Environmental Barriers are Associated With Rehabilitation Needs 10 to 15 Years After Traumatic Brain Injury: A Veterans Affairs TBI Model Systems Study.
Marc A Silva, Jeanne M Hoffman, Therese M O'Neil-Pirozzi and 5 others
PMID 40054477WHAT IT FOUND
Veterans with traumatic brain injury reported more unmet rehabilitation needs 10 to 15 years later when they faced environmental barriers.
Attitudes of others, discrimination, and lack of accessible services were the strongest links, even after accounting for cognitive disability.
Key findings
01Higher total environmental barriers were significantly associated with greater perceived rehabilitation needs in multivariable models controlling for demographics and cognitive functioning.
02Among specific barrier types, only policies, attitudes/support, and services/assistance remained significantly associated with rehabilitation needs; physical/structural and work/school barriers did not.
03Cognitive disability at follow-up was independently associated with rehabilitation needs, suggesting those with more severe cognitive deficits struggle more to get needs met.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The sample consisted only of Veterans and Service Members who received intensive comprehensive rehabilitation at VA Polytrauma Centers, so findings may not generalize to civilians or those who did not receive this level of care. The study was cross-sectional at the 10- or 15-year mark, so it cannot determine the direction of causality between environmental barriers and rehabilitation needs. The sample was predominantly male (95.6%) and Non-Hispanic White (68.4%), limiting generalizability to women and other racial/ethnic groups. Self-reported measures were used for both rehabilitation needs and environmental barriers, which may be subject to recall bias or subjective interpretation.
Declared interests
No specific funding sources or conflicts of interest were declared in the provided text.
The easy way to misread this
Do not assume that physical accessibility or employment support are the primary drivers of unmet needs in this population. The study found no significant association between physical/structural barriers or work/school barriers and rehabilitation needs; instead, barriers related to attitudes, support, and service availability were the significant factors.