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Poster 14: Preinjury Emotional Functioning and Health-Related Quality of Life 3 Months After Mild Traumatic Brain Injury
E12
CONGRESS ANNUAL CONFERENCE ABSTRACTS
Poster 12 Psychologic Adjustment and Coping and Problem-Solving Styles: Correlates of Satisfaction With Life for Caregivers and Survivors of Traumatic Brain Injury. Lance E. Trexler (Rehabilitation Hospital of Indiana, Indianapolis, IN), Daniel Klyce, Summer Ibarra, Samantha Backhaus. Disclosure: None declared. Objective: To determine the relationship of satisfaction with life with coping styles, problem-solving, and psychologic adjustment for caregivers and survivors of traumatic brain injury (TBI). Design: Correlational study. Setting: Postacute rehabilitation clinic. Participants: 20 survivors of TBI and 20 caregivers. Interventions: Not applicable. Main Outcome Measures: Satisfaction With Life Scale (SWLS), Brief Symptom Inventory⫺18 (BSI-18), Coping Inventory for Stressful Situations (CISS), and Social Problem Solving Inventory⫺Revised (SPSI-R). Results: For caregivers, the SWLS correlated positively with task-oriented coping (.488, P⫽.029), negatively with emotion-oriented coping (⫺.455, P⫽.044), and negatively with problem orientation (⫺.497, P⫽.026). Psychologic distress (BSI) correlated highly and negatively with SWLS (somatization, ⫺.506, P⫽.023; depression, ⫺.642, P⫽.002; anxiety, ⫺.625, P⫽.003). Regression analyses showed depression was the best predictor of the SWLS (F⫽12.590, P⫽.002). In contrast, none of the BSI, CISS, or SPSI-R variables correlated significantly with SWLS scores for survivors of TBI. Conclusions: Adaptive coping strategies are related to better satisfaction with life among caregivers. Poorer satisfaction with life is associated with emotion-based coping, negative problem-solving, and psychologic distress. In stark contrast, satisfaction with life for TBI survivors was not associated with coping, problem solving, or psychologic adjustment. Other moderator variables (such as neurocognitive and behavioral dysfunction) may influence satisfaction with life for survivors. Key Words: Brain injuries; Rehabilitation. Poster 13 Prevention of Depression and Enhancing Cognitive Recovery in Traumatic Brain Injury With Duloxetine: Preliminary Results. Lance Trexler (Rehabilitation Hospital of Indiana, Indianapolis, IN), Nancy Lipson. Disclosure: None declared. Objective: To determine if duloxetine prevents depression and improves cognitive recovery following traumatic brain injury (TBI). Design: Double-blind, randomized, placebo-controlled study. Setting: Acute rehabilitation hospital. Participants: 6 subjects randomly assigned to the duloxetine (n⫽4) and placebo (n⫽2) groups. Interventions: Participants randomized to the duloxetine group received 30mg of duloxetine every day for 1 week and then 60mg every day for 9 months. Main Outcome Measures: Hamilton Depression Scale (HAM-D), Hopkins Verbal Learning Test (HVLT), and the Community Integration Questionnaire (CIQ). Results: Given the small sample size, the results are preliminary. HAM-D scores for all participants were notably low. Participants who received duloxetine demonstrated consistently better performance on the HVLT total recall and delayed recall subtests over the follow-up periods, with the significant differences from placebo at 6 months for the HVLT total recall subtest (2-tailed t test, P⫽.06) and for the delayed recall subtest (2-tailed t test, P⫽.03). The duloxetine group subjects rated themselves consistently better on the CIQ. The 9-month follow-up comparison demonstrated that the duloxetine group was superior to placebo (2-tailed t test, P⫽.007) on the CIQ productivity subscale. Conclusions: While preliminary, these data suggest that duloxetine may be effective in improving community participation and return to work or school after TBI. Results also suggest improved cognitive recovery, particularly Arch Phys Med Rehabil Vol 89, October 2008
with respect to verbal memory and learning capacity. No long-term advantage for the duloxetine group was found in terms of depression, but it was also noteworthy that levels of depression for both groups were remarkably low. Key Words: Cognition; Duloxetine; Rehabilitation. Poster 14 Preinjury Emotional Functioning and Health-Related Quality of Life 3 Months After Mild Traumatic Brain Injury. Allison Clark (Baylor College of Medicine, Houston, TX), Angelle Sander, Margaret Struchen, Diana Mazzei. Disclosure: None declared. Objective: To investigate the relationship of preinjury emotional functioning to health-related quality of life (HRQOL) 3 months after mild traumatic brain injury (TBI). Design: Prospective outcome study. Setting: County level 1 trauma emergency center in central Houston, TX. Participants: 181 persons with mild TBI consecutively admitted to a county level 1 trauma emergency center; 73.5% were men. Mean age ⫾ SD was 33.29⫾11.9 years, education was 10.60⫾3.88 years, and emergency department Glasgow Coma Scale score was 14.28⫾1.87. 