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Impact of the "polytrauma clinical triad" on sleep disturbance in a department of veterans affairs outpatient rehabilitation setting.
Am J Phys Med Rehabil. 2010 Jun; 89(6):437-45.AJ

Abstract

OBJECTIVE

There is a high prevalence of Operation Enduring Freedom/Operation Iraqi Freedom veterans returning with the "polytrauma clinical triad" of pain, posttraumatic stress disorder, and traumatic brain injury. This study examined the effect of the polytrauma clinical triad on sleep disturbance, defined as difficulty falling or staying asleep, a common problem in Operation Enduring Freedom/Operation Iraqi Freedom veterans.

DESIGN

A chart review was conducted for 200 Operation Enduring Freedom/Operation Iraqi Freedom veterans evaluated at a polytrauma outpatient clinic. Data that were abstracted included a sleep disturbance severity index, diagnoses of posttraumatic stress disorder and traumatic brain injury, and reported problems of pain.

RESULTS

Sleep disturbance was highly prevalent (93.5%) in this sample, in which the majority of traumatic brain injury diagnoses were mild. In the multiple regression analysis, posttraumatic stress disorder, pain, the interaction of traumatic brain injury and posttraumatic stress disorder, and the interaction of posttraumatic stress disorder and pain significantly accounted for sleep disturbance. As a separate independent variable, traumatic brain injury was not associated with sleep disturbance.

CONCLUSIONS

Our preliminary results showed that posttraumatic stress disorder and pain significantly contributed to sleep disturbance. When traumatic brain injury or pain coexisted with posttraumatic stress disorder, sleep problems worsened. In this clinical population, where the majority of traumatic brain injury diagnoses tend to be in the mild category, traumatic brain injury alone did not predict sleep disturbance. Through increased awareness of pain, posttraumatic stress disorder, and traumatic brain injury, clinicians can work collaboratively to maximize rehabilitation outcomes.

Authors+Show Affiliations

Defense and Veterans Brain Injury Center, Richmond, Virginia 23219, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20489391

Citation

Lew, Henry L., et al. "Impact of the "polytrauma Clinical Triad" On Sleep Disturbance in a Department of Veterans Affairs Outpatient Rehabilitation Setting." American Journal of Physical Medicine & Rehabilitation, vol. 89, no. 6, 2010, pp. 437-45.
Lew HL, Pogoda TK, Hsu PT, et al. Impact of the "polytrauma clinical triad" on sleep disturbance in a department of veterans affairs outpatient rehabilitation setting. Am J Phys Med Rehabil. 2010;89(6):437-45.
Lew, H. L., Pogoda, T. K., Hsu, P. T., Cohen, S., Amick, M. M., Baker, E., Meterko, M., & Vanderploeg, R. D. (2010). Impact of the "polytrauma clinical triad" on sleep disturbance in a department of veterans affairs outpatient rehabilitation setting. American Journal of Physical Medicine & Rehabilitation, 89(6), 437-45. https://doi.org/10.1097/PHM.0b013e3181ddd301
Lew HL, et al. Impact of the "polytrauma Clinical Triad" On Sleep Disturbance in a Department of Veterans Affairs Outpatient Rehabilitation Setting. Am J Phys Med Rehabil. 2010;89(6):437-45. PubMed PMID: 20489391.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of the "polytrauma clinical triad" on sleep disturbance in a department of veterans affairs outpatient rehabilitation setting. AU - Lew,Henry L, AU - Pogoda,Terri K, AU - Hsu,Pei-Te, AU - Cohen,Sara, AU - Amick,Melissa M, AU - Baker,Errol, AU - Meterko,Mark, AU - Vanderploeg,Rodney D, PY - 2010/5/22/entrez PY - 2010/5/22/pubmed PY - 2010/6/9/medline SP - 437 EP - 45 JF - American journal of physical medicine & rehabilitation JO - Am J Phys Med Rehabil VL - 89 IS - 6 N2 - OBJECTIVE: There is a high prevalence of Operation Enduring Freedom/Operation Iraqi Freedom veterans returning with the "polytrauma clinical triad" of pain, posttraumatic stress disorder, and traumatic brain injury. This study examined the effect of the polytrauma clinical triad on sleep disturbance, defined as difficulty falling or staying asleep, a common problem in Operation Enduring Freedom/Operation Iraqi Freedom veterans. DESIGN: A chart review was conducted for 200 Operation Enduring Freedom/Operation Iraqi Freedom veterans evaluated at a polytrauma outpatient clinic. Data that were abstracted included a sleep disturbance severity index, diagnoses of posttraumatic stress disorder and traumatic brain injury, and reported problems of pain. RESULTS: Sleep disturbance was highly prevalent (93.5%) in this sample, in which the majority of traumatic brain injury diagnoses were mild. In the multiple regression analysis, posttraumatic stress disorder, pain, the interaction of traumatic brain injury and posttraumatic stress disorder, and the interaction of posttraumatic stress disorder and pain significantly accounted for sleep disturbance. As a separate independent variable, traumatic brain injury was not associated with sleep disturbance. CONCLUSIONS: Our preliminary results showed that posttraumatic stress disorder and pain significantly contributed to sleep disturbance. When traumatic brain injury or pain coexisted with posttraumatic stress disorder, sleep problems worsened. In this clinical population, where the majority of traumatic brain injury diagnoses tend to be in the mild category, traumatic brain injury alone did not predict sleep disturbance. Through increased awareness of pain, posttraumatic stress disorder, and traumatic brain injury, clinicians can work collaboratively to maximize rehabilitation outcomes. SN - 1537-7385 UR - https://www.unboundmedicine.com/medline/citation/20489391/Impact_of_the_"polytrauma_clinical_triad"_on_sleep_disturbance_in_a_department_of_veterans_affairs_outpatient_rehabilitation_setting_ L2 - https://doi.org/10.1097/PHM.0b013e3181ddd301 DB - PRIME DP - Unbound Medicine ER -