Long term neurobehavioral symptoms and return to productivity in Operation Enduring Freedom/Operation Iraqi Freedom Veterans with and without traumatic brain injury

Publication date: Available online 11 January 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Marianne H. Mortera, Stacy A. Kinirons, Jessie Simantov, Heidi Klingbeil
ObjectivesTo describe Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans who underwent the Comprehensive Traumatic Brain Injury Evaluation (CTBIE), differences between the traumatic brain injury (TBI) and non- traumatic brain injury (non-TBI) subgroups, and factors associated with return to productivity (RTP).DesignRetrospective medical record review.SettingVeterans Affairs Medical Center, Polytrauma/TBI Network Site.ParticipantsMedical records of 236 OEF/OIF Veterans who underwent the CTBIE between 2009-2013.InterventionsNot applicable.Main Outcome MeasuresDemographic characteristics, injury history, clinical presentation, and factors associated with RTP.ResultsVeterans (n=236) were male (90.7%), White (45.3%) or Black (34.7%), with half of Hispanic origin, and a mean age of 33 years. The mean time since injury was approximately 4 years. Reported symptoms were high, with greater than 90% reporting anxiousness, irritability, sleep difficulty, forgetfulness, and headaches.TBI diagnosis was found in 163 (69%) Veterans. The TBI subgroup was younger (TBI 32.5 years versus non-TBI 34.9 years, p=0.02), reported a greater number of injuries (p= 0.000), and had significantly higher rates of half of the reported symptoms. Greatest differences were noted with forgetfulness (TBI 95.7% versus non-TBI 79.5%, p=0.000), poor concentration (TBI 90.2% versus non-TBI 76.7%, p=0.007), and headaches (TBI 93.9% versus non-TBI 83.6%, p=0.014).RTP was 60.6% for the total Veteran population. Factors associated with RTP were race (white) (OR=2.00; 95%CI:1.13-3.55, p=0.018), sensitivity to light (OR=2.58; 95%CI:1.17-5.66, p=0.018), and fatigue (OR=3.68; 95%CI:1.51-8.95, p=0.004). Veterans that did RTP wessre three times less likely to report depression (OR=0.323; 95%CI:0.12-.85, p=0.022).ConclusionsVeterans reported a substantial number of lingering symptoms, with a higher prevalence in Veterans with TBI. Veterans with reported depression were less likely to RTP. Future research should focus on the relationship between depression and non-RTP and the effectiveness of VA services.



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