Search

Primary objective: To examine return to driving and variables associated with that activity in a longitudinal database. Research design: Retrospective analysis of a large, national database. Methods and procedures: The sample was comprised of people with predominantly moderate-severe traumatic brain injury (TBI) enrolled in the TBI Model System national database at 16 centres and followed at 1 ( n = 5942), 2 ( n = 4628) and 5 ( n = 2324) years after injury. Main outcomes and results: Respondents were classified as driving or not driving at each follow-up interval. Five years after injury, half the sample had returned to driving. Those with less severe injuries were quicker to return to driving, but, by 5 years, severity was not a factor. Those who were driving expressed a higher life satisfaction. Functional status at rehabilitation discharge, age at injury, race, pre-injury residence, pre-injury employment status and education level were associated with the odds of a person driving. Conclusions: Half of those with a moderate-severe TBI return to driving within 5 years and most of those within 1 year of injury. Driving is associated with increased life satisfaction. There are multiple factors that contribute to return to driving that do not relate to actual driving ability. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To assess the suitability of the Barroso Fatigue Scale (BFS) for assessment of posttraumatic brain injury (post-TBI) fatigue. DESIGN: Analysis of self-report data. SETTING: Community. PARTICIPANTS: 183 individuals with TBI in California, and 233 individuals with TBI and a comparison group of 85 persons without brain injury in New York. INTERVENTIONS: None. RESULTS: Both individuals with TBI and comparison participants reported high levels of fatigue on the Fatigue Severity Scale and the Fatigue Assessment Instrument, which can be scored from the BFS. Factor analysis of 40 BFS items resulted in 5 factors; because factors appeared to be based on both substantive issues and the format and location of the items, a BFS scoring algorithm was not pursued. The other 16 BFS items provided useful information in understanding post-TBI fatigue. CONCLUSIONS: The BFS in its current format is not recommended for assessing fatigue as a multidimensional entity after TBI. It may have utility for the 3 widely known fatigue measures that can be derived from it, and it generates information on the circumstances of fatigue. [ABSTRACT FROM AUTHOR]

Fatigue is a well-recognized issue for individuals with traumatic brain injury (TBI). This prospective study examined the rate and types of fatigue that are experienced by a cohort of individuals with TBI within the first 2 years, using a multidimensional fatigue scale. The impact of factors such as demographics, injury severity indices, and concomitant psychosocial variables was also examined. Using 2 measures of overall fatigue, 16%-32% at Year 1 and 21%-34% at Year 2 reported significant levels of fatigue. Fatigue did not appear to change between 1 and 2 years post-TBI. Sleep quality was the most prevalent concomitant disturbance followed by depression and pain. [ABSTRACT FROM AUTHOR]

This study used a prospective longitudinal design to quantify fatigue and associated factors during the first 2 years after traumatic brain injury (TBI). Fifty-one individuals were assessed at 3 time points: within the first 6, 12, and 18-24 months after TBI. Self-reported fatigue improved during the first year, as did pain, sleep quality, cognitive independence, and involvement in productive activity. Further changes up to 2 years after TBI were not observed. The subset of individuals who reported significant increases in fatigue over the first 2 years demonstrated poorer outcomes in cognition, motor symptoms, and general functioning than those with decreased or stable fatigue. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To study cognitive, communication, and social changes experienced by individuals between 1 and 5 years after traumatic brain injury (TBI). DESIGN: Prospective cohort. SETTING AND PARTICIPANTS: TBI Model System Database with 927 eligible subjects using a cohort with complete 1- and 5-year data (N = 292). MAIN OUTCOME MEASURES: Change in Functional Independence Measure trade mark -Cognitive (FIM-Cog) items from Year 1 to Year 5 postinjury. RESULTS: On the FIM-Cog Total score, 26% individuals improved, 61% stayed the same, and 14% worsened by more than 1 point from Year 1 to Year 5. On the 2 FIM Communication items, 19% individuals improved, 68% stayed the same, and 13% worsened by greater than 1 point. On the FIM Social Interaction item, 12% individuals improved, 76% stayed the same, and 11% worsened. On the FIM Memory and Problem Solving items, 34% individuals improved, 48% stayed the same, and 19% worsened. Several variables predicted this improvement and worsening, some of which were available at the time of injury and most were those available at 1 year postinjury. The Memory and Problem Solving items, taken together, showed fewer participants at ceiling at Year 1 and more change between Year 1 and Year 5 compared to the Communication and Social Interaction items. CONCLUSIONS: Many individuals did not demonstrate meaningful change on FIM-Cog and its component items from Year 1 to Year 5. In particular, a high proportion of improvement was observed in Memory/Problem Solving, and worsening in Social Interaction. Demographic and functional indicators present at 1 year postinjury may be predictive of subsequent change. [ABSTRACT FROM AUTHOR]

This investigation evaluated yearly trends in charges and lengths of stay for patients with brain injury in acute care and rehabilitation settings over a 7 year period. Data was collected from 800 consecutive patients enrolled in four NIDRR Model Systems Traumatic Brain Injury programmes. Acute care daily charges showed almost routine increases, averaging nearly $550 per year. Conversely, lengths of stay generally showed a downward trend, with annual reductions averaging 2.25 days. Admission lengths of stay averaged 22-29 days between 1990-1994. Admissions averaged less than 20 days beginning in 1995, with the 1996 average of 16 days, nearly half that of the 1993 average. Between 1990-1996, average daily rehabilitation charges increased each year, with the rise averaging $83 or 7%. The rise in daily rehabilitation charges was offset by corresponding decreases in lengths of stay averaging 3.65 days or 8% annually. Increases in daily charges for brain injury rehabilitation care were roughly comparable to those for general medical care prices. However, the rate of change in acute care charges was substantially greater, with annual increases averaging 10% more than national medical care prices. The steady downward trend in lengths of stay raises serious concerns about the future availability of health care services to persons with brain injury. [ABSTRACT FROM AUTHOR]

