OBJECTIVE:To determine the predominant temporal direction of relations between pain intensity and pain interference with depression in the year following moderate-to-severe traumatic brain injury (TBI). SETTING:Enrolled participants who completed an inpatient rehabilitation stay following moderate-to-severe TBI. Participants were recruited from 4 National Institute on Disability, Independent Living, and Rehabilitation Research TBI Model Systems sites from June 2018-June 2021. PARTICIPANTS:Participants were 16 years or older at the time of injury and were diagnosed with a moderate-to-severe TBI (N = 180; 81% male, 77% White, mean age = 49.9 years, mean years of education = 13.6). DESIGN:1-year prospective cohort study at 4 participating sites. MAIN OUTCOME MEASURES:Brief Pain Inventory for pain intensity and interference; Patient Health Questionnaire for depression. RESULTS:A cross-lagged panel analysis was conducted to evaluate the predominant temporal association between pain intensity and pain interference with depression at inpatient rehabilitation discharge and 12 months after discharge. In 2 separate cross-lagged panel analysis models (model 1, pain intensity and depression; model 2, pain interference and depression), pain-related variables and depression demonstrated equally strong relations across time. In addition, both pain intensity and pain interference models demonstrated equally strong associations with depression. CONCLUSIONS:Pain intensity, pain interference, and depression are important comorbid conditions to assess at inpatient rehabilitation discharge and up to 1 year post-TBI. All 3 conditions should be assessed early following TBI, and ongoing assessment and interventions should be tailored to the conditions present for particular patients.

Access to timely post-acute stroke rehabilitation remains inconsistent, contributing to persistent disability despite advances in acute stroke care. Telemedicine has been proposed as a strategy to improve continuity and access to rehabilitation services, but its effectiveness across functional domains remains incompletely defined. To evaluate the effectiveness of telemedicine-delivered post-acute follow-up and rehabilitation on functional recovery and disability outcomes among adult stroke survivors. A systematic review was conducted in accordance with PRISMA guidelines. PubMed, Embase, Scopus, and Web of Science were searched for studies published between January 2015 and December 2025. Eligible studies included adult stroke populations receiving telemedicine-based post-acute follow-up or rehabilitation and reporting functional, motor, balance, quality-of-life, or feasibility outcomes. Randomized controlled trials and observational studies were included. Risk of bias was assessed using validated tools, and findings were synthesized narratively without quantitative pooling due to heterogeneity. Twenty-eight studies comprising approximately 1237 participants were included. Telerehabilitation was associated with improvements in activities of daily living, although between-group differences varied across studies. Activities of daily living improved post-discharge (Barthel Index + 23.3 vs + 9.3; p < 0.001), and Functional Independence Measure scores increased in tele-CIMT and wearable-assisted interventions. Upper limb performance improved (WMFT time − 2.28 s; Box and Block Test + 5.57 vs 1.0; Nine-Hole Peg Test − 71.6 s; Jebsen–Taylor − 26.6 s). Spasticity decreased (MAS) with wrist improvements maintained at 6 months. Mobility and balance also improved, with intervention groups walking farther (6MWT 141.6 ± 8.7 m vs 129.5 ± 7.1 m; p < 0.001) and showing comparable improvements in BBS outcomes across groups. Technology-assisted telerehabilitation programs were more frequently associated with statistically significant improvements; however, these findings were not consistently superior to standard rehabilitation across all studies. Most randomized trials had some concerns for bias, and half of non-randomized studies were rated as serious risk, limiting overall certainty. Telemedicine-based post-acute stroke rehabilitation is feasible and associated with functional improvements comparable to in-person care. Reported adverse events were infrequent and generally minor, though safety outcomes were inconsistently measured across studies. High feasibility, adherence, and patient satisfaction support its role as a scalable component of post-stroke rehabilitation pathways.