59.7% were Hispanic, 22.7% were black, and 14.4% were white. Interventions: Not applicable. Main Outcome Measures: Physical (PCS) and mental (MCS) component summary scales from the 36-Item Short-Form Health Survey. Results: Preinjury emotional functioning accounted for a significant proportion of variance in MCS score (R2 change, .063; P⫽.004), controlling for age, education, injury severity, and disability. Preinjury anger was a significant predictor, with greater preinjury anger associated with lower MCS scores. There was a trend for greater preinjury stress to be associated with lower MCS scores. Preinjury emotional functioning was not related to PCS score. Conclusions: Results suggest that preinjury emotional functioning plays an important role in the mental components of HRQOL following mild TBI, and that assessment of mild TBI should include evaluation of preinjury emotional functioning, which may inform treatment targets. Key Words: Brain injuries; Quality of life; Rehabilitation. Poster 15 Inpatient Rehabilitation Case-Mix for Acquired Brain Injury in Canada: A Population-Based Perspective. Angela Colantonio (Toronto Rehabilitation Institute, University of Toronto, Toronto, ON), Gary Gerber, Mark Bayley, Raisa Deber, Junlang Yin, Hwan Kim. Disclosure: None declared. Objective: To examine the demographic and clinical characteristics for persons receiving inpatient rehabilitation services for different causes of acquired brain injury in Canada from a population-based perspective. Design: Cross-sectional study utilizing data from the National Rehabilitation Reporting System (NRS) from the Canadian Institute for Health Information from April 2001 through March 2006. Setting: Designated inpatient rehabilitation program in Canada, with 60.5% from Ontario where data collection is mandatory. Participants: 2675 patients with traumatic brain injury (TBI) versus 2759 nontraumatic cases, such as from encephalitis and anoxia, were compared. Interventions: Not applicable. Main Outcome Measures: Demographic characteristics and FIM scores. Results: TBI cases were significantly younger and more likely to be male and from urban areas. Non-TBI cases had lower FIM admission scores, with generally worse perceived health status and more comorbidity. Length of stay averaged 50 days for both groups. Conclusions: This study highlights differences in characteristics of non-TBI cases compared with those with TBI that are not well documented in the literature. We will discuss
CONGRESS ANNUAL CONFERENCE ABSTRACTS
Poster 12 Psychologic Adjustment and Coping and Problem-Solving Styles: Correlates of Satisfaction With Life for Caregivers and Survivors of Traumatic Brain Injury. Lance E. Trexler (Rehabilitation Hospital of Indiana, Indianapolis, IN), Daniel Klyce, Summer Ibarra, Samantha Backhaus. Disclosure: None declared. Objective: To determine the relationship of satisfaction with life with coping styles, problem-solving, and psychologic adjustment for caregivers and survivors of traumatic brain injury (TBI). Design: Correlational study. Setting: Postacute rehabilitation clinic. Participants: 20 survivors of TBI and 20 caregivers. Interventions: Not applicable. Main Outcome Measures: Satisfaction With Life Scale (SWLS), Brief Symptom Inventory⫺18 (BSI-18), Coping Inventory for Stressful Situations (CISS), and Social Problem Solving Inventory⫺Revised (SPSI-R). Results: For caregivers, the SWLS correlated positively with task-oriented coping (.488, P⫽.029), negatively with emotion-oriented coping (⫺.455, P⫽.044), and negatively with problem orientation (⫺.497, P⫽.026). Psychologic distress (BSI) correlated highly and negatively with SWLS (somatization, ⫺.506, P⫽.023; depression, ⫺.642, P⫽.002; anxiety, ⫺.625, P⫽.003). Regression analyses showed depression was the best predictor of the SWLS (F⫽12.590, P⫽.002). In contrast, none of the BSI, CISS, or SPSI-R variables correlated significantly with SWLS scores for survivors of TBI. Conclusions: Adaptive coping strategies are related to better satisfaction with life among caregivers. Poorer satisfaction with life is associated with emotion-based coping, negative problem-solving, and psychologic distress. In stark contrast, satisfaction with life for TBI survivors was not associated with coping, problem solving, or psychologic adjustment. Other moderator variables (such as neurocognitive and behavioral dysfunction) may influence satisfaction with life for survivors. Key Words: Brain injuries; Rehabilitation. Poster 13 Prevention of Depression and Enhancing Cognitive Recovery in Traumatic Brain Injury With Duloxetine: Preliminary Results. Lance Trexler (Rehabilitation Hospital of Indiana, Indianapolis, IN), Nancy Lipson. Disclosure: None declared. Objective: To determine if duloxetine prevents depression and improves cognitive recovery following traumatic brain injury (TBI). Design: