Self-reported Participation Restrictions Among Male and Female Veterans With Traumatic Brain Injury in Veterans Health Administration Outpatient Polytrauma Programs

Alison M. Cogan*, Bridget Smith, Theresa L. Bender Pape, Trudy Mallinson, Blessen C. Eapen, Joel Scholten

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: To identify areas of most restricted self-reported participation among veterans with traumatic brain injury (TBI), explore associations among participation restriction and clinical characteristics, and examine differences in participation restrictions by sex. Design: Retrospective cross-sectional design. Setting: National VA Polytrauma System of Care outpatient settings. Participants: Veterans with a confirmed TBI event (N=6065). Interventions: Not applicable. Main Outcome Measure(s): Mayo-Portland Participation Index (M2PI), a 5-point Likert-type scale with 8 items. Total score was converted to standardized T score for analysis. Results: The sample consisted of 5679 male and 386 female veterans with ≥1 clinically confirmed TBI events (69% white; 74% with blast exposure). The M2PI items with greatest perceived restrictions were social contact, leisure, and initiation. There were no significant differences between men and women on M2PI standardized T scores. Wilcoxon rank-sum analyses showed significant differences by sex on 4 items: leisure, residence, employment, and financial management (all P<.01). In multinomial logistic regression on each item controlling for demographics, injury characteristics, and comorbidities, female veterans had significantly greater relative risk for part-time work and unemployment on the employment item and significantly less risk for impairment on the residence and financial management item. Conclusions: There was no significant difference between men and women. Veterans on M2PI standardized T scores, which masks differences in response patterns to individual items. Clinical teams should be encouraged to discuss perceived restrictions with patients and target these areas in treatment planning. Future work is needed to investigate the psychometric properties of the M2PI by biological sex.

Original languageEnglish (US)
Pages (from-to)2071-2079
Number of pages9
JournalArchives of physical medicine and rehabilitation
Volume101
Issue number12
DOIs
StatePublished - Dec 2020

Keywords

  • Community participation
  • Gender
  • Polytrauma
  • Rehabilitation
  • Traumatic brain injury
  • Veterans

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation

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