Autonomic dysfunction symptoms have previously been described amongst those with persistent post-traumatic headache (PTH) attributed to mild traumatic brain injury (mTBI). This novel study investigated symptoms of autonomic dysfunction amongst those with acute (< 3 months) PTH (APTH) due to mTBI and the association of these symptoms with the likelihood for PTH improvement. It was hypothesized that participants with APTH would exhibit significantly higher symptoms of autonomic dysfunction compared to healthy controls (HC), and that, individuals with APTH whose headaches improve with time would have less severe symptoms of autonomic dysfunction at baseline compared to those who did not have PTH improvement. Adults aged 18 to 70 years with APTH attributed to mTBI according to International Classification of Headache Disorders (ICHD-3) diagnostic criteria, with PTH onset between 7 and 56 days prior to enrollment, were enrolled. Participants maintained a daily headache diary and attended a baseline research visit, and 4-week and 16-week follow-up research visits. Presence and impact of autonomic symptoms were measured at each research visit using the Survey of Autonomic Symptoms (SAS). PTH improvement vs. non-improvement was determined using headache diary data. Compared to HC (n = 36), individuals with APTH (n = 56) reported significantly greater symptoms of autonomic dysfunction (SAS symptom scores) and negative impact from such symptoms (total impact scores). At the baseline research visit, mean [SD] SAS symptom score among those with APTH was 2.9 [2.0] vs. 0.9 [0.8] (p < 0.001) in HC. At baseline, the impact of autonomic symptoms measured using the SAS total impact score was 8.3 [6.2] among those with APTH vs. 2.1 [1.9] (p < 0.001) among HC. The most common and severe symptoms in the APTH group were lightheadedness, dry mouth or eyes, nausea, and cold feet. Participants who went on to have PTH improvement had numerically lower baseline autonomic symptom scores (p = 0.068) and significantly lower total impact scores (p = 0.024) than those who did not have PTH improvement. Participants with APTH due to mTBI have significantly more symptoms of autonomic dysfunction than HC. Higher baseline severity of autonomic symptoms corresponds to a lower likelihood of PTH improvement over time.

Objectives/Goals: The goal of this project is to integrate human and animal data to explore the relationship between social participation and cognitive functioning after traumatic brain injury (TBI). Further, we aim to determine whether reduced social participation is not only a consequence of TBI but a potential driver of post-injury cognitive deficits. Methods/Study Population: This study uses a translational framework to examine how social participation influences cognitive outcomes after traumatic brain injury (TBI) using complementary human and animal models. Longitudinal TBIMS data will be analyzed to assess associations between social participation (PART-O: productivity, out and about, social relations) and cognition (BTACT: memory, fluency, reasoning, processing speed) using linear regression (potentially a Random Intercept Cross-Lagged Panel Model to capture bidirectional effects over time). Further, mice with mild, moderate, or severe TBI will be housed in isolated, standard, or enriched social environments. Post-injury cognitive performance (NOR, Y-maze) and neuronal proliferation and survival in the prefrontal cortex and hippocampus will be evaluated. Results/Anticipated Results: We anticipate that both humans and animals with greater social participation will demonstrate superior cognitive performance over time. In the animal model, we further expect that mice housed in social or enriched environments will exhibit reduced cell death and enhanced neuronal survival in the prefrontal cortex and hippocampus compared to socially isolated counterparts. Discussion/Significance of Impact: Together, these findings may inform future rehabilitation strategies that integrate social participation as a core component of cognitive recovery supporting more personalized and multidisciplinary approaches to chronic TBI care.