Objectives: To identify personal, clinical, and environmental factors associated with 4 previously identified distinct multidimensional participation profiles of individuals following traumatic brain injury (TBI)., Setting: Community., Participants: Participants ( n = 408) enrolled in the TBI Model Systems (TBIMS) Participation Module, all 1 year or more postinjury., Design: Secondary data analysis of cross-sectional data from participants in a multicenter TBIMS module study on participation conducted between May 2006 and September 2007. Participants provided responses to questionnaires via a telephone interview at their study follow-up (1, 2, 5, 10, or 15 years postinjury)., Main Measures: Participants provided responses to personal (eg, demographic), clinical (eg, function), environmental (eg, neighborhood type), and participation measures to create multidimensional participation profiles. Data from measures collected at the time of injury (preinjury questionnaire, injury characteristics) were also included. The primary outcome was assignment to one of 4 multidimensional participation profile groups based on participation frequency, importance, satisfaction, and enfranchisement. The measures used to develop the profiles were: Participation Assessment with Recombined Tools-Objective, Importance, and Satisfaction scores, each across 3 domains (Productivity, Social Relationships, Out and About in the Community) and the Enfranchisement Scale (contributing to one's community, feeling valued by the community, choice and control)., Results: Results of the multinomial regression analysis, with 4 distinct participation profile groups as the outcome, indicated that education, current employment, current illicit drug use, current driving status, community type, and FIM Cognitive at follow-up significantly distinguished participation profile groups. Findings suggest a trend toward differences in participation profile groups by race/Hispanic ethnicity., Conclusions: Understanding personal, clinical, and environmental factors associated with distinct participation outcome profiles following TBI may provide more personalized and nuanced guidance to inform rehabilitation intervention planning and/or ongoing clinical monitoring., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Socioeconomic risk factors are known drivers of adverse birth outcomes. Housing is a key target for policy interventions., Objective: To estimate the associations of housing tenure (renting vs owning) and unaffordable housing with preterm birth and other adverse birth outcomes., Methods: We used 2014-2016 Canadian birth registration data linked with the 2016 long-form census and included singleton births among homeowners and renters. Unaffordable housing was defined at the family level as the proportion of pre-tax income spent on shelter, using a 30% cut-off. The primary outcome was preterm birth. Secondary outcomes were stillbirth and infant death. Log-binomial regression estimated the association of housing tenure and unaffordability with outcomes adjusting for sociodemographic risk factors and parity., Results: Among 162 700 live births and stillbirths (52 740 renters, 109 960 owners), 31% of renters and 17% of owners experienced unaffordable housing. Renting was associated with an increased risk of preterm birth (7.5% vs 6.1%; adjusted risk ratio (aRR) 1.13; 95% CI 1.08 to 1.17), stillbirth (9.5 vs 6.6 per 1000; aRR 1.33, 95% CI 1.14 to 1.56) and infant death (4.2 vs 3.0 per 1000; aRR 1.52, 95% CI 1.26 to 1.82). There was no association of housing unaffordability with preterm birth or other adverse birth outcomes among owners or renters., Conclusions: This nationally representative study in Canada found associations between renting versus owning and preterm birth, stillbirth and infant death, as well as a high burden of unaffordable housing, particularly among renters. This study suggests that home tenure itself is a social determinant of adverse birth outcomes., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: In Cycle 7 (2022), the Canadian Health Measures Survey (CHMS) introduced the OMRON (OM) IntelliSense HEM-907XL blood pressure (BP) monitor after using the BpTRU (BT) BPM-300 BP monitor for six cycles. This study assessed differences between adult BP values measured by both devices and whether equations could be developed to compare BP measurements taken using the two devices., Data and Methods: In Cycle 6 (2018 to 2019) of the CHMS, BP was measured using BT and OM devices. Between-device estimates of systolic BP (SBP), diastolic BP (DBP), and hypertension prevalence were compared for 1,072 adults aged 18 to 79 years. Sex, age, body mass index (BMI), and the use of antihypertensive medication were examined in linear regression models to predict SBP and DBP values measured with OM based on those measured with BT., Results: Average SBP measured with OM was 6 millimetres of mercury (mmHg) higher than average SBP measured with BT, and average DBP measured with OM was 2 mmHg lower than DBP measured with BT. Hypertension prevalence based on OM readings was 35.4%, compared with 34.0% based on BT readings. Between-device BP differences varied in magnitude by sex, age group, and BMI category. Average model-predicted estimates of BP were comparable to measured estimates, but predicted values were lower at higher levels of BP., Interpretation: Switching BP monitors will substantively affect population estimates of adult SBP and DBP but may have less impact on estimates of adult hypertension prevalence. The prediction equations proposed in this study can be applied to adult BP data from cycles 1 to 6 of the CHMS for comparison with BP measurements taken in Cycle 7, with some caveats. The impact of changing to the OM monitor in Cycle 7 should be acknowledged when reporting estimates of adult BP based on the CHMS.