Double-blind, randomized, placebo-controlled study. Setting: Acute rehabilitation hospital. Participants: 6 subjects randomly assigned to the duloxetine (n⫽4) and placebo (n⫽2) groups. Interventions: Participants randomized to the duloxetine group received 30mg of duloxetine every day for 1 week and then 60mg every day for 9 months. Main Outcome Measures: Hamilton Depression Scale (HAM-D), Hopkins Verbal Learning Test (HVLT), and the Community Integration Questionnaire (CIQ). Results: Given the small sample size, the results are preliminary. HAM-D scores for all participants were notably low. Participants who received duloxetine demonstrated consistently better performance on the HVLT total recall and delayed recall subtests over the follow-up periods, with the significant differences from placebo at 6 months for the HVLT total recall subtest (2-tailed t test, P⫽.06) and for the delayed recall subtest (2-tailed t test, P⫽.03). The duloxetine group subjects rated themselves consistently better on the CIQ. The 9-month follow-up comparison demonstrated that the duloxetine group was superior to placebo (2-tailed t test, P⫽.007) on the CIQ productivity subscale. Conclusions: While preliminary, these data suggest that duloxetine may be effective in improving community participation and return to work or school after TBI. Results also suggest improved cognitive recovery, particularly Arch Phys Med Rehabil Vol 89, October 2008
with respect to verbal memory and learning capacity. No long-term advantage for the duloxetine group was found in terms of depression, but it was also noteworthy that levels of depression for both groups were remarkably low. Key Words: Cognition; Duloxetine; Rehabilitation. Poster 14 Preinjury Emotional Functioning and Health-Related Quality of Life 3 Months After Mild Traumatic Brain Injury. Allison Clark (Baylor College of Medicine, Houston, TX), Angelle Sander, Margaret Struchen, Diana Mazzei. Disclosure: None declared. Objective: To investigate the relationship of preinjury emotional functioning to health-related quality of life (HRQOL) 3 months after mild traumatic brain injury (TBI). Design: Prospective outcome study. Setting: County level 1 trauma emergency center in central Houston, TX. Participants: 181 persons with mild TBI consecutively admitted to a county level 1 trauma emergency center; 73.5% were men. Mean age ⫾ SD was 33.29⫾11.9 years, education was 10.60⫾3.88 years, and emergency department Glasgow Coma Scale score was 14.28⫾1.87. 59.7% were Hispanic, 22.7% were black, and 14.4% were white. Interventions: Not applicable. Main Outcome Measures: Physical (PCS) and mental (MCS) component summary scales from the 36-Item Short-Form Health Survey. Results: Preinjury emotional functioning accounted for a significant proportion of variance in MCS score (R2 change, .063; P⫽.004), controlling for age, education, injury severity, and disability. Preinjury anger was a significant predictor, with greater preinjury anger associated with lower MCS scores. There was a trend for greater preinjury stress to be associated with lower MCS scores. Preinjury emotional functioning was not related to PCS score. Conclusions: Results suggest that preinjury emotional functioning plays an important role in the mental components of HRQOL following mild TBI, and that assessment of mild TBI should include evaluation of preinjury emotional functioning, which may inform treatment targets. Key Words: Brain injuries; Quality of life; Rehabilitation. Poster 15 Inpatient Rehabilitation Case-Mix for Acquired Brain Injury in Canada: A Population-Based Perspective. Angela Colantonio (Toronto Rehabilitation Institute, University of Toronto, Toronto, ON), Gary Gerber, Mark Bayley, Raisa Deber, Junlang Yin, Hwan Kim. Disclosure: None declared. Objective: To examine the demographic and clinical characteristics for persons receiving inpatient rehabilitation services for different causes of acquired brain injury in Canada from a population-based perspective. Design: Cross-sectional study utilizing data from the National Rehabilitation Reporting System (NRS) from the Canadian Institute for Health Information from April 2001 through March 2006. Setting: Designated inpatient rehabilitation program in Canada, with 60.5% from Ontario where data collection is mandatory. Participants: 2675 patients with traumatic brain injury (TBI) versus 2759 nontraumatic cases, such as from encephalitis and anoxia, were compared. Interventions: Not applicable. Main Outcome Measures: Demographic characteristics and FIM scores. Results: TBI cases were significantly younger and more likely to be male and from urban areas. Non-TBI cases had lower FIM admission scores, with generally worse perceived health status and more comorbidity. Length of stay averaged 50 days for both groups. Conclusions: This study highlights differences in characteristics of non-TBI cases compared with those with TBI that are not well documented in the literature. We will discuss