Objective To study the reliability and validity of adverse childhood experiences (ACE) scores measured using a questionnaire versus abstraction of medical records, and to test whether the scores vary by history of bilateral oophorectomy, or by age and presence of anxiety or depressive symptoms at the time of questionnaire administration.Design The study involved a reliability component and a predictive validity component.Setting A population-based sample in Olmsted County, Minnesota, was derived from the Mayo Clinic Cohort Study of Oophorectomy and Aging-2.Participants We included 198 women who underwent premenopausal bilateral oophorectomy for a non-malignant indication between 1988 and 2007 and 174 referent women of the same age randomly sampled from the general population (total of 372 women). At a later time (median of 22.7 years later), the women were contacted and invited to self-administer the ACE questionnaire during an inperson visit. Independent of the visit, their medical records were abstracted for ACE by a physician.Interventions Questionnaire and abstraction-based ACE scores.Main outcome measures Agreement between the two ACE scores (reliability; weighted kappa statistics) and comparison of incidence of multimorbidity in women with ACE scores ≥1 vs 0 (predictive validity; survival analyses). Data were analysed in March and April 2024.Results The 372 women in the study had a median age of 65 years at the time of ACE questionnaire self-administration (IQR, 62–69). Questionnaire-based ACE scores showed moderate agreement with abstracted ACE scores (weighted kappa 0.44 (95% CI 0.34 to 0.54)). The cut-off score of ACE ≥1 showed an overall fair agreement between the two scores (kappa 0.33 (95% CI 0.24 to 0.43)). A comparison of the cumulative incidence of multimorbidity in women with an ACE score ≥1 versus women with ACE score of 0 yielded a HR of 1.13 (95% CI 1.00 to 1.27) for abstracted ACE and 1.13 (95% CI 1.01 to 1.27) for questionnaire-based ACE. The best predictive validity was for ACE measured by both methods combined (either or) with a HR of 1.29 (95% CI 1.13 to 1.46).Conclusions and relevance Questionnaire-based ACE scores have moderate agreement with medical records abstracted ACE scores. However, both sets of ACE scores are predictive of the accumulation of multimorbidity at older age and should be considered complementary.

BACKGROUND:Persistent postural-perceptual dizziness (PPPD) is a chronic functional vestibular disorder that is a potential sequela of traumatic brain injury (TBI). Currently, little is known about how patients with TBI associated PPPD respond to typical PPPD treatment modalities. OBJECTIVE:To investigate the prevalence of TBI as a precipitant for PPPD and assess outcomes of usual treatment. DESIGN:Retrospective cohort study. SETTING:Electronic medical records from a tertiary care center. PARTICIPANTS:Patients ≥18 years of age diagnosed with PPPD secondary to TBI between January 2015 and December 2022 who underwent 6 months of treatment with at least one return clinic visit. INTERVENTIONS:Not applicable. MAIN OUTCOME MEASURE(S):Patients' best clinical global impression-improvement scale (CGI-I) score following 6 months of treatment were collected and then compared with previously published literature, with CGI-I scores of 1 or 2 (indicating the patient was "very much" or "much" improved, respectively) considered treatment responders. RESULTS:In total, 134 (8.9%) of 1503 patients had a TBI as the triggering event for PPPD. The mean age of this cohort was 47.6 years with most of these cases occurring after a mild TBI (85.8%). The proportion of females with post-TBI PPPD (58.2%) was significantly lower than the proportion with PPPD due to all causes (p < .037). The most common treatment prescribed was vestibular therapy (82.2%), and 53.3% of patients were considered treatment responders after 6 months. Patients with TBI-induced PPPD had a significantly worse mean CGI-I score (2.49 ± 1.1) when compared to prior literature (1.71 ± 0.83) (p < .001). CONCLUSIONS:This study found a 9% prevalence of PPPD following TBI in the largest cohort studied to date. Patients who developed PPPD following TBI did not respond as well to standard treatments as patients with other causes of the disorder, and thus may require closer clinical follow-up to assess treatment efficacy.

