Four distinct patterns of symptoms occur after mild traumatic brain injury in military service members, according to new research that also validates a new tool for assessing the quality-of-life impact of TBI.

OT_News-01The research results appear in the January-February issue of The Journal of Head Trauma Rehabilitation, an annual special issue devoted to TBI in the military. JHTR is the official journal of the Brain Injury Association of America and is published by Wolters Kluwer.

In print and online, the special issue includes 13 original research studies on TBI in the military, including a special focus on how TBI affects quality of life. TBI is a major concern in military personnel, both deployed and nondeployed, according to a news release. More than 294,000 service members suffered TBI between 2000 and 2013, according to a news release. More than 80% of these injuries were mild TBI, also known as concussion.

Four subtypes of symptoms after military TBI

Jason M. Bailie, PhD, of the Defense and Veterans Brain Injury Center and colleagues analyzed patterns of neurobehavioral and psychiatric symptoms in more than 1,300 veterans who had suffered combat-related mild TBI within the past two years. The goal was to develop a classification, or taxonomy, of symptoms after mild TBI in military personnel.

The analysis identified four clusters, or subtypes, of symptoms. The largest group of veterans — about 38% — had good recovery, with relatively low rates of behavioral and mental health symptoms, findings showed.

About 22% of veterans had primarily psychiatric symptoms, according to the analysis. This included mood symptoms associated with post-traumatic stress disorder, such as hyperarousal and dissociation or depression. But findings showed veterans in this group were less likely to have cognitive difficulties or headaches.

Another 22% had primarily cognitive symptoms and headaches, with few mood problems, the analysis showed. The remaining 19% of veterans fell into a mixed subtype, with a combination of mood problems, cognitive complaints and headaches, researchers found.

Some other characteristics also differed between groups, including the timing of TBI and the severity of other injuries. Bailie and co-authors emphasized their classification is preliminary. However, “the clinical differences among these subtypes indicate a need for unique treatment resources and programs,” they concluded.

New questionnaire for assessing QOL after military TBI

Rael T. Lange, PhD, of the DVBIC and colleagues report an evaluation of the TBI-QOL — a new questionnaire for assessing health-related quality of life after TBI. The TBI-QOL evaluates 20 subscales in the areas of physical and emotional health, cognition and social participation.

The researchers compared TBI-QOL scores for about 100 veterans with mild TBI with smaller groups of injured or uninjured veterans without TBI. The results showed good reliability and validity, providing evidence that the responses were consistent and accurate. The TBI-QOL also performed well in distinguishing between veterans with and without TBI, findings showed.

Researchers found veterans with TBI scored worse than the other groups on 10 out of 14 subscales. The differences were largest in areas reflecting cognitive function, grief and loss; pain interfering with daily activities; and headache. Somewhat surprisingly, findings showed the differences were not as great for symptoms of anxiety and depression.

The complete contents of the special issue are available on the journal website: www.headtraumarehab.com.

“We thank all our contributors and editors for their help in putting together this special issue,” JHTR Editor-in-Chief John D. Corrigan, PhD, ABPP, of The Ohio State University, Columbus, said in the release. “As always, our goal in assembling this annual research collection is to expand and improve the evidence base underlying our efforts to intervene and improve outcomes for military service members affected by TBI.”

Special issue: http://journals.lww.com/headtraumarehab/pages/currenttoc.aspx