Development of the traumatic brain injury Rehabilitation Needs Survey: a Veterans Affairs TBI Model Systems study

Abstract

Purpose

To describe the development of the Rehabilitation Needs Survey (RNS) for persons in the chronic phase of traumatic brain injury (TBI) recovery.

Materials and methods

RNS items were generated following a literature review (January – March 2015) on the topic of rehabilitation needs and revised via consensus from an expert panel of TBI clinicians and researchers. The RNS was added to the VA TBI Model Systems longitudinal study; data collection occurred between 2015–2019. Needs were classified as current (if endorsed) or absent; if current, needs were classified as unmet if no help was received. Need frequency and association with rehabilitation outcomes were presented.

Results

Eight studies examined rehabilitation needs and formed the initial item pool of 42 needs. This was reduced to form the 21-item RNS which was administered at year 1 (n = 260) and year 2 (n = 297) post-TBI. Number of needs endorsed was 8–9, and number of unmet needs was 1–2, on average. Number of needs was correlated with functional status, neurobehavioral symptoms, and mental health symptoms (p < 0.05) suggesting support for convergent validity of the RNS.

Conclusion

The RNS is a new measure of rehabilitation needs following TBI. Further investigation into its psychometrics and clinical utility is recommended.

Implications for rehabilitation

• Veterans and Service Members with traumatic brain injury across the severity spectrum have ongoing rehabilitation needs during the chronic phase of recovery.

• The Rehabilitation Needs Survey is a standardized measure of rehabilitation needs following traumatic brain injury.

• Identification of unmet rehabilitation needs is important for raising awareness of service gaps and providing justification for resource allocation.

Keywords:

• Brain injuries
• traumatic
• health service needs and demand
• health care surveys
• military personnel
• rehabilitation
• surveys and questionnaires
• veterans

Acknowledgments

Portions of this research was presented at the 93^rd Annual Conference of the American Congress of Rehabilitation, Chicago, IL, November 2016. The authors would like to thank Courtney Lynn for literature retrieval assistance, Dr. Gregory Lamberty, Dr. Mary Jo Pugh, Dr. Felicia Qashu, and Dr. Susan Ropacki for their participation in item development and refinement, and Xinyu Tang for statistical support. Dr. Stevens is no longer affiliated with the Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA.

Disclosure statement

This research was conducted with resources and the use of facilities at the Hunter Holmes McGuire Veterans Affairs Medical Center, James A. Haley Veterans’ Hospital, Minneapolis VA Health Care System, Palo Alto VA Health Care System, and South Texas Veterans Health Care System. The views expressed in this publication are those of the authors and do not necessarily represent the official policy or position of the Defense Health Agency, Department of Defense, or any other U.S. government agency. This work was prepared under Contract HT0014-19-C-0004 with DHA Contracting Office (CO-NCR) HT0014 and, therefore, is defined as U.S. Government work under Title 17 U.S.C.§101. Per Title 17 U.S.C.§105, copyright protection is not available for any work of the U.S. Government. For more information, please contact [email protected]. UNCLASSIFIED

Additional information

Funding

This work was supported by the Defense and Veterans Brain Injury Center subcontract from General Dynamics Information Technology (HT0014-19-C-0004,W91YTZ-13-C-0015).