OBJECTIVE:To examine the use of primary care (PCP) and brain injury physicians in the years after a traumatic brain injury (TBI) and the perceived reasons for lack of utilization. DESIGN:Prospective, observational cohort study of persons who received inpatient brain injury rehabilitation under the care of a brain injury rehabilitation physician. SETTING:Fifteen TBI Model System centers. PARTICIPANTS:Participants in the TBI Model Systems (N=1520) cohort who experienced TBI 1-35 years previously. INTERVENTIONS:Not applicable. MAIN OUTCOME MEASURES:The proportion of participants under the care of a PCP and/or a brain injury physician, and if applicable, the reasons not cared for by a physician; and what type of physician the participant would see if they had 8 common brain injury conditions. RESULTS:Most participants (85%) reported having a PCP, and 35% reported active care from a brain injury physician. More than 90% have visited their physician in the past 1-2 years. Factors independently associated with not having either a PCP or a brain injury physician were being younger, men, black, unmarried, having fewer health conditions, and having a more rapid initial recovery from their TBI. The most frequent reasons for not having a specific type of physician were a lack of perceived need or their physician taking care of most of their health care problems. The PCP was most often the first contact for 8 common health conditions. CONCLUSIONS:Most individuals in this longitudinal cohort of TBI survivors report having a PCP. Demographic and clinical characteristics identified subgroups who may lack regular contact with primary care or brain injury specialty care. While all participants were cared for by a brain injury physician during their initial rehabilitation, only a minority had ongoing care from a brain injury physician years later.

Background:Post-traumatic headache (PTH) is a common acute and persistent symptom following mild traumatic brain injury (mTBI). Symptoms of cutaneous allodynia and presence of nociceptive sensitization might be associated with acute PTH and its persistence. The objectives of this study were to compare allodynia symptoms and cutaneous heat pain thresholds amongst males and females with acute PTH to healthy controls (HC) and determine if pain thresholds and allodynia symptoms are associated with PTH outcomes. Methods:This prospective longitudinal study enrolled 139 adults with acute PTH attributed to mTBI as defined by the International Classification of Headache Disorders and 95 HC. All PTH participants completed a baseline research visit near PTH onset and a follow-up visit three to four months later. All PTH participants and a subset of HC completed the Allodynia Symptom Checklist (ASC-12) at each research visit. A different subset of the participants underwent quantitative sensory testing (QST) during baseline, 4-week, and 16-week research visits to quantify cutaneous heat pain thresholds at the forehead and forearms. Data from daily headache diaries were used to determine longitudinal PTH improvement versus non-improvement at three months. ASC-12 score and pain threshold comparisons were made between PTH and HC groups, PTH improved versus non-improved cohorts, and between PTH males and females. Results:Participants with PTH had an average age of 42.6 years and 64.0% were female. HC had an average age of 40.0 years and 65.3% were female. At the first visit, PTH participant ASC-12 scores averaged 3.6 versus 0.1 amongst HC, p < 0.001. 44.8% of PTH participants had headache improvement at 3 months. ASC-12 scores were higher in the PTH non-improved versus improved group at baseline (4.0 versus 2.4, p = 0.038) and 3-month follow-up (3.4 versus 1.9, p = 0.012). ASC-12 scores were higher in females than males at baseline (4.7 versus 1.6, p < 0.001) and 3-months (3.9 versus 1.2, p < 0.001). Cutaneous heat pain thresholds at the forehead and forearm did not differ between any group. Conclusions:PTH attributed to mTBI is associated with symptoms of cutaneous allodynia. Greater allodynia symptoms are present in females with PTH compared to males and may be associated with PTH non-improvement.

