Examining Driving and Participation 5 Years After Traumatic Brain Injury

Abstract

Participation is often considered a primary goal of traumatic brain injury (TBI) rehabilitation, but little is known about the influence of driving on participation after TBI. The objective of this study was to examine the independent contribution of driving status to participation at 5 years post TBI, after controlling for demographic, psychosocial, and functional factors. Participants ( N = 2,456) were community-dwelling individuals with moderate to severe TBI, age 18 to 65 at time of injury, and enrolled in the TBI Model Systems (TBIMS) National Database (NDB). Hierarchical linear regressions for the dependent variable of participation at 5 years post TBI were performed. Findings showed that driving was a highly significant independent predictor of participation and was a stronger relative predictor of participation than FIM® Cognitive, FIM® Motor, and depression. The independent contribution of driving to participation suggests the need to develop evidenced-based occupational therapy assessments and interventions that facilitate safe engagement in the occupation of driving to address the long-term goal of improved participation.

The Traumatic Brain Injury Model Systems National Database: A Review of Published Research

“…Twelve of these 51 studies focused further on a specific cohort within the data set. Examples of these specific cohorts include mortality, 40 participants of a specified age range, 23,36,[41][42][43][44] and patients who underwent cranial procedures, 45 developed post-injury conditions such as post-traumatic brain injury fatigue (PTBIF), 34 post-traumatic confusional state (PTCS), 37 or disorders of consciousness (DOC). 28 It is important to note that each study's objective(s) determined how the TBIMS data were used, and whether other data sources were required to conduct their analysis.…”

“…14,18,20,23,27,28,[32][33][34]38,40,50,53,55,[57][58][59][60][61][62]64,[66][67][68][69][70][71] In addition, certain variable groups such as ''race'' were under-or over-representative of the U.S. population overall, therefore serving as a limitation to generalizability in results due to the unequal representation of groups within variables. 60 In many studies, cohorts were dichotomized into sub-cohorts based on specific thresholds 21,23,[28][29][30][31]34,37,41,45,55,60,61,68,69,72,73 ; therefore caution is required when applying these findings to a more general population.…”

“…Despite the wide coverage of variables, several studies that have used TBIMS data indicated that the amount of detail provided by the variables collected could potentially be problematic when interpreting results. Examples of variables include collection of general information with a lack of details 70 and dichotomized data (yes/no) 41 provided in the data set.…”

Baseline Predictors of Survival, Neurological Recovery, Cognitive Function, Neuropsychiatric Outcomes, and Return to Work in Patients after a Severe Traumatic Brain Injury: an Updated Review

“…Psychiatric conditions that often follow sTBI include depression ( 74 - 78 ), anxiety disorders ( 77 , 78 ), post-traumatic stress disorder (PTSD) ( 79 , 80 ) and substance abuse ( 81 ). In addition, patients also experience declines in their mobility due to being unable to drive ( 82 ), decreased participation in activities outside the home ( 82 ), emotional instability ( 83 , 84 ), and reduced communication skills ( 85 ), all of which may reduce the number and quality of their interpersonal relationships ( 78 , 86 ), and in turn impair their psychosocial functioning, community involvement and overall satisfaction with and quality of life ( 87 ). Despite this, to date, relatively little research has been published on factors predicting psychosocial and neuropsychiatric outcomes in patients post sTBI.…”

Participation Following Inpatient Rehabilitation for Traumatic Disorders of Consciousness: A TBI Model Systems Study

“…Although a precise operational definition of participation has not emerged from the literature, it is widely recognized to encompass varied life domains at the societal level, such as home activities, learning, social interactions (12)(13)(14), and productivity (15,16). The World Health Organization International Classification of Functioning, Disability and Health (ICF) defines participation as "involvement in a life situation" and conceptualizes participation as one of the major components of function and disability in the context of health (17).…”