Telerehabilitation for OIF/OEF Returnees With Combat-Related Traumatic Brain Injury
Condition: Traumatic Brain Injury; Post-traumatic Stress Disorder
MeSH terms: Brain Injuries; Brain Injuries, Traumatic; Wounds and Injuries; Stress Disorders, Traumatic; Stress Disorders, Post-Traumatic
Study type: Observational

Summary: 
      The scientific objective of this program is to meet the rehabilitation needs of combat
      wounded Veterans with mild to moderate Traumatic Brain Injury (TBI) via telerehabilitation
      and determine the effect of this modality of care on patients' physical health and outcomes
      including function and community participation. The investigators will also evaluate the
      benefits and limitations of rehabilitation using telehealth from the Veteran and caregiver
      perspectives and evaluate the impact of rehabilitation via telehealth on Veterans
      Administration (VA) healthcare facility use.
    

Detailed description: 
      Rational: TBI can cause life-long impairments in physical, cognitive, behavioral and social
      function that are usually more disabling than the residual physical deficits. Recovery can
      continue many years after initial trauma. Little is known about optimal methodologies to
      treat the vast and complicated secondary manifestations of combat related TBI. Applicability:
      The goal of this rehabilitation program is eventually to optimally define telerehabilitation
      services for all Veterans with polytrauma, including accurate and efficient screening
      instruments, educational material for patients and families, family support, and family
      counseling to enhance care coordination and to maximize functional outcomes and quality of
      life.

      Patient population: The program will help wounded Veterans with a diagnosis of TBI from
      combat operations in Iraq and Afghanistan. Many Veterans reside in rural and underserved
      areas. Although access to health care for rural patients remains a critical challenge,
      telerehabilitation may represent a viable means for the delivery of therapeutic services to
      such patients, particularly those served by the VA. The program has implications for civilian
      populations as well including those injured in automobile or industrial accidents and similar
      in illness to the cohort of Veterans the investigators intend to follow.

      Clinical applications, benefits and risks: The goals of the rehabilitation project will be to
      enhance the wounded Veteran's capacity to process and interpret information and to improve
      his ability to function in all aspects of family and community life. It will involve a
      combination of restorative training which focuses on improving a specific cognitive function
      and compensatory training which educates Veterans on adapting to the presence of a cognitive
      deficit that may or may not be curable using singular one to one interventions as well as
      integrated interdisciplinary approaches to target multiple conditions. The investigators see
      no risks involved in this clinical intervention.

      Projected time to achieve a consumer-related outcome: The results of the telerehabilitation
      project should immediately be available for dissemination throughout the VA. The VA has
      already committed itself to a nationwide rollout of similar telerehabilitation projects for
      wounded Veterans. Hence, the findings should have immediate application in VA care for
      returnees from combat.

      The investigators recently added MyHealtheVet to the TeleRehab I care coordination for
      existing TeleRehab I subjects. MyHealtheVet is the VA's Personal Health Record and offers
      Veterans an additional way for Veterans to partner with the health care team in making
      informed decisions. MyHealtheVet is an existing, innovative program available to Veterans
      throughout the VA. (see https://www.myhealth.va.gov/index.html for additional information)
      Most of the remaining TeleRehabilitation Veterans are already enrolled in the MyHealtheVet
      program. Besides giving patients access to their health records and online prescription
      ordering, there is a secure messaging system with VA providers, who can save the secure
      message into the patient's electronic medical record (CPRS) with a single click.

      A total of 75 of the 85 IRB-approved subjects were initially enrolled. The investigators
      wanted to enroll up to 10 new subjects, and the existing TeleRehab I subjects were all be
      asked to sign a revised ICF that adds MyHealtheVet to the study, and makes other changes to
      the ICF required by Tampa VA R&D. If the subjects consent they will be required to register
      and be authenticated to use MyHealtheVet in order to participate or continue to participate
      in the study. An additional 6 subjects were enrolled for a total of 81 subjects on whom
      demographic data was collected. Sufficient data was collected on 75 subject for analyses of
      their responses to surveys.

      MyHealtheVet enrollment and secure messaging authentication is required to continue in the
      study, and changes to the protocol will reflect this additional eligibility criterion. All
      other methods of communication with subjects and existing surveys will continue. Eventually
      MyHealtheVet will replace the LAMP for secure communications with the Care Coordinator.
    

Intervention name(s): Telerehabilitation
Intervention type(s): Other
Intervention description(s): Rehabilitation via computer assisted internet capabilities
Observational model: Case-Only
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Convenience sample of OIF/OEF Veterans discharged from the James A. Haley Veterans'
        Hospital in Tampa, FL with a diagnosis of mild/moderate TBI with or without comorbid PTSD.