The UWTBIMS has existed for 9 consecutive years and represents two major teaching hospitals, Harborview Medical Center (HMC) and the University of Washington Medical Center, coordinated by the UW Department of Rehabilitation Medicine. With HMC as the region’s only Level I Trauma Center for Washington, Alaska, Montana and Idaho, these hospitals and programs provide a comprehensive, integrated continuum of medical, surgical and rehabilitation services to persons with acute and chronic TBI. We have been a major contributor of high-quality data to the Model System National Database and have forged strong relationships with other Model System centers, consumers, and other institutions. The research track record of the investigators in this center is extremely solid and the UW is a national leader in rehabilitation research. Dissemination efforts have included a heavily utilized Web site with downloadable materials (newsletters and educational brochures), three statewide videoconference series on TBI topics and a TV/DVD documentary about recovery from TBI in partnership with the Washington state HRSA grantee, and a newsletter featuring information for the greater community. Since 1998 our faculty has authored over 54 peer-reviewed publications on TBI as well as 171 professional presentations and book chapters. These publications have been referenced by the Institute of Medicine, congressional reports by the Centers for Disease Control, and in published TBI management guidelines.
In this proposal, we seek to respond to the NIDRR priorities by:
(1) contributing an average of 50 new subjects per year to the TBIMS national database,
(2) meeting scientifically rigorous standards for subject recruitment and retention (meeting all data benchmarks),
(3) conducting site-specific and collaborative research that contributes to improved outcomes for people with TBI and their caregivers and is of such quality that it improves evidence-based rehabilitation and clinical guidelines,
(4) providing a multidisciplinary system of rehabilitation within a full continuum of medical care, and
(5) coordinating with the Knowledge Translation Center to enhance dissemination.
We are proposing two site-specific projects. The first is a randomized controlled intervention study evaluating the effect of a structured, telephone-based mentoring program for caregivers focusing on self-management skills. This study builds upon our successful experiences with telephone counseling for both people with traumatic brain injury and multiple sclerosis. This research is particularly important because caregivers are so crucial to the successful rehabilitation and community re-integration of persons with TBI and the literature on successful interventions for this population is so sparse. The use of a telephone-based program will allow us to reach those (especially in rural regions) who lack ready access to knowledgeable advice, behavior change support, and specialty care sufficient to maintain the health of their significant other and themselves. Our second project will utilize a large and rich database to formulate principles and practical means for prediction of outcomes after TBI using clinical signs and symptoms.
The proposed modular project studies the natural history of headache under conditions of usual care during the first year after TBI. This project will characterize the course and nature of headache, a common but poorly studied consequence of TBI. It will examine the impact of headache on outcome and its potential modifiers and will describe patient treatment preferences and lay the foundation for a multi-site clinical trial.