Determining the pain impairment and global mental health in individuals with traumatic brain injury >two years and chronic pain: impact on life care planning and health care utilization

      In individuals with Traumatic Brain Injury (TBI), research on the effect of anxiety, depression (AD) and chronic pain on health care utilization, which can be assessed by global health measures, is scarce. The use of global health items permits an efficient way of: gathering general health perceptions; providing useful summary information about health; and, predicting of health care utilization and subsequent mortality. The study determined the pain-related impairment (PRI) using the Pain Disability Questionnaire (PDQ), a pain severity assessment from the AMA Guides to Evaluation of Permanent Impairment, 6th Ed. in individuals with TBI >two years and with chronic pain, along with their global mental health status. A retrospective study was done in a comprehensive outpatient rehabilitation facility on 39 of 100 subjects (21 men). Outcome measures used were: the PDQ, PROMIS-Anxiety, PROMIS-Depression, and Berg Balance Scale (BBS). PRI was categorized by the PDQ, based on Functional Status (FS) and Psychosocial Distress Status (PS). Global Mental Health (GMH) was measured using the PROMIS-Anxiety & PROMIS-Depression (AD) subscales. Physical Performance Status (PPS) was calculated using BBS. Clinical scores ranged: total PDQ 6-150 of 150 (average 92); PROMIS-Anxiety T-score 37-83 (average 60); PROMIS-Depression T-score 38-81 (average 59.2); and, BBS 8-56 out of 56 (average 42.0). Subjects with TBI >2 years and with chronic pain tend to be with moderate pain-related impairment and decreased global mental health, along with fair physical performance. The study found a trend relationship of the PRI to GMH and PPS and that the health burden of TBI care to be extensive due to the clinical complexity involving both physical and psychosocial aspects. It recommends that the PDQ and PROMIS be part of the outcome measures for these difficult-to-manage subjects who needs integrated care. Further study on the correlation of the PDQ, PROMIS, & PPS scores should be done.