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Family needs after traumatic brain injury: A VA TBI model systems study

APA Citation:

Finn, J. A., Klocksieben, F. A., Smith, A. N., Bernstein, J., O'Neil-Pirozzi, T., Kreutzer, J. S., Sander, A. M., Dreer, L. E., Niemeier, J. P., Cotner, B. A., & Nakase-Richardson, R. (2022). Family needs after traumatic brain injury: A VA TBI model system study. The Journal of Head Trauma Rehabilitation, 37(6), 327-337. https://doi.org/10.1097/HTR.0000000000000799

Abstract Created by REACH:

This study first examined 6 domains of caregiving needs (i.e., health information, care involvement, and emotional, professional, community, and instrumental supports) to explore the met and unmet needs of family caregivers of a Service member/Veteran (SM/V) with a traumatic brain injury (TBI). Researchers then used medical records and questionnaires completed by SM/Vs (n = 427) and their caregivers (n = 427 family members) to examine the links between caregiver needs, SM/V mental health treatment, environmental barriers for SM/Vs with disabilities, and SM/V functioning (e.g., self-care, mobility). Overall, caregivers reported that more than half (59.2%) of their caregiving needs were being met, but unmet needs (e.g., emotional support) remained present – especially when there were additional stressors (e.g., environmental barriers to SM/V activity).


Physical health
Mental health

Branch of Service:

Multiple branches

Military Affiliation:

Active Duty

Subject Affiliation:

Active duty service member
Guard/Reserve member
Parent of a service member or veteran
Spouse of service member or veteran


Adulthood (18 yrs & older)
Young adulthood (18 - 29 yrs)
Thirties (30 - 39 yrs)
Middle age (40 - 64 yrs)
Aged (65 yrs & older)
Very old (85 yrs & older)


Cross-Sectional Study
Quantitative Study


Finn, Jacob A., Klocksieben, Farina A., Smith, Austin N., Bernstein, John, O'Neil-Pirozzi, Therese M., Kreutzer, Jeff S., Sander, Angelle M., Dreer, Laura E., Niemeier, Janet P., Cotner, Bridget A., Nakase-Richardson, Risa


Objective:  To describe the self-reported needs of family caregivers of service members and veterans (SMVs) who sustained a traumatic brain injury (TBI) and to identify predictors of the unmet family caregiver needs. Setting:  Five Department of Veterans Affairs (VA) Polytrauma Rehabilitation Centers (PRCs). Participants:  Family caregivers of SMVs enrolled in the VA PRC TBI Model Systems (TBIMS) national database who were within their first 5 years post-TBI (n = 427). Design:  Observational study. Main Outcome Measure:  The Family Needs Questionnaire-Revised (FNQ-R) was completed by each SMV's designated caregiver. Analyses:  Descriptive analyses were conducted on the FNQ-R responses at the item, domain, and total score levels. Unadjusted univariable and adjusted multivariable regression models were fitted to identify predictors of total unmet needs and unmet family need domains. Results:  FNQ-R item-level and domain-level descriptive results indicated that health information was the most frequently met need domain. In contrast, emotional and instrumental support domains were the least often met. On average, family caregivers reported that 59.2% of the 37 FNQ-R needs were met at the time of the follow-up assessment. Regression models indicated that both the number of SMV-perceived environmental barriers and whether the SMV received mental health treatment within the past year predicted the number of unmet FNQ-R needs. SMV-reported environmental barriers predicted increased unmet needs in all 6 family caregiver domains, and SMV mental health treatment in the past year predicted more unmet family caregiver emotional support, community support, and professional support needs. Conclusions:  The current findings can be used to inform policy and programming for VA and Department of Defense to proactively address the specific needs of families and caregivers experienced in the first 5 years post-TBI.

Publisher/Sponsoring Organization:

Wolters Kluwer

Publication Type:

REACH Publication

Author Affiliation:

Rehabilitation & Extended Care, Minneapolis VA Health Care System, JAF
Mental Health Service Line, Minneapolis VA Health Care System, JB
Department of Psychiatry & Behavioral Sciences, University of Minnesota, JAF
Morsani College of Medicine, University of South Florida, FAK
Department of Anthropology, University of South Florida, BAC
Pulmonary and Sleep Medicine Division, Department of Internal Medicine, University of South Florida, RKR
Mental Health Service, Holmes McGuire VA Medical Center, ANS
Traumatic Brain Injury Center of Excellence, Holmes McGuire VA Medical Center, ANS
Department of Psychology, Louisiana State University, JB
Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, TOP
Department of Communication Sciences & Disorders, Northeastern University, TOP
Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University, JSK
H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, AMS
Brain Injury Research Center, TIRR Memorial Hermann, AMS
Departments of Ophthalmology & Visual Sciences, University of Alabama-Birmingham, LED
Physical Medicine & Rehabilitation, University of Alabama-Birmingham, JPN
Traumatic Brain Injury Center of Excellence, BAC
Traumatic Brain Injury Center of Excellence, RNR
Mental Health and Behavioral Services, James A. Haley Veterans Hospital, RNR


traumatic brain injury, family needs, caregiver

View Research Summary:

REACH Publication Type:

Research Summary


The VA Polytrauma Rehabilitation Center Traumatic Brain Injury Model System is a funded collaboration between the Department of Veterans Affairs and the Department of Health and Human Services (National Institute on Disability, Independent Living, and Rehabilitation Research [NIDILRR]).
This work was prepared under contract W91YTZ-13-C-0015/HT0014-19-C-0004 with VHA Central Office VATBIModelSystemsProgram of Research/DHA Contracting Office (CONCR)HT0014and,therefore, is defined as US government work under Title 17 USC§101.
The content of this article was also developed under grant support from NIDILRR (OSP#000524920, Dreer, Niemeier; 90DPTB0005, Kreutzer; 90DPTB0011, O’Neil-Pirozzi; 90DPTB0016, Sander)

REACH Newsletter:

  December 2022

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