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Comparison of the VA and NIDILRR TBI Model System Cohorts

Nakase-Richardson, Risa PhD, FACRM; Stevens, Lillian Flores PhD; Tang, Xinyu PhD; Lamberty, Greg J. PhD; Sherer, Mark PhD; Walker, William C. MD; Pugh, Mary Jo PhD; Eapen, Blessen C. MD; Finn, Jacob A. PhD; Saylors, Mimi MS; Dillahunt-Aspillaga, Christina PhD; Adams, Rachel Sayko PhD; Garofano, Jeffrey S. MS

Section Editor(s): Nakase-Richardson, Risa PhD, FACRM; Stevens, Lillian Flores PhD, LCP

Journal of Head Trauma Rehabilitation: July/August 2017 - Volume 32 - Issue 4 - p 221–233
doi: 10.1097/HTR.0000000000000334
Original Articles

Objective: Within the same time frame, compare the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) and VA Traumatic Brain Injury Model System (TBIMS) data sets to inform future research and generalizability of findings across cohorts.

Setting: Inpatient comprehensive interdisciplinary rehabilitation facilities.

Participants: Civilians, Veterans, and active duty service members in the VA (n = 550) and NIDILRR civilian settings (n = 5270) who were enrolled in TBIMS between August 2009 and July 2015.

Design: Prospective, longitudinal, multisite study.

Main Measures: Demographics, Injury Characteristics, Functional Independence Measures, Disability Rating Scale.

Results: VA and NIDILRR TBIMS participants differed on 76% of comparisons (18 Important, 8 Minor), with unique differences shown across traumatic brain injury etiology subgroups. The VA cohort was more educated, more likely to be employed at the time of injury, utilized mental health services premorbidly, and experienced greater traumatic brain injury severity. As expected, acute and rehabilitation lengths of stay were longer in the VA with no differences in death rate found between cohorts.

Conclusions: Substantial baseline differences between the NIDILRR and VA TBIMS participants warrant caution when comparing rehabilitation outcomes. A substantive number of NIDILRR enrollees had a history of military service (>13%) warranting further focused study. The TBIMS participant data collected across cohorts can be used to help evidence-informed policy for the civilian and military-related healthcare systems.

Supplemental Digital Content is Available in the Text.

MHBS, James A. Haley Veterans' Hospital, Tampa, Florida (Dr Nakase-Richardson); Defense and Veterans Brain Injury Center, Tampa, Florida (Dr Nakase-Richardson); Department of Internal Medicine, University of South Florida, Tampa (Dr Nakase-Richardson); VA HSRD Center of Innovation on Disability and Rehabilitation Research, Tampa, Florida (Dr Nakase-Richardson); Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia (Drs Stevens and Walker); Departments of Psychology (Dr Stevens) and Physical Medicine and Rehabilitation (Drs Stevens, and Walker), Virginia Commonwealth University, Richmond; Defense and Veterans Brain Injury Center, Richmond, Virginia (Drs Stevens, and Walker); Biostatistics Program, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock (Dr Tang and Ms Saylors); Mental Health Service, Minneapolis VA Health Care System, Minneapolis, Minnesota (Drs Lamberty and Finn); Department of Psychiatry, University of Minnesota School of Medicine, Minneapolis (Drs Lamberty and Finn), Defense and Veterans Brain Injury Center (DVBIC), Minneapolis, Minnesota (Drs Lamberty and Finn); Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas (Dr Sherer); Polytrauma Rehabilitation Center, South Texas Veterans Health Care System, San Antonio (Drs Pugh and Eapen); Department of Epidemiology and Biostatistics, University of Texas Health Sciences Center, San Antonio (Dr Pugh); College of Behavioral and Community Sciences, University of South Florida, Tampa (Dr Dillahunt-Aspillaga); Brandeis University, Boston, Massachusetts (Dr Adams); and College of Education, University of South Florida, Tampa, Florida (Mr. Garafano).

Corresponding Author: Risa Nakase-Richardson, PhD, FACRM, James A. Haley Veterans Hospital, MH/BS, Polytrauma Mail Code 117, 13000 Bruce B Downs Blvd, Tampa, FL 33612 (

The authors acknowledge the support of US Department of Veterans Affairs Health Services Research and Development COIN grant (1 I50 HX001233-01; CINDRR) for assistance in manuscript preparation.

The views, opinions, and/or findings contained in this article are those of the authors and should not be construed as an official Department of Defense position or any other federal agency, policy, or decision unless so designated by other official documentation.

The participating agencies' institutional review boards approved this study, and informed consent was obtained after the details of the study were thoroughly explained to participants.

The Polytrauma Rehabilitation Center Traumatic Brain Injury (TBI) Model System collaboration is funded through an Interagency Agreement between the Department of Veterans Affairs and the Department of Health & Human Services (National Institute on Disability, Independent Living, and Rehabilitation Research). This research is sponsored by VHA Central Office VA TBI Model System Program of Research, and Subcontract from General Dynamics Health Solutions (W91YTZ-13-C-0015) from the Defense and Veterans Brain Injury Center within the Defense Health Agency.

The contents of this publication were developed under grants from the National Institute on Disability, Independent Living, and Rehabilitation Research (grant numbers 90DP0028 [PI: Sherer] and 90DP00303 [PI: Kreutzer]). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this publication do not necessarily represent the policy of NIDILRR, ACL, HHS, and Veterans Affairs, and endorsement by the Federal Government should not be assumed.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

The authors declare no conflicts of interest.

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