Jeanne M Hoffman

University of Washington Seattle | UW · Department of Rehabilitation Medicine

Objective: To examine, among persons discharged from inpatient rehabilitation for traumatic brain injury (TBI), the degree to which pre-TBI factors were associated with post-TBI hospitalization for psychiatric reasons. The authors hypothesized that pre-TBI psychiatric hospitalization and other pre-TBI mental health treatment would predict post-TBI...

Introduction Chronic pain is common after traumatic brain injury (TBI), frequently limits daily activities, and is associated with negative outcomes such as decreased community participation. Despite the negative impact of chronic pain, few people with TBI receive effective treatment. This paper describes a collaborative care (CC) intervention, TBI...

Objective Our primary outcome was to determine the feasibility of patients with post‐traumatic headache (PTH) keeping a daily headache diary and using sumatriptan as directed. Secondary outcomes include determining if sumatriptan is effective in aborting PTH and whether headache resolution is dependent on PTH phenotype. Background PTH is prevalent...

As health care attempts to bridge the gap between evidence and practice, the concept of the learning health system (LHS) is becoming increasingly relevant. LHS integrates evidence with health systems data, driving health care quality and outcomes through updates in policy, practice, and care delivery. In addition, LHS research is becoming criticall...

Importance Traumatic encephalopathy syndrome (TES), the suggested clinical manifestation of chronic traumatic encephalopathy (CTE), is believed to result from repetitive head impacts (RHI) and the prevalence of TES and its component symptoms have not been thoroughly investigated in individuals with single TBI. Objective To use prospectively collec...

Objective To describe the incidence of self-reported COVID-19 history in a longitudinal cohort of individuals with complicated mild to severe traumatic brain injury (TBI) and describe demographic, injury and functional differences based on history of COVID-19 infection. Design Individuals with complicated mild to severe TBI aged 16 or older at tim...

Traumatic brain injury (TBI) is a risk factor for neurodegeneration and cognitive decline, yet the underlying pathophysiologic mechanisms are incompletely understood. This gap in knowledge is in part related to the lack of analytic methods to account for cortical lesions in prior neuroimaging studies. The objective of this study was to develop a le...

Background Long COVID is a serious public health concern due to its high prevalence and potentially debilitating symptoms. Symptoms may include fatigue, dyspnea, cognitive problems, insomnia, anxiety, and depression. There is currently no cure for long COVID, and the average length of recovery and proportion of patients who fully recover are still...

Importance Chronic pain after traumatic brain injury (TBI) is prevalent and associated with poor outcomes. By providing multidisciplinary care through expert consultation, a collaborative care (CC) treatment approach may reduce pain interference. Objective To compare CC with usual care (UC) in decreasing pain interference. Design, Setting, and Pa...

Objective To ascertain patient and caregiver satisfaction with an individualized case management intervention to improve transition from inpatient rehabilitation care to the community after traumatic brain injury (TBI). Setting Participants from 6 National Institute on Disability, Independent Living, and Rehabilitation Research-funded TBI Model Sy...

Introduction Self-management programs for spinal cord injury (SCI) are a growing adjunct to traditional healthcare services aiding individuals with SCI in learning and managing symptoms and medical care. A benefit of self-management programs is that they can be facilitated by peers, offering a unique lived experience of adjusting to and managing SC...

Objective To assess the cost-effectiveness of alternative approaches to diagnose and treat obstructive sleep apnea (OSA) in patients with traumatic brain injury (TBI) during inpatient rehabilitation. Setting Data collected during the Comparison of Sleep Apnea Assessment Strategies to Maximize TBI Rehabilitation Participation and Outcome (C-SAS) cl...

Background: Long COVID is a serious public health concern due to its high prevalence and potentially debilitating symptoms. Symptoms may include fatigue, dyspnea, cognitive problems, insomnia, anxiety and depression. There is currently no cure for long COVID and the average length of recovery and proportion of patients who fully recover are still u...

Objective To identify facilitators and barriers to reaching and utilizing chronic pain treatments for persons with traumatic brain injury (TBI) organized around an Access to Care framework, which includes dimensions of access to healthcare as a function of supply (ie, provider/system) and demand (ie, patient) factors for a specified patient populat...

Objective The purpose of this article is to illustrate the process of stakeholder-engaged intervention mapping approach to identify implementation strategies to overcome data-driven prioritized barriers to receiving chronic pain services for persons with traumatic brain injury (TBI). Setting Community. Participants Healthcare providers ( n = 63)...

