Rehabilitation needs at 5 years post-traumatic brain injury: A VA TBI model systems study

Objective: Describe rehabilitation needs and factors associated with unmet needs at 5 years post-traumatic brain injury (TBI). Setting: Five Veterans Affairs (VA) polytrauma rehabilitation centers (PRCs). Participants: VA TBI Model Systems participants (N = 283; 96% male, 75%, 57% severe TBI). Design: Prospective observational cohort. Main Measures: Rehabilitation Needs Survey (21-item survey that assesses cognitive, emotional, social, and functional needs); Craig Hospital Inventory of Environmental Factors (25-item survey of potential environmental barriers). Results: Participants endorsed a mean of 8 (SD: 6.2) ongoing and 3 (SD: 4.7) unmet rehabilitation needs at 5 years post-TBI. Approximately 65% of participants reported at least 1 rehabilitation need that remained unmet. The number and nature of needs differed across TBI severity groups. In unadjusted and adjusted linear regression models, Black race and environmental barriers (Craig Hospital Inventory of Environmental Factors total score) were predictive of unmet needs (P <.001). Those with greater unmet needs reported the physical environment (54%-63%), informational sources (54%), social attitudes (55%), healthcare access (40%), public policy (32%-37%), transportation availability (33%), and in-home assistance (32%) as the most frequent environmental barriers at 5 years post-TBI. Conclusion: Veterans and Service Members continue to have rehabilitation needs at 5 years post-TBI. Veterans Affairs programs to address ongoing needs and policy to support them are needed.