Biomedical subjects

Charles H Bombardier

Publications and source records attributed to Charles H Bombardier.

15 recordsLinked to original sources

PubMed2006

Posttraumatic stress disorder symptoms during the first six months after traumatic brain injury.

Controversy exists regarding the rate and risk factors for posttraumatic stress disorder (PTSD) following traumatic brain injury (TBI). The authors determined the rate and phenomenology of PTSD symptoms in the 6 months after TBI by conducting a prospective cohort study of 124 subjects who completed the PTSD Checklist-Civilian Version. The cumulative incidence of meeting PTSD symptom criteria at 6 months was 11% and full criteria 5.6%. Prevalence peaked at 1 month (10%). Eighty-six percent had another psychiatric disorder and 29% a history of PTSD. Symptoms were associated with not completing high school, assault, recalling being terrified or helpless, and positive toxicology. PTSD after TBI is rare and the relation to risk factors and comorbidities must be examined.

Adult↗

PubMed2005

The effect of a scheduled telephone intervention on outcome after moderate to severe traumatic brain injury: a randomized trial.

OBJECTIVE: To measure the effectiveness of a scheduled telephone intervention offering counseling and education to people with traumatic brain injury (TBI) on behavioral outcomes compared with standard follow-up at 1 year postinjury. DESIGN: Two-group randomized, prospective clinical trial throughout the first year after injury. SETTING: Subjects' homes via telephone in an urban-rural catchment area from a level I trauma center. PARTICIPANTS: Subjects (N=171; age range, 18-70 y) with a primary diagnosis of TBI who were discharged from an acute rehabilitation unit. They were randomly assigned to the telephone intervention (n=85) or to standard follow-up (n=86) groups at discharge. Of these, 79 participated in the intervention and completed the outcome assessment (3 withdrew; 3 were lost to follow-up), and 78 participated in usual care and completed the outcome assessment (8 were lost to follow-up). INTERVENTIONS: Subjects were randomly assigned to receive telephone calls at 2 and 4 weeks and 2, 3, 5, 7, and 9 months after discharge. The calls consisted of brief motivational interviewing, counseling, and education, plus facilitating usual care or usual care alone through follow-up appointments and therapy prescriptions. MAIN OUTCOME MEASURES: A composite outcome was used as the primary endpoint on an intent-to-treat basis. Secondary analyses were conducted with individual measures, including the FIM instrument, Disability Rating Scale, Community Integration Questionnaire, Neurobehavioral Functioning Inventory, Functional Status Examination, Glasgow Outcome Scale-Extended, Medical Outcomes Study 36-Item Short-Form Health Survey, Brief Symptom Inventory, EuroQol, and Modified Perceived Quality of Life scale. The primary analysis was a blocked Mann-Whitney U test. RESULTS: At 1-year follow-up, those who had received scheduled telephone intervention fared significantly better on the primary composite outcome index ( P =.002). In addition, this group fared better on specific composites such as functional status ( P =.003) and quality of well-being ( P =.006). There were no significant differences on vocational status ( P =.08) or community integration status ( P =.13). CONCLUSIONS: Scheduled telephone counseling and education resulted in improved overall outcome, particularly for functional status and quality of well-being, when compared with usual outpatient care. Telephone counseling shows promise as a low-cost, widely available rehabilitation intervention for TBI.

Adolescent↗

PubMed2005

Fatigue and psychiatric illness in a large community sample of persons with multiple sclerosis.

BACKGROUND: Fatigue and depression are among the most common and disabling symptoms in multiple sclerosis (MS), but the nature and extent of the relationships between fatigue and psychiatric disorders in MS patients remain poorly understood. METHODS: A mail survey was completed by 739 members of the King County (WA) MS Association. Fatigue was evaluated by questions from the Modified Fatigue Impact Scale (MFIS), depressive symptoms by the Center for Epidemiologic Studies Depression Scale (CES-D), substance-use disorders from the PRIME-MD. Information on demographics, employment and characteristics of MS was also collected. Logistic regression was used to identify covariates significantly associated with disabling fatigue. Receiver operating characteristic (ROC) curve analysis evaluated the sensitivity and specificity of fatigue for depression. RESULTS: Twenty-five percent of this community-dwelling sample reported that their activities were often or almost always limited by fatigue. Seventy-six percent of subjects with disabling fatigue had significant depressive symptoms (CES-D >16), compared with 31% of those without disabling fatigue. Depression was strongly associated with fatigue, after controlling for age, gender, marital status, and severity, course and duration of illness. In logistic regression analysis, subjects with clinically significant depressive symptoms (CES-D >16) were much more likely to report disabling fatigue: OR = 6.24 (4.16, 9.35). Anxiety and substance-use disorders did not have the same strong associations with fatigue. Fatigue was highly sensitive and specific for clinically significant depressive symptoms. CONCLUSIONS: Disabling fatigue is strongly associated with clinically significant depressive symptoms. Patients who report disabling fatigue should be screened for depression.

