Informing the Needs of Veterans and Service Members With TBI and Their Families: Leveraging the VA TBI Model System Program of Research

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Excerpt

DURING the most recent State of the Art (SOTA) conference sponsored by the Department of Veterans Affairs (VA) Office of Research and Development, VA was noted to be at an advantage to facilitate research in traumatic brain injury (TBI) and understanding lifetime needs. This special issue highlights the use of the VA TBI Model System (TBIMS) program of research in addressing some of the key focus areas discussed at the SOTA meeting. The TBIMS of research is a longitudinal multicenter study that examines the course of recovery and outcomes following inpatient rehabilitation for TBI within the 5 VA Polytrauma Rehabilitation Centers located in Minneapolis, Minnesota, Palo Alto, California, Richmond, Virginia, San Antonio, Texas, and Tampa, Florida.1 This lifetime study conducts follow-up at years 1, 2, 5, 10, 15, and every subsequent 5 years postinjury.2,3
The VA TBIMS parallels the legacy civilian hospital–based TBIMS funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), now housed in the Department of Health and Human Services. Since inception, the 16 currently funded civilian sites (since 1987) and 5 VA Polytrauma Rehabilitation Centers have conducted more than 50 000 follow-up interviews on more than 16 000 participants. At the time of this submission, the VA TBIMS had enrolled more than 1000 of those participants, all since 2010. The TBIMS infrastructure includes funding for a Model Systems Knowledge Translation Center that helps translate TBIMS science to products relevant for stakeholders including patients, caregivers, policy makers, and other scientists that are available online.4 Another measure of success includes the online registry of the more than 830 peer-reviewed publications generated from TBIMS database studies.4
Historically, special issues in scientific journals have often been used to highlight special focus areas leveraging the TBIMS longitudinal study. This is the first special issue exclusively featuring articles using the VA TBIMS database. Following a prolonged period of war, Congress has mandated longitudinal studies to examine the long-term rehabilitation needs following TBI. The VA TBIMS is uniquely positioned to inform policy about the health, mental health, socioeconomic, rehabilitation, and caregiver needs following TBI.5 Funding for this special issue would not be possible without the support of the Defense and Veterans Brain Injury Center within the Defense Health Agency. In the true spirit of federal interagency collaboration, scientists from VA, Department of Defense (DoD), and academia partnered to generate the articles highlighted.
The first article (Nakase-Richardson et al) in this issue is the first comparison of TBI participants enrolled in the VA Polytrauma Rehabilitation Centers with those enrolled in the civilian-based TBIMS settings across a similar time frame (2009-2015) and on baseline enrollment variables (eg, premorbid history, injury characterization, acute rehabilitation outcome).6 Although inclusion and exclusion criteria differ across the 2 data sets, the authors constrained the VA sample to increase comparability on key variables. While both data sets had large proportions with motor vehicle–related crashes, the VA cohort had more violence-related TBIs and the civilian TBIMS had a greater proportion of those with fall-related TBIs. As such, comparisons were made within similar mechanisms of injury.6 Overall and within subgroups, bidirectional differences emerged across demographic, injury characterization, and outcomes during acute inpatient rehabilitation.6 A surprising finding was that 13% of the civilian cohort had a military history.6 However, years of duty and combat exposure were significantly less than the cohort enrolled in the VA TBIMS database. This is consistent with literature highlighting that service members in recent conflicts have had multiple and prolonged deployments relative to their predecessors and likely comprise a greater proportion of the military database.
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