Objective: To examine the experience of menopause symptoms in women with traumatic brain injury (TBI)., Design: Cross-sectional descriptive study., Setting: Five sites of the TBI Model Systems (TBIMS) program., Participants: Participants were 210 women, ages 40-60 years, who were not taking systemic hormones and did not have both ovaries removed: Sixty-one participants were enrolled in the TBIMS, who were at least 2 years post TBI and living in the community. One hundred forty-nine participants without TBI were recruited from a research registry and the metropolitan Detroit community., Interventions: Not applicable., Main Outcome Measures: A checklist comprised of 21 menopause symptoms assessing four symptom clusters (vasomotor, somatic, psychological, and cognitive)., Results: TBI and non-TBI groups did not significantly differ and showed small effect sizes on vasomotor symptoms. On the remaining symptom clusters, women with TBI showed greater presence and severity of symptoms than women without TBI, as well as fewer differences between premenopausal and postmenopausal women on those symptoms. A profile indicating an additive or potentiating effect of TBI on menopause symptoms was not observed., Conclusions: Findings support a conceptual model of menopause and TBI indicating that symptoms most closely associated with estrogen decline are similar for women with and without TBI, whereas symptoms that overlap with common TBI sequelae are generally more frequent and severe among these women. Likely due to lower baseline of symptoms premenopause, postmenopausal women without TBI reported more numerous and severe symptoms relative to their premenopausal counterparts without TBI. Overall, it may be that women without TBI experience menopause as more of a "change" of life, whereas women with TBI chronically face significantly more of these symptoms than women without TBI., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to disclose., (Copyright © 2024. Published by Elsevier Inc.)

Objectives: Alexithymia an emotional processing deficit that interferes with a person's ability to recognize, express, and differentiate emotional states. Study objectives were to (1) determine rates of elevated alexithymia among people with moderate-to-severe traumatic brain injury (TBI) 1-year post-injury, (2) identify demographic and injury-related variables associated with high versus low-average levels of alexithymia, and (3) examine associations among alexithymia with other aspects of emotional functioning and life satisfaction., Setting: Data were collected during follow-up interviews across four TBI Model System (TBIMS) centers., Participants: The sample consisted of 196 participants with moderate-to-severe TBI enrolled in the TBIMS. They were predominately male (77%), White (69%), and had no history of pre-injury mental health treatment (66.3%)., Design: Cross-sectional survey data were obtained at study enrollment and 1-year post-injury., Main Measures: Toronto Alexithymia Scale-20 (TAS-20) as well as measures of anger, aggression, hostility, emotional dysregulation, post-traumatic stress, anxiety, depression, resilience and life satisfaction. Sociodemographic information, behavioral health history and injury-related variables were also included., Results: High levels of alexithymia (TAS-20 score > 1.5 standard deviation above the normative mean) were observed for 14.3%. Compared to individuals with low/average levels of alexithymia, the high alexithymia group tended to have lower levels of education. At 1-year follow-up, high TAS-20 scores were strongly associated with emotional dysregulation and post-traumatic stress; moderately associated with anger, hostility, depression, anxiety, lower resilience and lower satisfaction with life; and weakly associated with aggression., Conclusion: These findings provide further evidence that alexithymia is associated with poor emotional functioning and life satisfaction after TBI. Longitudinal studies are needed to determine if alexithymia is a risk factor that precipitates and predicts worse emotional outcomes in the TBI population. This line of work is important for informing treatment targets that could prevent or reduce of psychological distress after TBI., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To examine the unique contribution of alexithymia at 1 year after traumatic brain injury (TBI) to the prospective prediction of emotional and social health outcomes at 2 years after injury., Design: Multicenter, longitudinal cohort study., Setting: Data were collected during year 1 and year 2 postinjury follow-up interviews across 4 TBI Model System centers., Participants: Persons with TBI (N=175; 134 men and 41 women) who had English fluency and were capable of providing self-reported data., Interventions: Not applicable., Main Outcome Measures: Primary independent variable was the Toronto Alexithymia Scale-20. Outcome measures included the Interpersonal Reactivity Index, National Institute of Health Toolbox Emotion Battery Anger, Difficulty with Emotion Regulation Scale, Connor-Davidson Resilience Scale, Posttraumatic Stress Disorder Checklist - Civilian, Satisfaction with Life Scale, General Anxiety Disorder-7, Patient Health Questionnaire 9, suicidal ideation, and problematic substance use., Results: Simple adjusted models demonstrated that after controlling for the specific outcome at year 1, Toronto Alexithymia Scale-20 scores significantly predicted year 2 scores for perspective-taking, physical aggression, emotional dysregulation, resilience, anxiety, depression, and suicidal ideation. All of these predictive findings except for physical aggression were maintained in the fully adjusted models that also controlled for age, sex, education level, number of prior TBIs, and motor and cognitive functioning., Conclusions: Compared with those with lower alexithymia scores, persons with TBI who had higher alexithymia scores at 1 year after injury reported poorer emotional health at 2 years after TBI, even after controlling for year 1 outcome scores, sociodemographic characteristics, and injury-related factors. These results support the need to assess for elevated alexithymia and to provide interventions targeting alexithymia early in the TBI recovery process., (Copyright © 2024 American Congress of Rehabilitation Medicine. All rights reserved.)