Adult↗

PubMed2005

Health promotion in people with multiple sclerosis.

Chronic diseases like MS present unique challenges and opportunities for patients and the medical care system. Patients are challenged because they are under tremendous pressure to actively engage themselves in multiple prevention, treatment, and health maintenance behaviors, often before they feel ready. Health care providers are challenged because health-promotion activities require more time, counseling skills, and organizational resources than traditional, acute medical care. Patients, clinicians, and researchers face the challenge of determining which health-promotion activities are not only supported by the evidence but also appropriate for a given patient. New models of health promotion are being developed that integrate self-help and professional help. These approaches have been applied in other chronic diseases and should be adapted and studied among people with MS.

Health Behavior↗

PubMed2005

Depression in persons with multiple sclerosis.

This article provides a critical review of what is currently known concerning the nature and scope of depression in persons who have MS. It begins with a discussion of relevant terminology,which is followed by a summary of the research literature concern-ing the prevalence; severity; and risk factors for, and impact of, depression in MS. Assessment issues also are reviewed. Gaps in the literature on the treatment of depression in persons who have MS also are discussed. The article concludes with a discussion of future directions that will improve our understanding of depression, its treatment, and the other side-resilience in the face of a serious neurologic condition.

Attitude to Health↗

PubMed2004

Do preinjury alcohol problems predict poorer rehabilitation progress in persons with spinal cord injury?

OBJECTIVE: To determine whether a history of alcohol-related problems is associated with inpatient rehabilitation progress. DESIGN: Cross-sectional cohort survey. SETTING: Acute inpatient rehabilitation program in a level I trauma center. PARTICIPANTS: Seventy-six of 104 consecutive patients with spinal cord injury (SCI) who met inclusion criteria and had completed interviews and functional outcome data. Participants were on average 38 years old; 84% were white, and 86% were men. Forty-two percent had tetraplegia and 39% had a history of problem drinking. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: FIM instrument admission, discharge, and efficiency scores as well as rehabilitation length of stay (LOS). RESULTS: The group with a history of problem drinking had significantly lower FIM admission, discharge, and efficiency scores and longer rehabilitation LOS. After controlling for potential confounding factors, a history of problem drinking accounted for a significant proportion of the variance in FIM efficiency scores. CONCLUSIONS: A history of problem drinking may be a risk factor for poorer rehabilitation progress among patients with SCI. They may be more costly to rehabilitate and may be discharged before attaining an adequate level of independence. Despite this, the current rehabilitation prospective payment system does not recognize this common comorbid condition.

Activities of Daily Living↗

PubMed2004

Natural history of depression in traumatic brain injury.

OBJECTIVE: To examine prospectively the rates, risk factors, and phenomenology of depression over 3 to 5 years after traumatic brain injury (TBI). DESIGN: Inception cohort longitudinal study. SETTING: Level I trauma center. PARTICIPANTS: Consecutive admissions of 283 adults with moderate to severe TBI. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Center for Epidemiologic Studies Depression (CES-D) Scale. RESULTS: The rates of moderate to severe depression ranged from 31% at 1 month to 17% at 3 to 5 years. With 1 exception, the relation between brain injury severity and depression was negligible. Less than high school education, preinjury unstable work history, and alcohol abuse predicted depression after injury. Examination of CES-D factors indicate that, in addition to somatic symptoms, both depressed affect and lack of positive affect contribute to elevated CES-D scores. CONCLUSIONS: High rates of depressive symptoms cannot be dismissed on grounds that somatic symptoms related to brain injury are mistaken for depression. Depressed affect and lack of positive affect are also elevated in persons with TBI. Preinjury psychosocial factors are predictive of depression and knowing them should facilitate efforts to detect, prevent, and treat depression after TBI.

Adolescent↗

PubMed2004

Patterns of alcohol and substance use and abuse in persons with spinal cord injury: risk factors and correlates.

