Longitudinal associations of time-varying homeboundness and life satisfaction after traumatic brain injury.

This was an observational study, so it shows association rather than proof that homeboundness causes lower life satisfaction. Reverse causation cannot be ruled out: people with poor mental health or dissatisfaction may choose not to leave home. The analytic sample only included people who survived at least 5 years post-injury and had enough follow-up data, so it may miss early deaths or people with missing data. Loss to follow-up was addressed with weighting, but bias may remain. Homebound status was measured only at 1, 2, 5 and 10 years, so brief changes, seasonal changes, and duration between visits were missed. The study did not assess why people were homebound, the quality of outings, income, cost of living, or community resources. The study definition of homeboundness differs from Medicare and Medicaid Services rules about needing assistance or significant effort to leave home. Results apply to moderate to severe TBI requiring inpatient rehabilitation in the United States, not milder injuries or injuries not needing inpatient care. The data were collected before the COVID-19 pandemic, which may have changed patterns of homeboundness. The study was not preregistered.

The authors declare no conflicts of interest.

Do not conclude that homeboundness causes lower life satisfaction, or that getting someone homebound to leave home more often will produce a large satisfaction gain. The study is observational, and the authors report reverse causation cannot be ruled out. The within-person change was small.