Improving the recognition and treatment of sleep disorders in TBI should be a central focus of rehabilitation. The Traumatic Brain Injury Model System (TBIMS) has created an infrastructure allowing multi-center investigations into sleep dysfunction in those who have had a moderate to severe TBI and received inpatient rehabilitation. OBJECTIVE This paper will describe the 1) infrastructure used to advance sleep dysfunction/disorders research following TBI, 2) preliminary findings from these studies, and 3) repository of data which can be accessed for secondary analyses by investigators outside of the TBIMS infrastructure. METHODS Two internal mechanisms allow investigators at TBIMS sites to collaborate on projects of shared interest: Research Modules and Special Interest Groups (SIG). RESULTS To date, five studies have resulted from the TBIMS collaborative process focusing on insomnia, circadian disruption, and sleep apnea. CONCLUSIONS Future directions for the SIG include continued development of available knowledge and understanding of the multidimensional factors that contribute to TBI-related sleep disturbance, optimal assessment tools, effectiveness of available treatments, and treatment compliance in this population.
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Lequerica AH, Tremaine MJ. Photosensitivity Among Individuals Reporting History of Head Injury With or Without Alteration of Consciousness. Arch Phys Med Rehabil 2018. [DOI: 10.1016/j.apmr.2018.07.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kim SH, Strutt AM, Olabarrieta-Landa L, Lequerica AH, Rivera D, De Los Reyes Aragon CJ, Utria O, Arango-Lasprilla JC. Item analysis of the Spanish version of the Boston Naming Test with a Spanish speaking adult population from Colombia. Clin Neuropsychol 2018; 32:29-45. [PMID: 29473441 DOI: 10.1080/13854046.2018.1441908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The Boston Naming Test (BNT) is a widely used measure of confrontation naming ability that has been criticized for its questionable construct validity for non-English speakers. This study investigated item difficulty and construct validity of the Spanish version of the BNT to assess cultural and linguistic impact on performance. METHODS Subjects were 1298 healthy Spanish speaking adults from Colombia. They were administered the 60- and 15-item Spanish version of the BNT. A Rasch analysis was computed to assess dimensionality, item hierarchy, targeting, reliability, and item fit. RESULTS Both versions of the BNT satisfied requirements for unidimensionality. Although internal consistency was excellent for the 60-item BNT, order of difficulty did not increase consistently with item number and there were a number of items that did not fit the Rasch model. For the 15-item BNT, a total of 5 items changed position on the item hierarchy with 7 poor fitting items. Internal consistency was acceptable. CONCLUSIONS Construct validity of the BNT remains a concern when it is administered to non-English speaking populations. Similar to previous findings, the order of item presentation did not correspond with increasing item difficulty, and both versions were inadequate at assessing high naming ability.
