Examining the Role of Behavioral Health Factors on Inpatient Traumatic Brain Injury Rehabilitation Outcomes Among Service Members and Veterans.

OBJECTIVE

To examine the association between behavioral health factors, specifically pretreatment alcohol and tobacco use, and traumatic brain injury (TBI)-related outcomes in the Intensive Evaluation and Treatment Program (IETP).

DESIGN

Retrospective longitudinal cohort design.

SETTING

The intervention and data collection were conducted at 5 Veterans Health Administration (VHA) sites (Florida, Texas, California, Minnesota, and Virginia).

PARTICIPANTS

Behavioral health and TBI-related outcome data were collected from N=205 veteran and active-duty service member participants with mild-to-moderate TBI.

INTERVENTIONS: The VHA IETP delivered interdisciplinary rehabilitation to veterans and service members with a history of mild-to-moderate TBI and related conditions, including posttraumatic stress disorder (PTSD), pain, impaired function, and adverse neurobehavioral symptoms.

MAIN OUTCOME MEASURES: The exploratory outcome measures included the Neurobehavioral Symptom Inventory, the PTSD Checklist for DSM-5, the Patient Reported Outcomes Measurement Information System Pain Interference scale, and the Mayo-Portland Adaptability Inventory. Pretreatment tobacco and alcohol use behaviors were extracted from patient medical records. Multiple linear regression models were fitted to the data to test our hypotheses.

RESULTS

Alcohol use was not shown to be associated with changes in any of the outcomes; however, tobacco use was associated with attenuated improvement in PTSD symptoms (p=.03).

CONCLUSIONS

This study suggests that pretreatment tobacco use may lessen the effects of long-term PTSD rehabilitation among patients with TBI.