Ionic imbalances and sodium channel dysfunction, well-known sequelae of traumatic brain injury (TBI), promote functional impairment in affected subjects. Therefore, non-invasive measurement of sodium concentrations using 23 Na MRI has the potential to detect clinically relevant injury and predict persistent symptoms. Recently, we reported diffusely lower apparent total sodium concentrations (aTSC) in mild TBI patients compared to controls, as well as correlations between lower aTSC and worse clinical outcomes. The main goal of this study was to determine whether these aTSC findings, and their changes over time, predict outcomes at 3- and 12-month from injury. Twenty-seven patients previously studied with 23 Na MRI and outcome measures at 22 ± 10 days (average ± standard deviation) after injury (visit-1, v1) were contacted at 3- (visit-2, v2) and 12-month after injury (visit-3, v3) to complete the Rivermead post-concussion symptoms questionnaire (RPQ), the extended Glasgow outcome scale (GOSE), and the brief test of adult cognition by telephone (BTACT). Follow-up 1 H and 23 Na MRI were additionally scheduled at v2. Linear regression was used to calculate aTSC in global grey and white matters. Six hypotheses were tested in relation to the serial changes in outcome measures and in aTSC, and in relation to the cross-sectional and serial relationships between aTSC and outcome. Twenty patients contributed data at v2 and fifteen at v3. Total RPQ and composite BTACT z -scores differed significantly for v2 and v3 in comparison to v1 (each P < 0.01), reflecting longitudinally reduced symptomatology and improved performance on cognitive testing. No associations between aTSC and outcome were observed at v2. Previously lower grey and white matter aTSC normalized at v2 in comparison to controls, in line with a statistically detectable longitudinal increase in grey matter aTSC between v1 and v2 ( P = 0.0004). aTSC values at v1 predicted a subset of future BTACT subtest scores, but not future RPQ scores nor GOSE-defined recovery status. Similarly, aTSC rates of change correlated with BTACT rates of change, but not with those of RPQ. Tissue aTSC, previously shown to be diffusely decreased compared to controls at v1, was no longer reduced by v2, suggesting normalization of the sodium ionic equilibrium. These changes were accompanied by marked improvement in outcome. The results support the notion that early aTSC from 23 Na MRI predicts future BTACT, but not RPQ scores, nor future GOSE status., Competing Interests: The authors report no competing interests., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Guarantors of Brain.)

Purpose. To characterize societal participation profiles after moderate-severe traumatic brain injury (TBI) along objective (Frequency) and subjective (Satisfaction, Importance, Enfranchisement) dimensions. Materials and Methods. We conducted secondary analyses of a TBI Model Systems sub-study ( N  = 408). Multiaxial assessment of participation included the Participation Assessment with Recombined Tools-Objective and -Subjective questionnaires (Participation Frequency and Importance/Satisfaction, respectively) and the Enfranchisement Scale. Participants provided responses via telephone interview 1-15 years post-injury. Multidimensional participation profiles (classes) were extracted using latent profile analysis. Results. A 4-class solution was identified as providing maximal statistical separation between profiles and being clinically meaningful based on profile demographic features. One profile group (48.5% of the sample) exhibited the "best" participation profile (High Frequency, Satisfaction, Importance, and Enfranchisement) and was also the most advantaged according to socioeconomic indicators. Other profile groups showed appreciable heterogeneity across participation dimensions. Age, race/ethnicity, education level, ability to drive, and urbanicity were features that varied between profiles. Conclusions. Societal participation is a critical, but inherently complex, TBI outcome that may not be adequately captured by a single index. Our data underscore the importance of a multidimensional approach to participation assessment and interpretation using profiles. The use of participation profiles may promote precision health interventions for community integration.Implications for RehabilitationOur study found unidimensional measures of societal participation in traumatic brain injury (TBI) populations that focus exclusively on frequency indicators may be overly simplistic and miss key subjective components of participationTaking a multidimensional perspective, we documented four meaningfully distinct participation subgroups (including both objective and subjective dimensions of societal participation) within the TBI rehabilitation populationMultidimensional profiles of participation may be used to group individuals with TBI into target groups for intervention (e.g., deeper goal assessment for individuals who do not rate standard participation activities as important, but also do not participate and do not feel enfranchised).

Objective: To synthesize evidence for the effectiveness of self-management interventions for chronic health conditions that have symptom overlap with traumatic brain injury (TBI) in order to extract recommendations for self-management intervention in persons with TBI., Design: An umbrella review of existing systematic reviews and/or meta-analyses of randomized controlled trials or nonrandomized studies targeting self-management of chronic conditions and specific outcomes relevant to persons with TBI., Method: A comprehensive literature search of 5 databases was conducted using PRISMA guidelines. Two independent reviewers conducted screening and data extraction using the Covidence web-based review platform. Quality assessment was conducted using criteria adapted from the Assessing the Methodological Quality of Systematic Reviews-2 (AMSTAR-2)., Results: A total of 26 reviews met the inclusion criteria, covering a range of chronic conditions and a range of outcomes. Seven reviews were of moderate or high quality and focused on self-management in persons with stroke, chronic pain, and psychiatric disorders with psychotic features. Self-management interventions were found to have positive effects on quality of life, self-efficacy, hope, reduction of disability, pain, relapse and rehospitalization rates, psychiatric symptoms, and occupational and social functioning., Conclusions: Findings are encouraging with regard to the effectiveness of self-management interventions in patients with symptoms similar to those of TBI. However, reviews did not address adaptation of self-management interventions for those with cognitive deficits or for populations with greater vulnerabilities, such as low education and older adults. Adaptations for TBI and its intersection with these special groups may be needed., Competing Interests: The authors declare no conflicts of interests., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc.)

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.

Background: To elucidate the sociodemographic and study factors involved in enrollment in the Traumatic Brain Injury Model System (TBIMS) database, this study examined the effect of a variety of variables on enrollment at a local TBIMS center., Methods: A sample of 654 individuals from the local TBIMS center was studied examining enrollment by age, gender, race, ethnicity, homelessness status at date of injury, history of homelessness, health insurance status, presence of social support, primary language, consenting in hospital or after discharge, and the need for an interpreter. Binary logistic regression was conducted to identify variables that predict center-based enrollment into TBIMS., Results: Results demonstrated that older age was associated with decreasing enrollment (OR = 0.99, p  = 0.01), needing an interpreter made enrollment less likely (OR = 0.33, p  < 0.01), being primarily Spanish speaking predicted enrollment (OR = 3.20, p  = 0.02), Hispanic ethnicity predicted enrollment (OR = 7.31, p  = 0.03), and approaching individuals in the hospital predicted enrollment (OR = 6.94, p  < 0.01). Here, OR denotes the odds ratio estimate from a logistic regression model and P denotes the corresponding p-value., Conclusions: These results can be useful in driving enrollment strategies at this center for other similar TBI research, and to contribute a representative TBI sample to the national database.