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Affiliation(s)
- Stella H Kim
- a Department of Neurology , University of Texas Health Science Center - McGovern Medical School , Houston , TX , USA
| | - Adriana M Strutt
- b Department of Neurology , Baylor College of Medicine , Houston , TX , USA
| | | | - Anthony H Lequerica
- d Kessler Foundation & Department of Physical Medicine and Rehabilitation, Rutgers , New Jersey Medical School , Newark , NJ , USA
| | - Diego Rivera
- e BioCruces Health Research Institute, Cruces University Hospital , Barakaldo , Spain
| | | | - Oscar Utria
- g Department of Psychology , Universidad San Buenaventura , Bogotá , Colombia
| | - Juan Carlos Arango-Lasprilla
- e BioCruces Health Research Institute, Cruces University Hospital , Barakaldo , Spain.,h IKERBASQUE, Basque Foundation for Science , Bilbao , Spain
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Krch D, Lequerica AH. The factor structure of the Disability Rating Scale in individuals with traumatic brain injury. Disabil Rehabil 2017; 41:98-103. [PMID: 28942681 DOI: 10.1080/09638288.2017.1378388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To examine the factor structure of the Disability Rating Scale and the predictive validity of the scale's factors among individuals with traumatic brain injury. MATERIALS AND METHODS Five hundred and eight individuals with moderate-to-severe traumatic brain injury were administered the Disability Rating Scale. The sample was randomly divided into two groups. An exploratory factor analysis was conducted on Group 1, and a confirmatory factor analysis on Group 2. Regressions were performed to determine the predictive ability of the factors. RESULTS The exploratory factor analysis generated a three-factor structure, explaining 82.1% of the variance. Factor 1, comprising three disability items (feeding, toileting, and grooming), accounted for 58.4% of the variance. Factor 2, comprising three impairment items (eye opening, communication ability, and motor response), accounted for 14.8% of the variance. Factor 3, comprising two handicap items (level of functioning and employability), accounted for 8.9% of the variance. The three-factor solution was confirmed by confirmatory factor analysis. Regressions revealed the impairment factor at admission and the disability factor at discharge accounted for unique variance in predicting functional outcomes at one year post-injury. CONCLUSION Each factor of the Disability Rating Scale may independently serve as a clinically useful outcome predictor after traumatic brain injury. Implications for rehabilitation The Disability Rating Scale is a measure used in brain injury rehabilitation that generates a total score indicating level of disability. This study confirmed a three-factor structure and showed that the individual factor scores provide unique information in predicting rehabilitation outcomes at one year post-injury.
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Affiliation(s)
- Denise Krch
- a Traumatic Brain Injury Department , Kessler Foundation , East Hanover , NJ , USA.,b Department of Physical Medicine and Rehabilitation , Rutgers New Jersey Medical School , Newark , NJ , USA
| | - Anthony H Lequerica
- a Traumatic Brain Injury Department , Kessler Foundation , East Hanover , NJ , USA.,b Department of Physical Medicine and Rehabilitation , Rutgers New Jersey Medical School , Newark , NJ , USA
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Lequerica AH, Botticello AL, Lengenfelder J, Chiaravalloti N, Bushnik T, Dijkers MP, Hammond FM, Kolakowsky-Hayner SA, Rosenthal J. Factors associated with remission of post-traumatic brain injury fatigue in the years following traumatic brain injury (TBI): a TBI model systems module study. Neuropsychol Rehabil 2016; 27:1019-1030. [PMID: 27633955 DOI: 10.1080/09602011.2016.1231120] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Post-traumatic brain injury fatigue (PTBIF) is a major problem in the years after traumatic brain injury (TBI), yet little is known about its persistence and resolution. The objective of the study was to identify factors related to PTBIF remission and resolution. TBI Model System registrants at five centres participated in interviews at either one and two years post-injury (Y1-2 Cohort), or two and five years post-injury (Y2-5 Cohort). Characteristics of participants with PTBIF remission were compared to those with PTBIF persistence. Variables studied included the presence of and changes in disability, sleep dysfunction, mood, and community participation. The Functional Independence Measure did not differ significantly between groups or over time. In the Y1-2 Cohort the Fatigue Resolved group scored significantly better on the Disability Rating Scale and Pittsburgh Sleep Quality Index. In the Y2-5 Cohort the Fatigue Resolved group scored significantly higher on a measure of community participation. It was concluded that fewer than half of the sample in each cohort experienced a remission of PTBIF between time points. Persistence of PTBIF 1-2 years post-injury is associated with disability, sleep disturbance, and depression while persistence of fatigue beyond 2 years post-injury appears to be related to participation level, underscoring the potential impact of effective surveillance, assessment, and treatment of this condition in optimising life after TBI. Differences in fatigue progression may point to the presence of different types of PTBIF.