Objective Identify determinants to chronic pain healthcare for persons with traumatic brain injury (TBI) informed by an Access to Care Framework. Findings related to the Access Framework's core domains of identifying a need, perceptions of the need, and seeking healthcare are reported. Setting Community. Participants Healthcare providers ( n = 63...

Objective To estimate the prevalence of chronic pain after traumatic brain injury (TBI) and identify characteristics that differ from those without chronic pain. Setting Community. Participants A total of 3804 TBI Model Systems (TBIMS) participants who completed the Pain Survey at TBIMS follow-up. Design A multisite, cross-sectional observationa...

Objective To examine the differences in participation, life satisfaction, and psychosocial outcomes among individuals with traumatic brain injury (TBI) endorsing current, past, or no chronic pain. Setting Community. Participants Three thousand eight hundred four TBI Model Systems participants 1 to 30 years of age postinjury classified into 1 of 3...

Persons aged 65 and older have the highest rates of traumatic brain injury (TBI), and this injury is known to be related to significant, persistent functional changes. What is not known is what factors may mediate these changes. The current study aimed 1) to examine interrelationships among social integration, functional outcome, and cognition in o...

Objective To characterize reasons for rehospitalization of Veterans and Service Members with mild, moderate, and severe traumatic brain injury (TBI) who received inpatient rehabilitation at a Veterans Affairs (VA) Polytrauma Rehabilitation Center (PRC) up to 10 years postinjury. TBI is a chronic condition, and a subset of TBI survivors experience r...

We examined whether females with a history of traumatic brain injury (TBI) and intimate partner violence (IPV) have greater exposure to lifetime trauma relative to females with TBI but no IPV history. Further, we assessed the effects of lifetime trauma on psychological outcomes following TBI. Female participants (n=70; age M(SD)= 50.5(15.2) years)...

Introduction Violence is the third leading cause of spinal cord injury (SCI) in the United States, and people with violence‐related SCI have worse long‐term outcomes compared to other traumatic SCI etiologies. Little is known, however, about the underlying reasons for these differences. Access to and utilization of rehabilitation services may diffe...

Objective To examine the relationship between extreme pain phenotypes (interference and improvement) and psychosocial outcomes among those with chronic pain after traumatic brain injury (TBI). Setting Community. Participants In total, 1762 TBI Model Systems (TBIMS) participants 1 to 30 years postinjury reporting chronic pain. Design Multisite, c...

Objective Although headache (HA) is a common sequela of traumatic brain injury (TBI), early predictors of chronic HA after moderate to severe TBI are not well established, and the relationship chronic HA has with psychosocial functioning is understudied. Thus, we sought to (1) determine demographic and injury predictors of chronic HA 1 or more year...

Objective To define and characterize extreme phenotypes based on pain interference for persons with chronic pain following traumatic brain injury (TBI). Setting Eighteen Traumatic Brain Injury Model System (TBIMS) Centers. Participants A total of 1762 TBIMS participants 1 to 30 years post-injury reporting chronic pain at their most recent follow-...

Objective To define and characterize extreme phenotypes based on perceived improvement in pain for persons with chronic pain following traumatic brain injury (TBI). Setting Eighteen Traumatic Brain Injury Model System (TBIMS) Centers. Participants A total of 1762 TBIMS participants 1 to 30 years post-injury reporting chronic pain at their most re...

Objective: To conduct a scoping review of models of care for chronic disease management in order to identify potentially effective components for management of chronic traumatic brain injury (TBI). Methods: Information sources: Systematic searches of three databases (Ovid MEDLINE, Embase, and Cochrane Database of Systematic Reviews) from January...

Introduction Sleep disturbance and chronic pain are very common after moderate to severe traumatic brain injury (msTBI). Despite having a bidirectional and mutually exacerbating relationship, there is a dearth of literature examining factors involved in the sleep-pain relationship following msTBI. Psychiatric symptoms (e.g., post-traumatic stress,...

Introduction Poor sleep quality and chronic pain are common after moderate-to-severe traumatic brain injury (msTBI). Prior studies have not examined the role of PTSD symptoms in the relationship between sleep quality and chronic pain experience (i.e., severity and pain-related interference) in those with msTBI. Yet, PTSD is known to be associated w...

