Unmet Rehabilitation Needs Indirectly Influence Life Satisfaction 5 Years After Traumatic Brain Injury: A Veterans Affairs TBI Model Systems Study

Abstract

Objective: To describe the association between unmet rehabilitation needs and life satisfaction 5 years after traumatic brain injury (TBI).

Design: Prospective observational cohort.

Setting: Five Veterans Affairs (VA) Polytrauma Rehabilitation Centers.

Participants: VA TBI Model Systems participants (N=301); 95% male; 77% white; average age, 39±14y).

Interventions: Not applicable.

Main outcome measures: Satisfaction With Life Scale (SWLS).

Results: Average SWLS score was 22±8. Univariable analyses demonstrated several statistically significant predictors of life satisfaction, including employment status, participation, psychiatric symptom severity, past year mental health treatment, and total number of unmet rehabilitation needs (all P<.05). Multivariable analyses revealed that depression and participation were each associated with life satisfaction. An ad hoc mediation model suggested that unmet rehabilitation needs total was indirectly related to life satisfaction. Total unmet rehabilitation needs ranged from 0-21 (mean, 2.0±3.4). Correlational analyses showed that 14 of the 21 unmet rehabilitation needs were associated with life satisfaction.

Conclusions: Findings support the need for rehabilitation engagement in later stages of TBI recovery. Ongoing assessment of and intervention for unmet rehabilitation needs in the chronic phase of recovery have the potential to mitigate decline in life satisfaction.

Keywords: Brain injuries; Personal satisfaction; Personnel; Rehabilitation; Social participation; Traumatic; Veterans.