Publication year
2016
Citation Title
Efficacy and acceptability of a home-based, family-inclusive intervention for veterans with TBI: A randomized controlled trial
Journal Name
Brain Injury
Journal Volume
30
Issue Number
4
Page Numbers
373-387
DOI
10.3109/02699052.2016.1144080
Summary
Traumatic brain injury can result in long-term physical, emotional, and interpersonal difficulties and has become a topic of increasing concern for Service members. An in-home treatment program that focused on environmental changes and included families was compared to usual care for Veterans with traumatic brain injuries. The program was highly acceptable to Veterans and resulted in greater improvements in community reintegration and symptom difficulties compared to usual care.
Key Findings
Veterans in the in-home treatment program reported higher levels of community reintegration and less difficulty managing troubling symptoms than controls at a four-month follow-up.
Veterans rated the in-home program as highly acceptable and participated in, on average, 91% of the eight sessions.
Veterans in the in-home treatment program did not report greater improvement in functioning, potentially due to the program targeting specific problems rather than overall functioning.
Implications for Program Leaders
Educate Service members diagnosed with traumatic brain injuries on in-home treatment options
Provide information on strategies for changing Service members’ home environments to better fit their abilities and needs following a traumatic brain injury
Educate Service members’ families on common difficulties related to traumatic brain injury
Implications for Policy Makers
Recommend the development of home-based treatment programs for traumatic brain injury
Continue to provide support for programs that address the unique difficulties associated with traumatic brain injury among Service members
Promote the use of traumatic brain injury treatments targeting environmental changes to fit Service members’ abilities in addition to standard cognitive rehabilitation treatments
Methods
Participants were recruited through the Medical Rehabilitation Service of the Veterans Affairs (VA) department, which, since 2001, screens all Veterans for possible traumatic brain injury.
Veterans reported community reintegration, levels of functioning, and difficulty managing troubling symptoms following a traumatic brain injury through in-home clinical interviews.
Symptoms and functioning of Veterans assigned to the in-home program or to usual care were compared at a four-month follow-up.
Participants
The sample included 81 Veterans, with an average age of 40 years old (SD = 13.01), who were primarily male (91%); treatment groups were stratified by gender.
Veterans were primarily White (58%) or Black (36%), and 14% identified as Latino.
The sample included Veterans of several war cohorts, including OIF (62%), OEF (24%), OIF and OEF (11%), Vietnam or post-Vietnam (17%), and other wars or stateside injuries (11%).
Most Veterans were diagnosed with mild, rather than moderate or severe, traumatic brain injuries (69%), and the majority had experienced multiple traumatic brain injuries (64%).
Limitations
More long-term follow-up is needed to draw conclusions about lasting effects of the treatment.
Study results may not generalize to Veterans who seek medical care outside of the VA system.
Only Veterans with a close family member were included in the sample, meaning results may not generalize to Veterans with less social support or other forms of support.
Avenues for Future Research
Conduct a study with long-term follow-up to assess maintenance and generalization of gains
Examine the effects of combining the in-home treatment with a cognitive rehabilitation program to target both cognitive functioning and environmental adaptation
Investigate how other forms of social support may be included in the treatment program
Focus
Multiple Branches
Target Population
Population Focus
Military Branch
Military Component
Abstract
Objective: Traumatic brain injury (TBI) often undermines community re-integration, impairs functioning and produces other symptoms. This study tested an innovative program for veterans with TBI, the Veterans' In-home Program (VIP), delivered in veterans' homes, involving a family member and targeting the environment (social and physical) to promote community re-integration, mitigate difficulty with the most troubling TBI symptoms and facilitate daily functioning. Setting: Interviews and intervention sessions were conducted in homes or by telephone. Participants: Eighty-one veterans with TBI at a VA polytrauma program and a key family member. Design: This was a 2-group randomized controlled trial. Control-group participants received usual-care enhanced by two attention-control telephone calls. Follow-up interviews occurred up to 4 months after baseline interview. Main measures: VIP's efficacy was evaluated using measures of community re-integration, target outcomes reflecting veterans' self-identified problems and self-rated functional competence. Results: At follow-up, VIP participants had significantly higher community re-integration scores and less difficulty managing targeted outcomes, compared to controls. Self-rated functional competence did not differ between groups. In addition, VIP's acceptability was high. Conclusion: A home-based, family-inclusive service for veterans with TBI shows promise for improving meaningful outcomes and warrants further research and clinical application.
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