Traumatic brain injury (TBI) is a global health priority, associated with substantial burden. Historically conceptualised as an injury event with finite recovery, TBI is now recognised as a chronic condition that can affect multiple domains of health and function, some of which might deteriorate over time. Many people who have had a TBI remain mode...

Objective: To test the effectiveness of a peer-led online self-management program for individuals with spinal cord injury (SCI). Design: Randomized waitlist control trial. Setting: Community. Participants: 184 adults with SCI. Interventions: SCI Thrive is a peer-led self-management program with self-paced online content and video-sessions...

Background: Pain after traumatic brain injury (TBI) is common and can become chronic. Acupuncture is an increasingly popular non-pharmacologic option in the United States and is commonly used for pain. Objective: We explored demographics, injury characteristics, and pain characteristics of individuals who reported using acupuncture for chronic p...

Intimate partner violence (IPV) is associated with risk for multi-etiology brain injury (BI), including repetitive head impacts, isolated traumatic brain injuries (TBI), and anoxic/hypoxic injury secondary to nonfatal strangulation (NFS). IPV-related injuries are often unreported, but evidence suggests that survivors are more likely to report when...

Objective: To determine disparities in pain severity, pain interference, and history of pain treatment for non-Hispanic Whites, non-Hispanic Blacks, and Hispanics with traumatic brain injury (TBI) and chronic pain. Setting: Community following discharge from inpatient rehabilitation. Participants: A total of 621 individuals with medically docu...

Background: People of color (POC), especially those who also hold social identities associated with disadvantage (non-English-speaking, female, older, lower socioeconomic level), continue to be underserved in the health system, which can result in poorer care and worsened health outcomes. Most disparity research in traumatic brain injury (TBI) foc...

Objective: To investigate catastrophizing and self-efficacy for managing pain among Non-Hispanic Whites, Non-Hispanic Blacks, and Hispanics with chronic pain following traumatic brain injury (TBI), and whether coping interacts with race/ethnicity to predict participation outcomes. Setting: Community following discharge from inpatient rehabilitat...

Objective LeaRRn, an NIH-funded rehabilitation research resource center, aims to advance learning health systems (LHS) research capacity within the rehabilitation community. A needs assessment survey was administered to inform development of educational resources. Methods The online survey included 55 items addressing interest in and knowledge of...

Research Objectives To examine the effectiveness of collaborative care (CC) compared to usual care (UC) to treat chronic pain in individuals with traumatic brain injury (TBI). Design Randomized Controlled Trial. Setting TBI Rehabilitation Clinics. Participants 158 individuals with TBI who were followed in Rehabilitation clinics and endorsed chro...

Research Objectives To determine is differences in objectively measured sleep related respiration exists between chronic pain cohorts post-TBI. Design Longitudinal, retrospective cohort study. Setting Six TBI Model Systems inpatient rehabilitation centers. Participants 66 patients (mean age 42, 60% Caucasian, 82% male) admitted for neurorehablit...

Research Objectives To investigate the disparities in recommendation, usage, and willingness to use interventions for pain in patients with spinal cord injuries (SCI), based on race, insurance status, age, and income. Design Survey. Setting Outpatient SCI clinics in two academic medical centers. Participants Convenience sample of 276 patients wi...

Research Objectives To test the effectiveness of a peer-led self-management program for individuals with spinal cord injury (SCI). Design Randomized wait-list control. Setting Community, virtual. Participants 184 individuals with SCI from 24 states and 3 countries who responded to listserv posts about the study and able to engage in the online f...

Research Objectives To examine primary care providers’ (PCPs) referral practices for concussion specialty care for patients who have a new concussion and potential pre-injury risk factors (i.e., anxiety, depression, ADHD, migraine), across the first year after diagnosis. Design Retrospective data analysis of an electronic health record system. Se...

Objective: To compare barriers and facilitators to accessing health care services among service members and veterans (SMVs) by traumatic brain injury (TBI) severity groups. Design: Qualitative descriptive study guided by an access to health care services conceptual framework. Setting: Five Veterans Affairs (VA) Polytrauma Rehabilitation Center...

Study objectives: To explore the relationship between polysomnography-derived respiratory indices and chronic pain status among individuals following traumatic brain injury (TBI). Methods: Participants (n = 66) with moderate to severe TBI underwent polysomnography during inpatient acute rehabilitation and their chronic pain status was assessed a...