Background: On average, 45% of Canadian adults meet the recommended 150 minutes per week of moderate-to-vigorous physical activity. This singular statistic masks a wide range of adherence levels among different groups within the population. The purpose of this paper is to determine how sex, age, and family arrangement intersect with known risk factors for physical inactivity to identify groups within the Canadian population most at risk of not meeting the physical activity recommendation., Methods: Using six combined cycles of the Canadian Health Measures Survey (from 2007 to 2019), this study examines how the percentage of Canadian males and females aged 18 to 79 years meeting the physical activity recommendation differs across sociodemographic, family arrangement, and health factors. Logistic regression was used to examine whether the association between specific factors and adherence to the physical activity recommendation differed by sex. Latent class analysis was used to identify sex-specific combinations of sociodemographic, family arrangement and health-related factors within the Canadian population that are associated with varying levels of adherence to the physical activity recommendation., Results: More males met the physical activity recommendation compared with females (49% versus 38%). Latent classes with the lowest adherence to the physical activity recommendation (19% among females and 29% among males) primarily included those who were single or married with no children and who had a high probability of having many risk factors for physical inactivity, including being older, having a lower education, having lower income, smoking, having central adiposity, and having poor or fair self-rated general health. Latent classes with the highest adherence to the physical activity recommendation (61% among females and 67% among males) primarily included individuals with no spouse and no children and who had a low probability of having any risk factors for physical inactivity. For females, an additional class (32% of which met the physical activity recommendation) comprised young single mothers who had several risk factors for physical inactivity, including having low income, smoking and having central adiposity., Interpretation: Understanding how risk factors for physical inactivity intersect with sex, age, and family arrangement may inform strategies aimed at increasing physical activity among those who are most vulnerable.

Introduction: There is a growing population of women with limb loss, yet limited research is available to provide evidentiary support for clinical decision-making in this demographic. As such, there is a critical gap in knowledge of evidence-based healthcare practices aimed to maximise the physical and psychosocial needs of women with limb loss. The objective of this study is to develop a comprehensive, survey-based needs assessment to determine the unique impact of limb loss on women, including physical and psychosocial needs., Methods and Analysis: A bank of existing limb loss-specific and non-limb loss-specific surveys were arranged around domains of general health, quality of life, prosthetic use and needs, psychosocial health and behaviours and body image. These surveys were supplemented with written items to ensure coverage of relevant domains. Written items were iteratively refined with a multidisciplinary expert panel. The interpretability of items and relevance to limb loss were then internally tested on a small group of rehabilitation, engineering and research professionals. A diverse sample of 12 individuals with various levels of limb loss piloted the instrument and participated in cognitive interviews. Items from existing surveys were evaluated for relevance and inclusion in the survey, but not solicited for content feedback. Pilot testing resulted in the removal of 13 items from an existing survey due to redundancy. Additionally, 13 written items were deleted, 42 written items were revised and 17 written items were added. The survey-based needs assessment has been crafted to comprehensively assess the wide spectrum of issues facing women with limb loss. The final version of the survey-based needs assessment included 15 subsections., Ethics and Dissemination: This study was approved by the Veterans Affairs Central Institutional Review Board. The results will be disseminated through national and international conferences, as well as through manuscripts in leading peer-reviewed journals., Trial Registration Number: No healthcare intervention on human participants was conducted., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Traumatic brain injury (TBI) triggers progressive neurodegeneration resulting in brain atrophy that continues months-to-years following injury. However, a comprehensive characterization of the spatial and temporal evolution of TBI-related brain atrophy remains incomplete. Utilizing a sensitive and unbiased morphometry analysis pipeline optimized for detecting longitudinal changes, we analyzed a sample consisting of 37 individuals with moderate-severe TBI who had primarily high-velocity and high-impact injury mechanisms. They were scanned up to three times during the first year after injury (3 months, 6 months, and 12 months post-injury) and compared with 33 demographically matched controls who were scanned once. Individuals with TBI already showed cortical thinning in frontal and temporal regions and reduced volume in the bilateral thalami at 3 months post-injury. Longitudinally, only a subset of cortical regions in the parietal and occipital lobes showed continued atrophy from 3 to 12 months post-injury. Additionally, cortical white matter volume and nearly all deep gray matter structures exhibited progressive atrophy over this period. Finally, we found that disproportionate atrophy of cortex along sulci relative to gyri, an emerging morphometric marker of chronic TBI, was present as early as 3 month post-injury. In parallel, neurocognitive functioning largely recovered during this period despite this pervasive atrophy. Our findings demonstrate msTBI results in characteristic progressive neurodegeneration patterns that are divergent across regions and scale with the severity of injury. Future clinical research using atrophy during the first year of TBI as a biomarker of neurodegeneration should consider the spatiotemporal profile of atrophy described in this study., (© 2023 The Authors. Human Brain Mapping published by Wiley Periodicals LLC.)