OBJECTIVE: To investigate patterns of alcohol consumption and abuse and substance use among persons with spinal cord injury (SCI), relating these patterns to demographic and injury-related characteristics, as well as to key medical and psychosocial outcomes. DESIGN: Retrospective cross-sectional. PARTICIPANTS: Subjects with traumatic SCI (N=3041) with dates of injury between June 6, 1975, and June 23, 2002, who were interviewed between November 2000 and March 2003. SETTING: Sixteen Model Spinal Cord Injury Systems participating in this collaborative study during the 2000-2005 grant cycle. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Alcohol consumption, substance use, CAGE questionnaire, Satisfaction With Life Scale, Craig Handicap Assessment Reporting Technique, and pain. Data were analyzed using chi-square tests, analysis of variance, analysis of covariance, and logistic regression models. RESULTS: Fourteen percent of the subjects were classified as likely to have an alcohol abuse issue, based on the CAGE, and 11% reported using illegal drugs or prescription medications for nonmedical reasons. Demographic and injury characteristics were associated with alcohol consumption patterns, abuse, and substance use. At-risk drinkers and substance users tended to be younger, single, male, and less educated. Those who were CAGE positive and substance users reported more pain and lower satisfaction with life. Persons who drank without indication of problem drinking had superior occupation outcomes. Pressure ulcers were associated with substance use. CONCLUSIONS: Alcohol abuse and substance use were related to a number of adverse outcomes. The specific role of drinking with increased work activity deserves further exploration.

Adolescent↗

PubMed2004

Symptoms of major depression in people with spinal cord injury: implications for screening.

OBJECTIVES: To provide psychometric data on a self-report measure of major depressive disorder (MDD) and to determine whether somatic symptoms are nonspecific or count toward the diagnosis. DESIGN: Survey. SETTING: Data from the National Spinal Cord Injury Statistical Center representing 16 Model Spinal Cord Injury Systems. PARTICIPANTS: Eight hundred forty-nine people with spinal cord injury who completed a standardized follow-up evaluation 1 year after injury. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Patient Health Questionnaire-9 (PHQ-9), a measure of MDD as defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition . We computed descriptive statistics on rates of depressive symptoms and probable MDD, evaluated internal consistency and construct validity, and analyzed the accuracy of individual items as predictors of MDD. RESULTS: Exactly 11.4% of participants met criteria for probable MDD. Probable MDD was associated with poorer subjective health, lower satisfaction with life, and more difficulty in daily role functioning. Probable MDD was not related to most demographic or injury-related variables. Both somatic and psychologic symptoms predicted probable MDD. CONCLUSIONS: The PHQ-9 has promise as a tool with which to identify probable MDD in people with SCI. Somatic symptoms should be counted toward the diagnosis and should alert health care providers to the likelihood of MDD. More efficient screening is only one of the quality improvement efforts needed to enhance management of MDD.

Activities of Daily Living↗

PubMed2003

The natural history of drinking and alcohol-related problems after traumatic brain injury.

OBJECTIVES: To describe changes in drinking from before traumatic brain injury (TBI) to 1 year after TBI. DESIGN: Inception cohort with 1-year follow-up. SETTING: Level I trauma center. PARTICIPANTS: Adults (N=197) hospitalized with a broad range of head injury severity. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Alcohol consumption and alcohol-related problems. RESULTS: Drinking and alcohol-related problems decreased substantially from preinjury to 1 year after TBI. However, about one quarter of the sample reported heavy drinking, significant problems, or both during the first year after TBI. Preinjury alcohol use and problems were highly predictive of heavy use and problems after TBI. CONCLUSION: Although drinking and alcohol-related problems decreased after TBI, there appears to be an ongoing need for prevention and intervention efforts. Screening for preinjury alcohol problems can be used to identify the vast majority of persons who will develop alcohol-related problems within 1 year after injury.

Adolescent↗

PubMed2003

A typology of alcohol use patterns among persons with recent traumatic brain injury or spinal cord injury: implications for treatment matching.

OBJECTIVE: To describe empirically valid and clinically meaningful types of alcohol use among persons with recent traumatic brain or spinal cord injury. DESIGN: Cross-sectional cohort survey. SETTING: Acute inpatient rehabilitation program in a level I trauma center. PARTICIPANTS: A total of 218 (87%) of 250 consecutive initial admissions who met inclusion criteria and completed interviews. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Alcohol and drug use questionnaires, alcohol problem questions, admission toxicology results, readiness to change, and treatment preference questions. RESULTS: Participants were on average 37 years old, 84% were men, and 82% were white. Four types were identified by using k-means cluster analysis based on preinjury alcohol consumption, alcohol problems, and alcohol dependence. Cluster groups differed on extrinsic variables such as drug use, readiness to change, and interest in treatment or in attending Alcoholics Anonymous. The 4 types corresponded to those with a history of (1) alcohol abuse; (2) alcohol dependence; (3) alcohol dependence in remission, partial remission, or relapsed; and (4) normal or nondrinkers. CONCLUSION: More effective care may be possible if clinicians match common patient types to specific interventions such as education, motivational interventions, formal substance abuse treatment, and relapse prevention.