BACKGROUND:The impact of early-life traumatic experiences on late-life morbidity, or chronic conditions, remains unclear. We tested the hypothesis that traumatic adverse childhood experiences, such as physical, verbal, emotional, or sexual abuse, experienced during childhood or early adulthood are associated with a higher rate of morbidity later in life in women. METHODS:We studied 1026 women aged 21-45 years randomly selected from the general population in Olmsted County, Minnesota and used the Rochester Epidemiology Project medical records-linkage system to measure the rate of development of 18 chronic conditions. The women had a median age of 41.0 years at inclusion in the study and were followed historically for a median of 21.0 years. RESULTS:Here we show that women who experienced 2 or more adverse childhood experiences have higher incidence of 10 of the 18 chronic conditions considered separately and an accelerated accumulation of chronic conditions measured as a morbidity score compared to women who did not experience any. In addition, women exposed to abuse in childhood or early adulthood have accelerated accumulation of morbidity. We exclude the possible confounding effect of socioeconomic status and explore a series of possible mediation events or characteristics. We also discuss several possible biological and social or behavioral mechanisms underlying these associations. CONCLUSIONS:We are reporting new evidence that adverse childhood experiences and abuse in childhood or early adulthood have multiple deleterious effects on late-life morbidity. Our findings indicate the importance of protecting children and young adults from abuse and other adverse events.

The purpose of this study was to investigate pain network and periaqueductal gray matter (PAG) functional connectivity (FC) in participants with acute post-traumatic headache (PTH) due to mild traumatic brain injury (mTBI) compared to healthy controls (HC). Ninety-eight participants with acute PTH and 85 HC underwent 3 T magnetic resonance imaging. Static FC among regions of the pain matrix and between PAG to the rest of the brain were examined. Correlations between FC and clinical parameters were investigated using linear regression. PTH outcomes (improved or not improved) were determined at 3 months post-enrollment. Stronger FC between the PAG and right somatosensory and left lingual areas, and weaker FC between left thalamus and left caudate were found in the PTH group compared to HC. Whole-brain analysis showed increased PAG FC, primarily with somatosensory, motor, and occipital areas of participants with PTH relative to HC. These differences had associations with headache frequency, state anxiety, and time since mTBI. A PAG FC model for PTH improvement at 3 months had a sensitivity of 82

BACKGROUND:Patients in the intensive care unit (ICU) often experience extended periods of immobility. Following hospital discharge, many face impaired mobility and never return to their baseline function. Although the benefits of physical and occupational rehabilitation are well established in non-ICU patients, a paucity of work describes effective practices to alleviate ICU-related declines in mobility. OBJECTIVE:To assess how rehabilitation with physical and occupational therapy (PT-OT) during ICU stays affects patients' mobility, self-care, and length of hospital stay. DESIGN:Retrospective cohort study. SETTING:Inpatient ICU. PARTICIPANTS:A total of 6628 adult patients who received physical rehabilitation across multiple sites (Arizona, Florida, Minnesota, and Wisconsin) of a single institution between January 2018 and December 2021. INTERVENTIONS:Not applicable. MAIN OUTCOME MEASURES:Descriptive statistics, linear regression models, and gradient boosting machine methods were used to determine the relationship between the amount of PT-OT received and outcomes of hospital length of stay (LOS), Activity Measure for Post-Acute Care Daily Activity and Basic Mobility scores. RESULTS:The 6628 patients who met inclusion criteria received an average (median) of 23 (range: 1-89) minutes of PT-OT per day. Regression analyses showed each additional 10 minutes of PT-OT per day was associated with a 1.0% (95% confidence interval [CI]: 0.41-1.66, p < .001) higher final Basic Mobility score, a 1.8% (95% CI: 1.30%-2.34%, p < .001) higher final Daily Activity score, and a 1.2-day (95% CI: -1.28 to -1.09, p < .001) lower hospital LOS. One-dimensional partial dependence plots revealed an exponential decrease in predicted LOS as minutes of PT-OT received increased. CONCLUSION:Higher rehabilitation minutes provided to patients in the ICU may reduce the LOS and improve patients' functional outcomes at discharge. The benefits of rehabilitation increased with increasing amounts of time of therapy received.