Objective: To examine the effect of the COVID-19 pandemic on societal participation in people with moderate-to-severe traumatic brain injury (TBI)., Design: Cross-sectional retrospective cohort., Setting: National TBI Model Systems centers, United States., Participants: TBI Model Systems enrollees (N=7003), ages 16 and older and 1-30 years postinjury, interviewed either prepandemic (PP) or during the pandemic (DP). The sample was primarily male (72.4%) and White (69.5%), with motor vehicle collisions as the most common cause of injury (55.1%)., Interventions: Not applicable., Main Outcome Measure: The 3 subscales of the Participation Assessment with Recombined Tools-Objective: Out and About (community involvement), Productivity, and Social Relations., Results: Out and About, but not Productivity or Social Relations, scores were appreciably lower among DP participants compared to PP participants (medium effect). Demographic and clinical characteristics showed similar patterns of association with participation domains across PP and DP. When their unique contributions were examined in regression models, age, self-identified race, education level, employment status, marital status, income level, disability severity, and life satisfaction were variably predictive of participation domains, though most effects were small or medium in size. Depression and anxiety symptom severities each showed small zero-order correlations with participation domains across PP and DP but had negligible effects in regression analyses., Conclusions: Consistent with the effect of COVID-19 on participation levels in the general population, people with TBI reported less community involvement during the pandemic, potentially compounding existing postinjury challenges to societal integration. The pandemic does not appear to have altered patterns of association between demographic/clinical characteristics and participation. Assessing and addressing barriers to community involvement should be a priority for TBI treatment providers. Longitudinal studies of TBI that consider pandemic-related effects on participation and other societally linked outcomes will help to elucidate the potential longer-term effect the pandemic has on behavioral health in this population., (Copyright © 2023 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Background: To date, population estimates of hypertension prevalence among children and adolescents in Canada have been based on clinical guidelines in the National High Blood Pressure Education Program's 2004 Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents (NHBPEP 2004). In 2017, the American Academy of Pediatrics published updated guidelines in Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents (AAP 2017), followed by Hypertension Canada in 2020 with its publication of Comprehensive Guidelines for the Prevention, Diagnosis, Risk Assessment, and Treatment of Hypertension in Adults and Children (HC 2020). This study compares national child and adolescent hypertension prevalence estimates based on NHBPEP 2004, AAP 2017 and HC 2020., Data and Methods: Six cycles of data spanning 2007 to 2019 from the Canadian Health Measures Survey were used to compare blood pressure (BP) categories and the prevalence of hypertension by sex and age group under all sets of guidelines for children and adolescents aged 6 to 17. The impact of applying AAP 2017 across time and selected characteristics, the resulting reclassification into a higher BP category under AAP 2017, and differences in hypertension prevalence resulting from applying HC 2020 versus AAP 2017 were examined., Results: Prevalence of Stage 1 hypertension was higher among children and adolescents aged 6 to 17 under AAP 2017 and HC 2020 than under NHBPEP 2004. Overall hypertension prevalence was also higher, and obesity was a major factor associated with being reclassified into a higher BP category under AAP 2017., Interpretation: Implementation of AAP 2017 and HC 2020 is associated with significant changes in the epidemiology of hypertension. Understanding the impact of applying updated clinical guidelines may help inform population surveillance efforts to track hypertension prevalence among Canada's children and adolescents.

Objective: To examine a resource provision program for individuals living with moderate-to-severe traumatic brain injury (TBI), using a comparison of the resources provided across social differences of language, nativity, and neighborhood., Setting: The Rusk Rehabilitation TBI Model System (RRTBIMS) collects data longitudinally on individuals from their associated private and public hospitals, located in New York City., Participants: A total of 143 individuals with TBI or their family members., Design: An observational study of relative frequency of resource provision across variables of language, nativity, and neighborhood, using related-samples nonparametric analyses via Cochran's Q test., Main Measures: Variables examined were language, place of birth, residence classification as medically underserved area/population (MUA), and resource categories., Results: Results indicate that US-born persons with TBI and those living in medically underserved communities are provided more resources than those who are born outside the United States or reside in communities identified as adequately medically served. Language was not found to be a factor., Conclusion: Lessons learned from this research support the development of this resource provision program, as well as guide future programs addressing the gaps in health information resources for groups negatively impacted by social determinants of health (SDoH). An approach with immigrant participants should take steps to elicit questions and requests, or offer resources explicitly. We recommend research looking at what interpreter strategies are most effective and research on SDoH in relation to the dynamic interaction of variables in the neighborhood setting., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: People with traumatic brain injury (TBI) can lack awareness of their own emotions and often have problems with emotion dysregulation, affective disorders, and empathy deficits. These impairments are known to impact psychosocial behaviors and may contribute to the burden experienced by care partners of individuals with TBI., Objective: To examine the associations of emotional awareness, emotional functioning, and empathy among participants with TBI with care partner burden., Method: This multisite, cross-sectional, observational study used data from 90 dyads (participants with TBI and their care partner) 1-year post-injury. Participants with TBI completed the Difficulty with Emotional Regulation Scale (DERS; Awareness, Clarity, Goals, Impulse, Nonacceptance, and Strategies subscales); PTSD Checklist-Civilian Version; NIH Toolbox Anger-Affect, Hostility and Aggression Subdomains; PHQ-9; GAD-7; and the Interpersonal Reactivity Index (empathic concern and perspective taking subscales). Care partners completed the Zarit Burden Inventory (ZBI) and provided demographic information., Results: Care partners were predominately female (77%), and most were either a spouse/partner (55.2%) or parent (34.4%). In an unadjusted model that included assessments of emotional awareness, emotional functioning, and empathy of the participant with TBI, the DERS-Awareness and NIH-Hostility subscales accounted for a significant amount of variance associated with care partner burden. These findings persisted after adjusting for care partner age, relationship, education, and the functional status of the participant with TBI (β= 0.493 and β= 0.328, respectively)., Conclusion: These findings suggest that high levels of hostility and low emotional self-awareness can significantly affect the burden felt by TBI care partners.