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Affiliation(s)
| | | | | | | | | | - Marcel P Dijkers
- c Department of Rehabilitation Medicine , Mount Sinai School of Medicine , New York , USA
| | - Flora M Hammond
- d Department of Physical Medicine and Rehabilitation , Indiana University School of Medicine , Indianapolis , IN , USA
| | | | - Joseph Rosenthal
- f Department of Physical Medicine and Rehabilitation , Ohio State University, Wexer Medical Center , Columbus , OH , USA
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Galletta EE, Lequerica AH, Pekrul SR, Eslinger PJ, Barrett AM. Visual distraction: an altered aiming spatial response in dementia. Dement Geriatr Cogn Dis Extra 2012; 2:229-37. [PMID: 22739431 PMCID: PMC3383303 DOI: 10.1159/000338571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background/Aims Healthy individuals demonstrate leftward bias on visuospatial tasks such as line bisection, which has been attributed to right brain dominance. We investigated whether this asymmetry occurred in patients with probable dementia of the Alzheimer type (pAD) which is associated with neurodegenerative changes affecting temporoparietal regions. Methods Subjects with pAD and matched controls performed a line bisection task in near and far space under conditions of no distraction, left-sided visual distraction and right-sided visual distraction. Results Participants with pAD manifested different motor-preparatory ‘aiming’ spatial bias than matched controls. There were significantly greater rightward ‘aiming’ motor-intentional errors both without distraction and with right-sided distraction. Conclusion ‘Aiming’ motor-preparatory brain activity may be induced by distraction in pAD subjects as compared to typical visual-motor function in controls.
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Arango-Lasprilla JC, Quijano MC, Nicholls E, Aponte M, Lequerica AH, Cuervo MT, Rogers H. The usefulness of self-generation to improve learning and memory in Spanish-speaking individuals with traumatic brain injury from Colombia. Brain Inj 2012; 26:875-81. [DOI: 10.3109/02699052.2012.655361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Castillo C, Arango JC, Cifu DX, Hammond FM, Ketchum JM, Lequerica AH, Watanabe TK. Poster 18: Predictors of Extended Rehabilitation Length of Stay After TBI. PM R 2010. [DOI: 10.1016/j.pmrj.2010.07.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Lequerica AH, Forchheimer M, Albright KJ, Tate DG, Duggan CH, Rahman RO. Stress appraisal in women with spinal cord injury: Supplementary findings through mixed methods. International Journal of Stress Management 2010. [DOI: 10.1037/a0019716] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Nolan KJ, Savalia KK, Lequerica AH, Elovic EP. Objective assessment of functional ambulation in adults with hemiplegia using ankle foot orthotics after stroke. PM R 2009; 1:524-9. [PMID: 19627941 DOI: 10.1016/j.pmrj.2009.04.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 04/22/2009] [Accepted: 04/28/2009] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To objectively evaluate the effect of ankle foot orthotics (AFOs) on functional ambulation in individuals with hemiplegia secondary to stroke using quantifiable outcome measures. DESIGN With-without repeated measures design. SETTING Rehabilitation research center. PARTICIPANTS Eighteen adults with stroke-related hemiplegia 6 months using a prescribed AFO. INTERVENTIONS Not applicable. MAIN OUTCOME MEASUREMENTS The distance (m) and velocity (m/s) during the 6-Minute Walk Test (6MWT) and total time (s) and velocity (m/s) during the 25-ft walk (25ftW). Secondary analysis evaluated the 6MWT and 25ftW grouped by the time component of the Ambulatory Index (AI). RESULTS Distance walked during the 6MWT was significantly greater with AFO (228.54 +/- 103.93) than without AFO (197.49 +/- 104.13), P = .002. Time to complete the 25ftW was significantly greater without AFO (21.22 +/- 20.57) than with AFO (15.49 +/- 14.65), P = .010. There was a significant difference in average velocity between the 25ftW and 6MWT during the with AFO condition, P = .010. Secondary analysis grouped by the AI time showed that as level of function decreases, brace effect on functional ambulation increases (Group 3: 25ftW with AFO, P = .040). CONCLUSIONS AFO usage in hemiplegic stroke patients improves functional ambulation, particularly in individuals with a slower gait velocity. The 25ftW, with and without AFO, may be useful to the patient and clinician when determining the importance of brace utilization. Speed modulation was improved when the AFO was added to the paretic limb, and AI grouping indicated that the AFO was more beneficial in people with a slower gait velocity (>20 seconds for the 25ftW). A more definitive study is needed to more completely address this issue. As an exploratory study, the feasibility of different walking assessments was determined so that future studies can validate which objective measures can be used and easily implemented in clinical settings.
