Vocational Rehabilitation of Clients with Brain Injury: An Investigation of Racial Disparity within The Rehabilitation Services Administration (RSA) 911 Database

Finding and maintaining employment is an ongoing problem for persons with disabilities, especially those with brain injuries. State vocational rehabilitation agencies are the primary authority responsible for providing employment-related services for individuals with disabilities throughout the United States. Little effort has been committed to identifying disparities in health and rehabilitation services provided to Americans with disabilities, particularly those with brain injuries. The purpose of this investigation was to utilize Aday and Andersen\u27s Framework for the Study of Access to examine racial disparity within the Rehabilitation Services Administration 911 Database, and thus the vocational rehabilitation system, among clients with brain injury. Upon review of the descriptive findings, Whites and Asian or Pacific Islanders were more likely to be accepted for rehabilitation than Blacks and American Indians or Alaskan Natives. Acceptance rates for males and females were similar. Clients, who received their primary source of support from “other” sources at the time of application, were least likely to be accepted for vocational rehabilitation. Hispanics appeared to have lower acceptance rates than non-Hispanics. Persons with greater than a high school education were more likely to be accepted for rehabilitation than persons with less education who had completed schooling through the regular education system. Exhaustive CHAID findings suggest that racial disparity in rehabilitation acceptance rates is not a clear cut issue. Each of the racial groups was more likely to be accepted for rehabilitation under different circumstances. Consequently, a definitive broadcast statement about racial disparity within the Federal Rehabilitation System cannot be made. With regard to reason for closure, although the Chi-square analyses for the current investigation were significant, the degree of association was extremely modest. There did not appear to be a practical difference between White and non-White clients with regard to reason for closure. Future research, and practice and policy implications are discussed

Factors associated with remission of post-traumatic brain injury fatigue in the years following traumatic brain injury (TBI): a TBI model systems module study

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

Relationship of patient characteristics and inpatient rehabilitation services to 5-year outcomes following spinal cord injury: A follow up of the SCIRehab project

Objective: To examine associations of patient characteristics and treatment quantity delivered during inpatient spinal cord injury (SCI) rehabilitation with outcomes at 5 years post-injury and compare them to the associations found at 1 year post-injury. Design: Observational study using Practice-Based Evidence research methodology in which clinicians documented treatment details. Regression modeling was used to predict outcomes. Setting: Five inpatient SCI rehabilitation centers in the US. Participants: Participants were 792 SCIRehab participants who were >12 years of age, gave informed consent, and completed both a 1-year and 5-year post-injury interview. Outcome measures: Outcome data were derived from Spinal Cord Injury Model Systems (SCIMS) follow-up interviews at 5 years post-injury and, similar to the 1-year SCIMS outcomes, included measures of physical independence, societal participation, life satisfaction, and depressive symptoms, as well as place of residence, school/work attendance, rehospitalization, and presence of pressure ulcers. Results: Consistent with 1-year findings, patient characteristics continue to be strong predictors of outcomes 5-years post-injury, although several variables add to the prediction of some of the outcomes. More time in physical therapy and therapeutic recreation were positive predictors of 1-year outcomes, which held less true at 5 years. Greater time spent with psychology and social work/case management predicted greater depressive symptomatology 5-years post-injury. Greater clinician experience was a predictor at both 1- and 5 -years, although the related positive outcomes varied across years. Conclusion: Various outcomes 5-years post-injury were primarily explained by pre-and post-injury characteristics, with little additional variance offered by the quantity of treatment received during inpatient rehabilitation

Outcome prediction from post-injury resilience in patients with TBI

The objective of the study was to evaluate the extent to which 1- and 2-year outcomes after traumatic brain injury (TBI) are predicted by resilience. Research Method/Design: This was an observational, longitudinal study of persons ( = 158) with moderate or severe TBI who completed both 1- and 2-year outcome assessments. Outcomes included anxiety (Generalized Anxiety Disorder-7), depression (Patient Health Questionnaire-9), life satisfaction (Satisfaction with Life Scale), substance misuse, and return-to-work measures. The Connor-Davidson Resilience Scale was used to assess resilience at 3 or 6 months after injury. Greater resilience predicted less anxiety, depression, and substance use and better satisfaction with life and return to work at 1 year after injury for both adjusted and unadjusted models. Standardized regression coefficients were all greater than 0.38 for continuous outcomes, whereas odds ratios were 1.34 and 0.81 for the return to work and substance misuse outcomes, respectively ( < .05). Similar but weaker trends were found at 2 years after injury, with statistical significance no longer met for all outcomes. Resilience was shown to have predictive ability for outcomes at 1 and 2 years after TBI. Resilience appears to be a salient and important variable for long-term outcomes in person with TBI after adjusting for injury and demographic characteristics. (PsycINFO Database Record (c) 2019 APA, all rights reserved)