Purpose: Proton magnetic resonance spectroscopy ( 1 H MRS) offers biomarkers of metabolic damage after mild traumatic brain injury (mTBI), but a lack of replicability studies hampers clinical translation. In a conceptual replication study design, the results reported in four previous publications were used as the hypotheses (H1-H7), specifically: abnormalities in patients are diffuse (H1), confined to white matter (WM) (H2), comprise low N-acetyl-aspartate (NAA) levels and normal choline (Cho), creatine (Cr) and myo-inositol (mI) (H3), and correlate with clinical outcome (H4); additionally, a lack of findings in regional subcortical WM (H5) and deep gray matter (GM) structures (H6), except for higher mI in patients' putamen (H7)., Methods: 26 mTBI patients (20 female, age 36.5 ± 12.5 [mean ± standard deviation] years), within two months from injury and 21 age-, sex-, and education-matched healthy controls were scanned at 3 Tesla with 3D echo-planar spectroscopic imaging. To test H1-H3, global analysis using linear regression was used to obtain metabolite levels of GM and WM in each brain lobe. For H4, patients were stratified into non-recovered and recovered subgroups using the Glasgow Outcome Scale Extended. To test H5-H7, regional analysis using spectral averaging estimated metabolite levels in four GM and six WM structures segmented from T1-weighted MRI. The Mann-Whitney U test and weighted least squares analysis of covariance were used to examine mean group differences in metabolite levels between all patients and all controls (H1-H3, H5-H7), and between recovered and non-recovered patients and their respectively matched controls (H4). Replicability was defined as the support or failure to support the null hypotheses in accordance with the content of H1-H7, and was further evaluated using percent differences, coefficients of variation, and effect size (Cohen's d)., Results: Patients' occipital lobe WM Cho and Cr levels were 6.0% and 4.6% higher than controls', respectively (Cho, d = 0.37, p = 0.04; Cr, d = 0.63, p = 0.03). The same findings, i.e., higher patients' occipital lobe WM Cho and Cr (both p = 0.01), but with larger percent differences (Cho, 8.6%; Cr, 6.3%) and effect sizes (Cho, d = 0.52; Cr, d = 0.88) were found in the comparison of non-recovered patients to their matched controls. For the lobar WM Cho and Cr comparisons without statistical significance (frontal, parietal, temporal), unidirectional effect sizes were observed (Cho, d = 0.07 - 0.37; Cr, d = 0.27 - 0.63). No differences were found in any metabolite in any lobe in the comparison between recovered patients and their matched controls. In the regional analyses, no differences in metabolite levels were found in any GM or WM region, but all WM regions (posterior, frontal, corona radiata, and the genu, body, and splenium of the corpus callosum) exhibited unidirectional effect sizes for Cho and Cr (Cho, d = 0.03 - 0.34; Cr, d = 0.16 - 0.51)., Conclusions: We replicated findings of diffuse WM injury, which correlated with clinical outcome (supporting H1-H2, H4). These findings, however, were among the glial markers Cho and Cr, not the neuronal marker NAA (not supporting H3). No differences were found in regional GM and WM metabolite levels (supporting H5-H6), nor in putaminal mI (not supporting H7). Unidirectional effect sizes of higher patients' Cho and Cr within all WM analyses suggest widespread injury, and are in line with the conclusion from the previous publications, i.e., that detection of WM injury may be more dependent upon sensitivity of the 1 H MRS technique than on the selection of specific regions. The findings lend further support to the corollary that clinic-ready 1 H MRS biomarkers for mTBI may best be achieved by using high signal-to-noise-ratio single-voxels placed anywhere within WM. The biochemical signature of the injury, however, may differ and therefore absolute levels, rather than ratios may be preferred. Future replication efforts should further test the generalizability of these findings., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Throughout the COVID-19 pandemic, Canadian public health officials have mandated and recommended precautions to slow the spread of COVID-19. This study examined which population groups were less compliant with precautions, such as mask-wearing and self-isolating, and where they were located in Canada., Data and Methods: Results are from the Canadian COVID-19 Antibody and Health Survey, a national survey aimed at estimating how many Canadians who were older than one year and living in private households had antibodies in their blood against the SARS-CoV-2 virus. Questionnaire data were collected in the 10 provinces and 3 territorial capitals, from November 2020 to April 2021. Respondents were asked about compliance with precautions related to COVID-19. Weighted prevalences and logistic regression models were used to identify which population groups were less compliant with precautions to prevent the spread of COVID-19, and where they were located in Canada., Results: Significant differences in compliance with precautions were found by sex, region, urban versus rural location, age, income, presence of chronic conditions, household size and work status. With covariate adjustment, Canadians who were less compliant with precautions were males, those living in the territorial capitals, those in rural areas, and people aged 34 and younger (compared with people aged 65 and older). Additional differences were found when analyzing compliance with consistently recommended precautions compared with those usually recommended., Interpretation: As Canada continues to navigate the waves of the pandemic, and with the emergence of new variants, precautions are still being mandated or recommended in many jurisdictions and locations. Continuing to understand which population groups were less compliant in earlier waves and where they were located in Canada can be beneficial to ongoing and future public health efforts to slow the transmission of COVID-19.

