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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

1107 — Development of a Quality of Life Tool for Deployment-Related TBI

Donnell AJ, COE-Tampa VAMC (HFJ/DVBIC); Groer SMutolo SSMoore DHOlney CM, and Vanderploeg RD, COE-Tampa VAMC;

Given that traumatic brain injury (TBI) is the “signature injury” of the Iraq war, a major gap identified by the Polytrauma QUERI and National Polytrauma Research Consortium is the lack of a psychometrically sound tool to measure health-related quality of life (HRQOL) issues uniquely associated with wounded warriors with TBI (also known as deployment-related TBI). The purpose of this study is to develop a psychometrically sound tool to measure HRQOL, addressing the unique issues associated with deployment-related TBI by developing the most parsimonious set of domains.

Three focus groups were held at each of the 4 VA Polytrauma Rehabilitation Centers; two focus groups included Veterans with deployment-related TBI (1 for mild TBI and 1 for moderate/severe TBI), and a third focus group included VA providers (12 total). Focus group participants were asked to identify HRQOL issues unique to deployment-related TBI. Content analysis of the transcripts was performed to generate a list of themes expressed by the Veteran and provider focus group members. Domains were identified as being unique to military deployment TBI, and items were written that reflected the participant responses.

Focus group discussion analysis identified 3 unique deployment-related TBI HRQOL domains (PTSD, Military-Related Loss, and Guilt) with several sub-domains. PTSD sub-domains included avoidance, hypervigilance/hyperarousal, re-experiencing, and depersonalization/derealization. Military-Related Loss sub-domains were loss of former self/self-image, loss of military life, and loss of complete physical self. Guilt sub-domains included caregiver/financial burden, guilt about abandoning fellow service members or letting them down, and survivor guilt.

The results confirm the existence of unique experiences for Veterans with deployment-related TBI not reflected in other HRQOL scales. Items were written that cover a wide range of quality of life issues for this specific population. The TBI HRQOL item pool is currently being field tested to develop a calibrated item bank.

While measurement of HRQOL is well established in regard to many medical conditions, there is a paucity of HRQOL measures developed specifically for use in TBI populations and none unique to military deployment-related TBI. This project is the first step in creating such a measure.

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