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Affiliation(s)
- Karen J Nolan
- Kessler Foundation Research Center, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA.
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Nolan KJ, Savalia KK, Lequerica AH, Elovic EP. Poster 65: Assessment of Functional Ambulation in Adults with Hemiplegia Using Ankle Foot Orthotics After Stroke. Arch Phys Med Rehabil 2009. [DOI: 10.1016/j.apmr.2009.08.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lequerica AH, Donnell CS, Tate DG. Patient engagement in rehabilitation therapy: physical and occupational therapist impressions. Disabil Rehabil 2009; 31:753-60. [DOI: 10.1080/09638280802309095] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lequerica AH, Forschheimer M, Tate DG, Roller S, Toussaint L. Ways of Coping and Perceived Stress in Women with Spinal Cord Injury. J Health Psychol 2008; 13:348-54. [DOI: 10.1177/1359105307088139] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Using a cross-sectional design, this research aimed to assess whether a three-factor model of Positive Reappraisal, Escape-Avoidance, and Seeking Social Support based on the Ways of Coping Questionnaire (WOCQ) appropriately depicts coping within a sample of women with spinal cord injury (SCI). Forty-four community-dwelling women with spinal cord injury were interviewed from two urban rehabilitation facilities in the Midwestern United States. The main outcome measures used were the Perceived Stress Scale (PSS) and the WOCQ. The Positive Reappraisal, Escape-Avoidance, and Seeking Social Support scales of the WOCQ significantly accounted for variance in perceived stress. These three scales appear to be most relevant to perceived stress in women with SCI. Implications for coping research in this population are discussed.
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Abstract
OBJECTIVE To examine the nature of agitation in patients with brain injury and quantify the relation between agitation and patient progress in rehabilitation. DESIGN Cross-sectional, correlational. SETTING Urban, inpatient rehabilitation facility in the midwestern United States. PARTICIPANTS Sixty-nine patients with acquired brain injury admitted to an acute rehabilitation hospital. MAIN OUTCOME MEASURES Therapy Engagement using the Rehabilitation Therapy Engagement Scale; Functional Status using the Functional Independence Measure. RESULTS Agitated behavior was inversely associated with engagement in rehabilitation therapy even after controlling for injury severity. Engagement in therapy mediated the relation between agitated behavior and progress in rehabilitation as assessed using a Functional Independence Measure efficiency ratio. CONCLUSIONS Progress in acute brain injury rehabilitation appears to be meaningfully influenced by the complex interplay among injury severity, agitation, and engagement. The findings are consistent with a theoretical model, suggesting that agitated patients make less progress in rehabilitation not only because of greater injury severity but also because agitation disrupts engagement in rehabilitation therapies. Multiple clinical purposes may be better served by measuring behavioral excess on a continuum than in a dichotomous fashion.
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Affiliation(s)
- Anthony H Lequerica
- Department of Physical Medicine and Rehabilitation, University of Michigan Health System, Ann Arbor, MI, USA
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Lequerica AH, Tate DG. Presentation 9. Arch Phys Med Rehabil 2006. [DOI: 10.1016/j.apmr.2006.07.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Lequerica AH, Rapport LJ, Whitman RD, Millis SR, Vangel SJ, Hanks RA, Axelrod BN. Psychometric properties of the rehabilitation therapy engagement scale when used among individuals with acquired brain injury. Rehabil Psychol 2006. [DOI: 10.1037/0090-5550.51.4.331] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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