Objective: To describe the rates and causes of rehospitalization over a 10-year period following a moderate-severe traumatic brain injury (TBI) utilizing the Healthcare Cost and Utilization Project (HCUP) diagnostic coding scheme. Setting: TBI Model Systems centers. Participants: Individuals 16 years and older with a primary diagnosis of TBI....

Introduction Sleep disorders and chronic pain (pain of >3 months duration) are common after traumatic brain injury (TBI). A recently completed multi-center trial found that two-thirds of adults with moderate-to-severe TBI had sleep apnea diagnosed during polysomnography (PSG) completed during inpatient rehabilitation. Although a bidirectional relat...

Research Objectives To describe how the COVID-19 pandemic influenced treatment practices for chronic pain in persons with traumatic brain injury (TBI) and facilitators and barriers to rehabilitation care. Design A descriptive, qualitative study. Setting Traumatic brain injury model systems (TBIMS) civilian and Veterans facilities. Participants T...

Objective: To examine the utility of the sleep disturbance item of the Patient Health Questionnaire-9 (PHQ-9) as a screening tool for insomnia among individuals with moderate to severe traumatic brain injury (TBI). Setting: Telephone interview. Participants: A sample of 248 individuals with a history of moderate to severe TBI participated in a...

Objective: Traumatic brain injury (TBI) is a complex health problem in military veterans and service members (V/SM) that often co-occurs with psychological and medical conditions such as posttraumatic stress disorder (PTSD) and sleep apnea. We aimed to examine if sleep apnea is associated with the presence and severity of PTSD in V/SM with TBI of...

Research Objectives To identify treatments utilized by Service Members and Veterans (SMVs) with TBI and chronic pain and characterize access barriers and facilitators to non-pharmacologic treatments. Design A secondary data analysis of SMV with TBI interview data guided by a biopsychosocial model of pain management1-3 and framework for accessing h...

Research Objectives To identify differences sleep related respiration between those receiving and not receiving opioid medications. Design Cross-sectional, secondary analyses. Setting Acute inpatient rehabilitation for moderate to severe TBI. Participants 248 consecutive admissions who underwent level-1 polysomnography. Interventions Receipt of...

Introduction: Falls and their consequences are known to be major contributors to decreased health and well-being in older adults. Several studies suggest that fall rates are higher among individuals with disabling conditions such as multiple sclerosis (MS). However, there is a knowledge gap regarding how individuals with a disability define falls...

Objective: To summarize the current literature to identify what research has been conducted, examine the approaches used, and determine what is presently known about prescription and nonprescription opioid receipts and use among individuals with traumatic brain injury (TBI). Data sources: The search strategy included the following: opioid; opiat...

Objectives: To describe patient and clinical characteristics associated with receipt of opioid medications and identify differences in sleep quality, architecture, and sleep-related respiration between those receiving and not receiving opioid medications. Setting: Acute inpatient rehabilitation care for moderate to severe traumatic brain injury...

Background: Despite the well-documented risks to patient safety associated with transitions from one care setting to another, health care organizations struggle to identify which interventions to implement. Multiple strategies are often needed, and studying the effectiveness of these complex interventions is challenging. Objective: The objective...

Background Few studies have investigated sleep in Veterans with comorbid traumatic brain injury (TBI) and chronic pain. Objective To describe mood and cognitive correlates with sleep disturbance in a sample of Veterans with both TBI and chronic pain. Research method Cross-sectional, correlational analyses were completed using baseline data from a...

Introduction Obstructive Sleep Apnea (OSA) is prevalent after moderate to severe traumatic brain injury (TBI) and may diminish recovery when left untreated. Despite the demonstrated importance of treating OSA following TBI, assessment for OSA during or soon after inpatient rehabilitation for TBI is limited. Little is known about barriers to impleme...

Objective To determine if functional measures of ambulation can be accurately classified using clinical measures, demographics, personal, psychosocial, and environmental factors (PPEF), and limb accelerations (LA) obtained during sleep, among individuals with chronic, motor incomplete spinal cord injury (SCI) in an effort to guide future, longitudi...

Moderate to severe traumatic brain injury (TBI) is a common cause of long-term disability. Due to challenges that include inconsistent access to follow-up care, persons with TBI being discharged from inpatient rehabilitation facilities (IRFs) are at risk for rehospitalization, poor reintegration into the community, family stress, and other unfavora...

