Access to Treatment of TBI-Related Vestibular Disorders_A Systemwide Investigation

背景资料。头晕是初级保健中最常见也是最常见的症状之一 轻度创伤性脑损伤(MTBI)合并头痛[1-3]。眩晕和头晕是 头痛持续性的预测因素[4]。前庭康复是最重要和最重要的 MTBI患者的成功治疗方式。重要性/影响力。这个项目面临的挑战 Addresses是将这种知识从专门机构转换到社区层面，在那里大多数 患有mTBI的退伍军人居住在这里。建议的研究项目涉及高铁和高铁研究的优先主题 包括使用医疗保健信息学来改善获得保健的机会和审查 提供服务和护理管理，促进最佳恢复、康复和重新融入社会 对于TBI。这一研究方案的长期目标是改善卫生保健的可及性和质量 适用于患有脑损伤相关前庭疾病的退伍军人。创新。短期目标是检查 报告头晕的退伍军人对退伍军人服务的利用情况(国家级数据)，并确定 提供的治疗是有效的(地方一级的数据)。明确的目标。其目的是：(1)确定、使用 国家数据，报告头晕症状的OEF/OIF患者对VA服务的利用情况，(2) 使用当地部署后恢复和评估计划(PREP)数据确定预测因素 前庭功能障碍的严重程度及影响前庭功能的因素 康复，以及(3)增加可靠地测量前庭功能的能力 MTBI患者的康复治疗。方法论。AIM 1采用回溯性大数据设计 和国家综合性颅脑损伤II级检查数据。频次： 不同类型的转介建议和后续访问将被列在表格中。物流 将使用回归分析来确定与以下各项相关的退伍军人、临床医生和系统级因素 患者接受转诊并跟进转诊的可能性。Aim 2将使用 回顾设计和当地(Tampa Prep)数据，进行不受控制的勘探 与前庭康复相关的变化幅度。姿势稳定、平衡、自觉 头晕障碍、脑震荡后症状和凝视稳定的结果措施将是 使用多元线性回归进行评估。解释的差异百分比将计算为 所有模型和比较，以确定哪个前庭康复结果变量似乎是最好的 由一组患者、临床医生和系统级别的预测者解释。目标3将使用目标2的数据来评估 选定前庭的心理测量学特征和对变化的反应性或临床敏感性 脑外伤相关前庭功能障碍人群的功能测量。如果这个项目的目标是 实现后，将确定以下内容：(1)患有脑损伤相关前庭的退伍军人人数 转诊治疗的功能障碍和谁跟进转诊以及(1b)条件/因素 将转诊/治疗置于风险/最大化；(2)给予高/低的治疗建议 临床有意义的改善的可能性；以及(3)一套评估措施，包括 相应的管理、评分和解释指南，可供临床医生使用 评估前庭康复的临床有意义的改善。后续步骤/实施。 这项研究的结果将与目前的一项调查HSR&D研究的结果相结合 传播多学科(PT、OT、听力学、 验光、物理、视觉专家和听力学)治疗方法。实施 指导方针将由参与关键政策的联合调查员和专家小组成员推动 职位和我们的计划办公室合作伙伴。

Background. Dizziness is one of the most common symptoms in primary care and the most frequent comorbidity of mild traumatic brain injury (mTBI) followed by headache [1-3]. Vertigo and dizziness are predictors of headache persistence [4]. Vestibular rehabilitation is one of the most important and successful treatment modalities for patients with mTBI. Significance/Impact. The challenge this project addresses is translation of this knowledge from the specialized facility to the community level where most Veterans with mTBI reside. The proposed research project addresses HSR&D Research Priority Topics including the use of healthcare informatics to improve access to care and the examination of models of service delivery and care management that promote optimal recovery, rehabilitation, and reintegration for TBI. The long-term goal of this program of research is to improve access to and quality of health care for Veterans with TBI-related vestibular disorders. Innovation. The short-term goals are to examine utilization of VA services by Veterans who report dizziness (national level data) and to determine if the treatment provided is effective (local level data). Specific Aims. The Aims are to: (1) Determine, using national data, the utilization of VA services by OEF/OIF patients who report dizziness symptoms, (2) Determine, using local Post-Deployment Rehabilitation & Evaluation Program (PREP) data, predictors of severity of vestibular dysfunction and factors that influence the effectiveness of vestibular rehabilitation, and (3) Increase the capacity to reliably measure the effectiveness of vestibular rehabilitation for individuals with mTBI. Methodology. Aim 1 uses a retrospective, big data design and national Comprehensive Traumatic Brain Injury Level II Examination data. Frequencies of the different types of referral recommendations made and follow up visits will be tabulated. Logistic regression analysis will be used to identify Veteran, clinician, and system-level factors associated with patient likelihood of receiving a referral and following up with the referral. Aim 2 will use a retrospective design and local (Tampa PREP) data to conduct an uncontrolled exploration of the magnitude of change associated with vestibular rehabilitation. Postural stability, balance, self-perceived dizziness handicap, post-concussive symptoms, and gaze stabilization outcome measures will be evaluated using multiple linear regression. The percentage of variance explained will be calculated for all models and compared to identify which vestibular rehabilitation outcome variable appears to be best explained by a set of patient, clinician, and system level predictors. Aim 3 will use Aim 2 data to evaluate the psychometric properties and responsiveness or clinical sensitivity to change of selected vestibular function measures for the TBI-related vestibular dysfunction population. If the aims of this project are achieved, the following will be identified: (1a) the number of Veterans with TBI-related vestibular dysfunction referred for treatment and who followed up with the referral and (1b) the conditions/factors that put referral/treatment at risk/maximize; (2) treatment recommendations that confer a high/low probability of achieving clinically meaningful improvement; and (3) a set of evaluation measures with corresponding administration, scoring, and interpretation guidelines that can be used by clinicians to assess clinically meaningful improvement in vestibular rehabilitation. Next Steps/Implementation. Findings from this study will be combined with findings from a current HSR&D study that investigates TBI-related vision impairment to disseminate guidelines for a multidisciplinary (PT, OT, audiology, optometry, physiatry, vision specialist, and audiology) treatment approach. Implementation of guidelines will be facilitated by co-investigators and Expert Panel members who sit in in key policy positions and by our Program Office Partner.