Objective: Implementation research is essential to accelerating the public health benefits of innovations in health settings. However, the US National Academies of Sciences, Engineering, and Medicine 2022 report identified a lag in published implementation research applied to traumatic brain injury (TBI). Our objectives were to characterize implementation science studies published to date in TBI clinical care and rehabilitation and provide recommendations for future directions. Methods: A scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Articles published between 2011 and 2023 were identified (MEDLINE, PubMed, PsychInfo, and Web of Science), and included if the study focused on the TBI population, measured at least one Proctor (2011) implementation outcome and aligned with implementation research designs. Data were charted using an extraction template. Results: Of the 38 articles, 76% were published between 2018 and 2023. About 37% of articles were in the pre-implementation phase, and 57.9% were in the implementation phase. Over half of articles used a theory, model, or framework to guide the research. Fifteen studies were descriptive, 10 were qualitative, 7 were mixed methods, and 4 were randomized controlled trials. Most studies investigated implementation outcomes regarding national guidelines following TBI or TBI symptom management. Adoption (42.1%) and fidelity (42.1%) were the most commonly studied implementation outcomes, followed by feasibility (18.4%), acceptability (13.2%), and penetration (10.5%). Only 55% of studies used or tested the effectiveness of one or more implementation strategies, with training and education used most commonly, followed by data warehousing techniques. Conclusions: Future research should prioritize the selection and investigation of implementation strategy effectiveness and mechanisms across contexts of care and use implementation research reporting standards to improve study rigor. Additionally, collaborative efforts between researchers, community partners, individuals with TBI, and their care partners could improve the equitable translation of innovations across service contexts.

OBJECTIVE:To determine the cross-sectional and temporal relationships between minutes per week of moderate to vigorous physical activity (MVPA) as measured by a wrist-worn accelerometer and secondary conditions in the first year after moderate to severe traumatic brain injury (TBI).DESIGN:Prospective longitudinal cohort study.SETTING:Four inpatient rehabilitation centers.PARTICIPANTS:Individuals (N = 180) with moderate-severe TBI enrolled in the TBI Model Systems Study.INTERVENTIONS:Participants wore a wrist accelerometer for 7 days immediately post discharge, and for 7 consecutive days at 6- and 12-months post injury.MAIN OUTCOME MEASURES:Minutes per week of MVPA from daily averages based on wrist worn accelerometer. Secondary conditions included depression (Patient Health Questionnaire-9), fatigue (PROMIS Fatigue), Pain (Numeric Rating Scale), Sleep (Pittsburgh Sleep Quality Index), and cognition (Brief Test of Adult Cognition by Telephone).RESULTS:At baseline, 6 and 12 months, 61%, 70% and 79% of the sample achieved at least 150 minutes per week of MVPA. The correlations between minutes of MVPA between baseline, 6 and 12 months were significant (r = 0.53-0.73), as were secondary conditions over these time points. However, no significant correlations were observed between minutes of MVPA and any secondary outcomes cross-sectionally or longitudinally at any time point.CONCLUSIONS:Given the robust relationships physical activity has with outcomes in the general population, further research is needed to understand the effect of physical activity in individuals with moderate-severe TBI.

The objective of this study was to understand whether exposure to adverse childhood experiences (ACEs) before 18 years of age predicts increased neurobehavioral symptom reporting in adults presenting for treatment secondary to persistent symptoms after mild traumatic brain injury (mTBI). This cross-sectional study identified 78 individuals with mTBI from 2014 to 2018 presenting for treatment to an outpatient multidisciplinary rehabilitation clinic. Neurobehavioral symptom inventory (NSI-22) scores were collected on admission, and ACEs for each patient were abstracted by medical record review. A linear regression model was used to assess if an individual who experienced at least one ACE before age 18 resulted in significantly different neurobehavioral scores compared with those not reporting any history of an ACE before age 18. Participants who reported at least one ACE before age 18 had significantly increased NSI-22 scores on admission to the rehabilitation clinic compared with patients without history of ACEs (mean difference 10.1, p = 0.011), adjusted for age and gender. For individuals presenting for treatment after mTBI, a history of ACEs before age 18 was associated with increased neurobehavioral symptoms.