Objective: To examine the impact of bright white light (BWL) exposure on sleep quality in persons with recent traumatic brain injury (TBI). Design: Randomized, controlled device-sham study Setting: 3 TBI Model System inpatient rehabilitation units Participants: 131 participants (mean 40.9 years, 68% male) Intervention: Intervention group (N = 65) r...

We assessed safety and potential efficacy of a chamomile gel compared with urea cream to prevent acute radiation dermatitis in head and neck cancer patients. We assessed safety and potential efficacy of the chamomile gel in escalating concentrations of 2.50%, 5.00% and 8.35% of chamomile. Concentration of 8.35% was chosen for a randomized trial com...

Objectives To examine heterogeneity in the temporal patterns of depression and participation over the first two years post-TBI. Design Observational prospective longitudinal study. Setting Inpatient rehabilitation centers, with 1- and 2-year follow-up conducted primarily by telephone. Participants Persons with TBI (N=2307) enrolled in the Trauma...

Background: Pain is a common problem after traumatic injury. We describe pain intensity and interference at baseline and one-year post injury in burn, traumatic brain (TBI) and spinal cord injury (SCI) survivors and compare them to the general population (GP). We tested a custom PROMIS® pain interference short form developed for use in trauma popu...

Introduction Recent studies highlight prevalent obstructive sleep apnea after moderate to severe TBI during a time of critical neural repair. The purpose of this study is to determine the diagnostic sensitivity, specificity and comparative effectiveness of traditional sleep apnea screening tools in TBI neurorehabilitation admissions. Methods This...

Objective To describe the cost-benefit of four different approaches to screening for sleep apnea in a cohort of participants with moderate to severe TBI receiving inpatient rehabilitation from the payor’s perspective. Design A cost-benefit analysis of phased approaches to sleep apnea diagnosis. Setting Six TBI Model System Inpatient Rehabilitatio...

Background Obstructive sleep apnea is prevalent during a time of critical neural repair following traumatic brain injury (TBI). The diagnostic utility of existing sleep studies is needed to inform clinical management during acute recovery from TBI. Research Question This study aimed to evaluate the non-inferiority and diagnostic accuracy of a port...

Introduction: Headache after traumatic brain injury (TBI) is frequent and persistent over the first year after injury. Providers may need to focus on different symptoms presentations depending on their patient's TBI severity. Objective: We evaluated headache symptoms in those with moderate-to-severe TBI compared to those with mild TBI and examin...

Objectives: The primary outcome of this study was to assess the efficacy and safety of preventive treatment with amitriptyline on headache frequency and severity after mild traumatic brain injury (mTBI). Background: Despite the fact that headache is the most common and persistent physical symptom after TBI, there has been little research on the...

Background: After stroke, individuals face a variety of impairments that impact function. Increasingly, rehabilitation for these impairments has moved into the community and home settings through the use of home programs. However, adherence to these programs is often low, limiting effectiveness. Objective: This scoping review investigated home prog...

Objective: To determine the diagnostic sensitivity and specificity and comparative effectiveness of traditional sleep apnea screening tools in traumatic brain injury (TBI) neurorehabilitation admissions. Design: Prospective diagnostic comparative effectiveness trial of sleep apnea screening tools relative to the gold standard, attended Level 1 p...

Objective: To examine the predictive ability of depression when considering long-term employment outcomes for individuals with moderate-to-severe TBI, after controlling for key pre-injury and injury-related variables. Design: Secondary data analysis. Setting: Community follow-up after discharge from an inpatient rehabilitation center. Partici...

Background and objectives: Chronic pain is a highly prevalent and potentially disabling condition in Veterans who have had a traumatic brain injury (TBI) and access to non-pharmacological pain treatments such as cognitive behavioral therapy is limited and variable. The purpose of this randomized controlled trial (RCT) is to evaluate the efficacy o...

Background: In patients with short-term percutaneous central venous catheter (CVC), it is recommended that a dressing be applied to the catheter insertion site to prevent catheter-related infections. Objectives: The objective of this study was to assess the feasibility of a randomised controlled trial to compare the efficacy of chlorhexidine-imp...

Background: Identification and management of comorbidities in TBI has become an increasing focus for optimizing TBI outcomes. Recent meta-analyses highlight sleep disturbance and sleep disorders following TBI (Mathias & Alvaro, 2012). Improving the recognition and treatment of sleep disorders in TBI should be a central focus of rehabilitation. The...