Acute Disease↗

PubMed2003

Chronic pain in a large community sample of persons with multiple sclerosis.

INTRODUCTION: This study examined the prevalence, intensity, interference, and biopsychosocial correlates of pain in a large community-based sample of persons with multiple sclerosis (MS). METHODS: Mail surveys were returned by 442 members of the King County (WA) MS Association. Average pain intensity, pain-related activity interference, depressive symptoms and severity of MS were assessed. RESULTS: Forty-four percent reported persistent, bothersome pain in the three months prior to completing the survey. Participants with pain reported an average pain intensity rating of 5.2 (SD = 2.3) on the 0 (no pain) to 10 (pain as bad as could be) scale. Twenty-seven percent reported severe pain (score of 7-10), while 51% of those with pain rated the interference of their pain with daily activities as none to minimal. Twenty percent reported severe interference in activities as a result of pain. In multivariate modeling, MS illness severity, marital status, and self-ratings of overall health were significantly associated with pain-related interference with activities. CONCLUSIONS: Approximately a fourth of this sample described having a chronic pain problem characterized by severe pain intensity and significant pain-related interference with activities. Disability due to pain may be more important than previously recognized for the MS population.

Activities of Daily Living↗

PubMed2002

The magnitude and correlates of alcohol and drug use before traumatic brain injury.

OBJECTIVE: To describe preinjury alcohol and drug use and opportunities for secondary prevention among persons with recent traumatic brain injury (TBI). DESIGN: Survey. SETTING: Acute inpatient rehabilitation program. PARTICIPANTS: A total of 142 (91%) of 156 consecutive admissions who met inclusion criteria and were screened. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Alcohol and drug use questionnaires, alcohol problem questions, toxicology results, readiness to change, and treatment preference questions. RESULTS: Subjects were on average 37 years old, 80% were men, and 80% were white. Fifty-nine percent of the sample was considered "at-risk" drinkers and, as a group, subjects reported a high degree of preinjury alcohol-related problems. Thirty-four percent reported recent illicit drug use, and 42 (37%) of 114 cases with toxicology results were positive for illicit drugs. Motivation to change alcohol use correlated positively with greater self-reported alcohol consumption and problem severity. Most at-risk drinkers wanted to change on their own, whereas a minority were interested in treatment or Alcoholics Anonymous. CONCLUSION: Both alcohol abuse and drug use are common before TBI. Inpatient brain injury rehabilitation represents an important opportunity to identify and intervene in substance abuse problems.

Adult↗

PubMedDate not supplied

Motivational interviewing in a group setting with mandated clients: a pilot study.

Some clients who are court-ordered to undergo substance abuse treatment are not able or willing to identify treatment-related goals. This situation can cause difficulties in the therapeutic relationship and compromise treatment. To address this problem, we offered a group-based motivational enhancement program prior to standard treatment. Over 2 years, 73 clients attended the motivation group while 94 did not. Compared to those who did not, those who attended the motivation group were significantly less likely to meet criteria for substance abuse dependence, they attended a higher proportion of their treatment sessions, and they were more likely to have completed treatment. After controlling for diagnosis, employment, and age, attending the motivation group was still related to higher rates of attendance and treatment completion. A motivation group may promote better participation in substance abuse treatment programs among persons who do not identify treatment goals. Additional research is needed to draw firm conclusions.

Adult↗

PubMedDate not supplied

Validity of the Patient Health Questionnaire-9 in assessing depression following traumatic brain injury.

OBJECTIVE: To test the validity and reliability of the Patient Health Questionnaire-9 (PHQ-9) for diagnosing major depressive disorder (MDD) among persons with traumatic brain injury (TBI). DESIGN: Prospective cohort study. SETTING: Level I trauma center. PARTICIPANTS: 135 adults within 1 year of complicated mild, moderate, or severe TBI. MAIN OUTCOME MEASURES: PHQ-9 Depression Scale, Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID). RESULTS: Using a screening criterion of at least 5 PHQ-9 symptoms present at least several days over the last 2 weeks (with one being depressed mood or anhedonia) maximizes sensitivity (0.93) and specificity (0.89) while providing a positive predictive value of 0.63 and a negative predictive value of 0.99 when compared to SCID diagnosis of MDD. Pearson's correlation between the PHQ-9 scores and other depression measures was 0.90 with the Hopkins Symptom Checklist depression subscale and 0.78 with the Hamilton Rating Scale for Depression. Test-retest reliability of the PHQ-9 was r = 0.76 and kappa = 0.46 when using the optimal screening method. CONCLUSIONS: The PHQ-9 is a valid and reliable screening tool for detecting MDD in persons with TBI.

Adult↗