The Coronavirus-19 pandemic has infected millions of people, resulting in ongoing symptoms now described as post-acute sequelae of SARS-COV2 infection (PASC). Persistent neurologic and behavioral sequelae including fatigue, depression, anxiety, sleep disorders, headache, memory loss, and cognitive complaints are common. Although there is increasing evidence related to treatment of physical symptoms such as fatigue through physical rehabilitation practices, to date there is very limited evidence about the efficacy of various treatment regimens directed at nonphysical symptoms such as cognitive concerns and behavioral sequelae. This case series discusses a series of 13 patients with PASC who underwent individualized multidisciplinary outpatient cognitive rehabilitation at a quaternary medical center. In this patient population, the median age was 46 years (Q1, Q3: 41, 50), 77% were women, and 85% were White. The median time from infection to treatment was 229 days (Q1, Q3: 117, 367) and median length of stay in the program was 4.9 months (Q1, Q3: 3.1, 6.3). A history of depression and anxiety was found in 38% and 46% of this population, respectively. On admission and at discharge, the Mayo-Portland Adaptability Inventory-4 Participation Index, the Satisfaction with Life Scale, the Patient Health Questionnaire-9, and the Neurobehavioral Symptom Inventory-22 were completed. After individualized outpatient cognitive therapy, no clear benefit was seen in any of the outcome measures. The ongoing investigation is important to better understand which approaches will benefit these patients.

Objective: To identify facilitators and barriers to reaching and utilizing chronic pain treatments for persons with traumatic brain injury (TBI) organized around an Access to Care framework, which includes dimensions of access to healthcare as a function of supply (ie, provider/system) and demand (ie, patient) factors for a specified patient population. Setting: Community. Participants: Clinicians (n = 63) with experience treating persons with TBI were interviewed between October 2020 and November 2021. Design: Descriptive, qualitative study. Main Measures: Semistructured open-ended interview of chronic pain management for persons with TBI. Informed by the Access to Care framework, responses were coded by and categorized within the core domains (reaching care, utilizing care) and relevant subdimensions from the supply (affordability of providing care, quality, coordination/continuity, adequacy) and demand (ability to pay, adherence, empowerment, caregiver support) perspective. Results: Themes from provider interviews focused on healthcare reaching and healthcare utilization resulted in 19 facilitators and 9 barriers reaching saturation. The most themes fell under the utilization core domain, with themes identified that impact the technical and interpersonal quality of care and care coordination/continuity. Accessibility and availability of specialty care and use of interdisciplinary team that permitted matching patients to treatments were leading thematic facilitators. The leading thematic barrier identified primarily by medical providers was cognitive disability, which is likely directly linked with other leading barriers including high rates of noncompliance and poor follow-up in health care. Medical and behavioral health complexity was also a leading barrier to care and potentially interrelated to other themes identified. Conclusion: This is the first evidence-based study to inform policy and planning for this complex population to improve access to high-quality chronic pain treatment. Further research is needed to gain a better understanding of the perspectives of individuals with TBI/caregivers to inform interventions to improve access to chronic pain treatment for persons with TBI.

This study sought to identify whether an anatomical indicator of injury severity as measured by multiparametric magnetic resonance imaging (MRI) including magnetic resonance elastography (MRE), is predictive of a clinical measure of injury severity after moderate-severe traumatic brain injury (TBI). Nine individuals who were admitted to acute inpatient rehabilitation after moderate-to-severe TBI completed a comprehensive MRI protocol prior to discharge from rehabilitation, which included conventional MRI with diffusion tensor imaging (DTI). Of those, five of nine also underwent brain MRE to measure the brain parenchyma stiffness. Clinical severity of injury was measured by the length of post-traumatic amnesia (PTA). MRI-assessed non-hemorrhage contusion score and hemorrhage score, DTI-measured white matter fractional anisotropy, and MRE-measured lesion stiffness were all assessed. A higher hemorrhagic score was significantly associated with a longer length of PTA (p?=?0.026). Participants with a longer PTA tended to have a higher non-hemorrhage contusion score and softer contusion lesions than the contralateral control side, although the small sample size did not allow for assessment of a significant association. To our knowledge, this is the first report applying MRI/MRE imaging protocol to quantitate altered brain anatomy after moderate-severe TBI and its association with PTA, a known clinical predictor of post-acute outcome. Future larger studies could lead to the development of prediction models that integrate clinical data with anatomical (MRI), structural (DTI), and mechanical (MRE) changes caused by TBI, to inform prognosis and care planning.

