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Titre : | Intensive Outpatient Program Response Among Service Members With Mild Traumatic Brain Injury: Change Between Distinct Post-Concussive Symptom Subgroups (2023) |
Auteurs : | Adam R. Kinney ; Rachel Sayko Adams ; Jesus J. Caban ; Thomas J. DeGraba ; Treven Pickett ; Peter Hoover |
Type de document : | Article |
Dans : | Archives of Physical Medicine and Rehabilitation (Vol. 104, n° 6, 2023) |
Article en page(s) : | p. 892-901 |
Note générale : | https://doi.org/10.1016/j.apmr.2022.12.191 |
Langues: | Anglais |
Descripteurs : |
HE Vinci Épilepsie post-traumatique ; Lésions encéphaliques ; Personnel militaire ; Réadaptation ; Syndrome post-commotionnel ; Troubles de stress traumatique |
Résumé : | Objective Among service members (SMs) with mild traumatic brain injury (mTBI) admitted to an intensive outpatient program (IOP), we identified qualitatively distinct subgroups based on post-concussive symptoms (PCSs) and characterized changes between subgroups from admission to discharge. Further, we examined whether co-morbid posttraumatic stress disorder (PTSD) influenced changes between subgroups. Design Quasi-experimental. Latent transition analysis identified distinctive subgroups of SMs and examined transitions between subgroups from admission to discharge. Logistic regression examined the effect of PTSD on transition to the Minimal subgroup (low probability of any moderate-very severe PCS) while adjusting for admission subgroup designation. Setting National Intrepid Center of Excellence (NICoE) at Walter Reed National Military Medical Center. Participants 1141 active duty SMs with persistent PCS despite prior treatment (N=1141). Interventions NICoE 4-week interdisciplinary IOP. Main Outcome Measure(s) Subgroups identified using Neurobehavioral Symptom Inventory items at admission and discharge. Results Model fit indices supported a 7-class solution. The 7 subgroups of SMs were distinguished by diverging patterns of probability for specific PCS. The Minimal subgroup was most prevalent at discharge (39.4%), followed by the Sleep subgroup (high probability of sleep problems, low probability of other PCS; 26.8%). 41% and 25% of SMs admitted within the Affective (ie, predominantly affective PCS) and Sleep subgroups remained within the same group at discharge, respectively. The 19% of SMs with co-morbid PTSD were less likely to transition to the Minimal subgroup (odds ratio=0.28; P<.001 and were more likely to remain in their admission subgroup at discharge with ptsd vs without conclusions most of sms achieved symptom resolution after participation the iop transitioning subgroups characterized by reduced burden. admitted affective sleep as well those have continuing clinical needs revealing priority targets for resource allocation follow-up treatment.> |
Disponible en ligne : | Oui |
En ligne : | https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/science/article/pii/S000399932300028X |