title: Caring for our wounded warriors: A qualitative examination of health-related quality of life in caregivers of individuals with military-related traumatic brain injury.
abstract: The purpose of this study was to develop a conceptual framework that captures aspects of health-related quality of life (HRQOL) for caregivers of individuals with military-related traumatic brain injury (TBI). We analyzed qualitative data from nine focus groups composed of caregivers of wounded warriors with a medically documented TBI. Focus group participants were recruited through hospital-based and/or community outreach efforts at the Walter Reed National Military Medical Center, the University of Michigan, and Hearts of Valor support groups (Tennessee and Washington). Participants were the caregivers (n = 45) of wounded warriors who had sustained a mild, moderate, severe, or penetrating TBI. Qualitative frequency analysis indicated that caregivers most frequently discussed social health (44% of comments), followed by emotional (40%) and physical health (12%). Areas of discussion that were specific to this population included anger regarding barriers to health services (for caregivers and servicemembers), emotional suppression (putting on a brave face for others even when things are not going well), and hypervigilance (controlling one's behavior/environment to prevent upsetting the servicemember). Caring for wounded warriors with TBI is a complex experience that positively and negatively affects HRQOL. While some aspects of HRQOL can be evaluated with existing measures, evaluation tools for other important components do not exist. The development of military-specific measures would help facilitate better care for these individuals.
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI.
authors.forename: Noelle E
authors.initials: NE
authors.lastname: Carlozzi
authors.affiliation: Defense and Veterans Brain Injury Center and Walter Reed National Military Medical Center, Bethesda, MD.|Uniformed Services University of the Health Sciences, Bethesda, MD.
authors.forename: Tracey A
authors.initials: TA
authors.lastname: Brickell
authors.affiliation: Defense and Veterans Brain Injury Center and Walter Reed National Military Medical Center, Bethesda, MD.|Uniformed Services University of the Health Sciences, Bethesda, MD.|Center for Neuroscience and Regenerative Medicine, Bethesda, MD.
authors.forename: Louis M
authors.initials: LM
authors.lastname: French
authors.affiliation: Brain Injury Research Center, TIRR Memorial Hermann and Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, and Harris Health System, Houston, TX.
authors.forename: Angelle
authors.initials: A
authors.lastname: Sander
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI.
authors.forename: Anna L
authors.initials: AL
authors.lastname: Kratz
authors.affiliation: Department of Physical Therapy, University of Delaware, Newark, DE.
authors.forename: David S
authors.initials: DS
authors.lastname: Tulsky
authors.affiliation: Neuropsychology and Neuroscience Laboratory, Traumatic Brain Injury Laboratory, Kessler Foundation Research Center, West Orange, NJ.
authors.forename: Nancy D
authors.initials: ND
authors.lastname: Chiaravalloti
authors.affiliation: Department of Medical Social Sciences, Northwestern University, Chicago, IL.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Hahn
authors.affiliation: Department of Medical Social Sciences, Northwestern University, Chicago, IL.
authors.forename: Michael
authors.initials: M
authors.lastname: Kallen
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI.
authors.forename: Amy M
authors.initials: AM
authors.lastname: Austin
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Miner
authors.affiliation: Defense and Veterans Brain Injury Center and Walter Reed National Military Medical Center, Bethesda, MD.|University of British Columbia, Vancouver, BC, Canada.
authors.forename: Rael T
authors.initials: RT
authors.lastname: Lange
mesh_terms: D000328:Adult; D000070642:Brain Injuries, Traumatic / Q000534:rehabilitation*; D017028:Caregivers / Q000523:psychology*; D005260:Female; D017144:Focus Groups; D006304:Health Status; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D008889:Military Personnel; D011788:Quality of Life
keywords: Veterans; caregiver; health-related quality of life; outcome assessment (health care); quality of life; rehabilitation; servicemembers; traumatic brain injury; underserved populations; wounded warriors