OBJECTIVES:To identify predictors of moderate to vigorous physical activity (MVPA) at 12-months post-moderate-severe traumatic brain injury (TBI). SETTING:Four inpatient rehabilitation centers. PARTICIPANTS:Individuals enrolled in the TBI Model Systems with moderate to severe TBI, admitted to inpatient rehabilitation, and able to ambulate without physical assistance from another person. DESIGN:Prospective longitudinal cohort study. MVPA was measured by having participants wear an ActiGraph GT3X on their wrist for 7 consecutive days. MAIN ANALYSES:We used multivariate regression to predict minutes per week of MVPA at 12 months after TBI. Three classes of predictors were entered hierarchically-demographic and clinical variables (age, sex, body mass index, education, TBI severity, neighborhood walkability score, and self-reported preinjury physical activity [PA] level), baseline TBI-related comorbid conditions (eg, measures of sleep, pain, mood, fatigue, and cognition), and intention to exercise and exercise self-efficacy assessed approximately 1 week after discharge from inpatient rehabilitation. RESULTS:180 participants (ages 17.7-90.3 years) were enrolled, and 102 provided at least 5 days of valid accelerometer data at 12 months. At 12 months, participants recorded an average of 703 (587) minutes per week of MVPA. In univariate and multivariate analyses, age was the only significant predictor of 12-month MVPA ( r = -0.52). A sharp decline in MVPA was observed in the tertile of participants who were over the age of 61. CONCLUSIONS:Older adults with TBI are at elevated risk of being physically inactive. Assuming PA may enhance health after TBI, older adults are a logical target for prevention or early intervention studies. Studies with longer outcomes are needed to understand the trajectory of PA levels after TBI.

Background Cigarette smoking prevalence is higher for rural than urban adults, yet digital access to cessation programming is reduced. We aim to investigate digital access interventions to promote engagement with an online evidence-based cessation treatment (EBCT) program among rural adults. Methods This pilot trial used a pragmatic, three-arm, randomized, parallel-group design (ClinicalTrials.gov: NCT05209451). Inclusion criteria included being aged >= 18, Mayo Clinic Midwest patient, rural residency, and currently smokes cigarettes. All participants received an online, 12-week EBCT program and were randomized to receive one of three digital access interventions: print materials (control, n = 30); print materials + loaner iPad device with data plan coverage (n = 30); or print materials + loaner device + up to six, 15-20-minute motivational interviewing-based coaching calls to support technology needs (n = 30). A composite score of trial engagement (primary outcome) and self-reported smoking abstinence and use of EBCT resources (secondary outcomes) were assessed online at 4 and 12 weeks. Qualitative interviews were used to assess patient experience. Neither participants nor outcome assessors were blinded to group assignment. Results Results are reported for all 30 participants in each group. The average age of participants is 51.0 years and 61% are women. We show no significant arm differences for the trial engagement composite score (p = 0.30). We also find coaching support is significantly (p < 0.05) associated with enhanced smoking-related treatment response, including cigarette abstinence and use of EBCT resources, and participants reported positive experiences with the intervention. Conclusions The coaching intervention to support technology needs is acceptable and shows preliminary evidence of its efficacy in smoking-related treatment response. Further studies could refine and implement the coaching intervention for trial engagement and long-term cessation.