Objective: To determine the incidence of cognitive dependence in adults who are physically independent at discharge from acute traumatic brain injury (TBI) rehabilitation., Design: Analysis of historical clinical and demographic data obtained from inpatient stay., Setting: Inpatient rehabilitation unit in a large, metropolitan university hospital., Participants: Adult inpatients with moderate to severe TBI (N=226) who were physically independent at discharge from acute rehabilitation., Interventions: Not applicable., Main Outcome Measures: FIM Motor and Cognitive subscales, discharge destination, and care plan., Results: Approximately 69% (n=155) of the physically independent inpatients were cognitively dependent at discharge from acute rehabilitation, with the highest proportions of dependence found in the domains of problem solving and memory. Most (82.6%; n=128) of these physically independent, yet cognitively dependent, patients were discharged home. Of those discharged home, 82% (n=105) were discharged to the care of family members, and 11% (n=15) were discharged home alone. Patients from racial and ethnic minority backgrounds were significantly more likely than White patients to be discharged while cognitively dependent., Conclusions: The majority of physically independent patients with TBI were cognitively dependent at the time of discharge from acute inpatient rehabilitation. Further research is needed to understand the effect of cognitive dependence on caregiver stress and strain and the disproportionate burden on racial and ethnic minority patients and families. Given the potential functional and safety limitations imposed by cognitive deficits, health care policy and practice should facilitate delivery of cognitive rehabilitation services in acute TBI rehabilitation., (Copyright © 2022 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: The aim of this study is to examine the effect of eight distinct marginalized group memberships and explore their compounding effect on injury severity, recovery, discharge location, and employment outcomes 1-year after traumatic brain injury (TBI)., Methods: Individuals with medically confirmed, complicated mild-severe TBI (N = 300) requiring inpatient rehabilitation care between the ages of 18 and 65 were recruited at two urban (public and private) health systems between 2013 and 2019. Data were collected from self-report and medical record abstraction. Marginalized group membership (MGM) includes racial and ethnic minority status, less than a high school diploma/GED, limited English proficiency, substance abuse, homelessness, psychiatric hospitalizations, psychiatric disorders, and incarceration history. Membership in four or more of these groups signifies high MGM. In addition, these factors were explored individually. Unadjusted and adjusted linear and logistic regressions and Kruskal-Wallis tests were used to assess the associations of interest in RStudio., Results: After adjusting for age, sex, and cause of injury, compared to TBI patients with low MGM, those with high MGM experience significantly longer post-traumatic amnesia (95% CI = 2.70, 16.50; p = 0.007) and are significantly more likely to have a severe TBI (per the Glasgow-Coma Scale) (95% CI = 1.70, 6.10; p ≤ 0.001) than a complicated mild-moderate injury. Individuals with high MGM also are significantly less likely to be engaged in competitive paid employment 1 year after injury (95% CI = 2.40, 23.40; p = 0.001). Patients with high MGM are less likely to be discharged to the community compared to patients with low MGM, but this association was not significant (95% CI = 0.36, 1.16; p = 0.141). However, when assessing MGMs in isolation, certain associations were not significant in unadjusted or adjusted models., Conclusion: This exploratory study's findings reveal that when four or more marginalization factors intersect, there is a compounding negative association with TBI severity, recovery, and employment outcomes. No significant association was found between high MGM and discharge location. When studied separately, individual MGMs had varying effects. Studying marginalization factors affecting individuals with TBI has critical clinical and social implications. These findings underline the importance of addressing multidimensional factors concurrent with TBI recovery, as the long-term effects of TBI can place additional burdens on individuals and their economic stability., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Garduño-Ortega, Li, Smith, Yao, Wilson, Zarate and Bushnik.)

Objective: In rehabilitation research and practice, participation is defined as involvement in life situations and most often measured as frequency of engaging in these life situations. This narrow measurement approach overlooks that individuals perceive importance of and satisfaction with participation in activities in various life areas differently. The purpose of this study was to determine differences in meaningful participation (perceived importance and satisfaction) after moderate to severe traumatic brain injury (TBI) across age groups and to identify predictors of participation satisfaction., Method: Secondary data analysis of a TBI Model Systems substudy, including the Participation Assessment with Recombined Tools-Subjective (PART-S) that rates participation importance and satisfaction in 11 life areas that we grouped into three domains (i.e., productivity, social relations, out-and-about). We identified differences across age groups (i.e., 16 to 24 years, 25 to 44 years, 45 to 64 years, and 65 + years) and predictors of participation satisfaction., Results: Participation satisfaction in and importance of the 11 life areas varied across age groups. In all age groups, participants rated relationships as being of medium or high importance more often than other life areas. Older adults reported the highest participation satisfaction across life areas, despite having the lowest participation frequency. Consistent predictors of participation satisfaction were cognitive functioning and frequency of participation in the domain examined., Conclusion: Participation importance, satisfaction, and frequency are related, yet distinct, dimensions of participation that should all be measured to adequately evaluate meaningful participation. Future research should explore interventions across the lifespan that target modifiable predictors, like functional cognition and access to frequent participation in important life activities. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Background: The burden of out-of-pocket costs among cancer patients/survivors in Canada is not well understood. The objective of this study was to examine the health-related out-of-pocket cost burden experienced by households with a cancer patient/survivor compared to those without, examine the components of health-related costs and determine who experiences a greater burden., Data and Methods: This study used a data linkage between the Survey of Household Spending and the Canadian Cancer Registry to identify households with a cancer patient/survivor (cases) and those without (controls). The out-of-pocket burden (out-of-pocket costs measured relative to household income) and mean costs were described and regression analyses examined the characteristics associated with the household out-of-pocket burden and annual out-of-pocket costs., Results: The health-related out-of-pocket cost burden and annual costs measured in households with a cancer patient/survivor were 3.08% (95% CI: 2.55-3.62%) and CAD 1600 (95% CI: 1456-1759), respectively, compared to a burden of 2.84% (95% CI: 2.31-3.38) and annual costs of CAD 1511 (95% CI: 1377-1659) measured in control households, respectively. Households with a colorectal cancer patient/survivor had a significantly higher out-of-pocket burden compared to controls (mean difference: 1.0%, 95% CI: 0.18, 0.46). Among both cases and controls, the lowest income quintile households experienced the highest health-related out-of-pocket cost burden., Interpretation: Within a universal health care system, it is still relevant to monitor health-related out-of-pocket spending that is not covered by existing insurance mechanisms; however, this is not routinely assessed in Canada. We demonstrate the feasibility of measuring such costs in households with a cancer patient/survivor using routinely collected data. While the burden and annual health-related out-of-pocket costs of households with a cancer patient/survivor were not significantly higher than control households in this study, the routine measurement of out-of-pocket costs in Canada could be systemized, providing a novel, system-level, equity-informed performance indicator, which is relevant for monitoring inequities in the burden of out-of-pocket costs.