Treatment Model of Occupational Therapy Intervention for Service Members With Chronic Symptoms Following Mild Traumatic Brain Injury

PURPOSE: The purpose of this study was to develop a treatment model for occupational therapy intervention to optimize participation in daily life of military service members with mild traumatic brain injury (mTBI) and persistent symptoms. The model includes treatment targets within the occupational therapy scope of practice, provider actions, and hypothesized mechanisms of action. This study addresses a gap in the literature to define occupational therapy practice with this population, which will support the development of appropriate interventions in practice.

METHOD: For this qualitative descriptive study, purposive sampling was used to identify potential participants. To be included, service member participants had to have a history of mTBI as defined by the Departments of Defense and Veterans Affairs, to have received occupational therapy services related to the mTBI injury, and to be on active duty status. Occupational therapy participants were required to have a minimum of 6 mo experience treating service members with mTBI in a military medical facility.

Two series of focus groups were held, one with service member participants and another with occupational therapy participants. Focus groups were held in a private conference room at a military medical facility and were audio recorded and transcribed verbatim. NVivo (QSR International, Melbourne, Australia) was used for data management. Initial coding was completed deductively using the treatment model categories as a priori codes. The portion of the analysis was based on intervention mapping methodology. Data that did not fit within the treatment model framework were analyzed inductively and coded thematically.

RESULTS: Six service members with chronic symptoms attributed to mTBI and five occupational therapy professionals who worked in military medical facilities participated in the study. After treatment targets were identified, they were mapped to provider actions and supporting theoretical mechanisms of action. Most of the prioritized needs, including community reintegration and symptom management, were addressed in current occupational therapy practice.

The areas of greatest difficulty described by the service members that were not currently being focused on by the occupational therapy participants were sleep disruption and chronic pain. Thematic analysis highlighted additional considerations that emphasized the patient perspective, such as the importance of the therapeutic relationship, the inclusion of family members in the intervention process, the differing needs of service members injured in combat versus noncombat settings, and the importance of patients’ finding purpose in life at the conclusion of their military career.

CONCLUSION: Occupational therapy services, as part of a multidisciplinary intervention program, should address all domains of occupational therapy practice in assessment and treatment. In cases in which scope overlaps with other disciplines, providers should coordinate to create complementary approaches. A unique and important consideration for active duty service members whose military careers are ending is to address finding purpose in their postmilitary lives.

IMPACT STATEMENT: This study provides a treatment planning resource for occupational therapy practitioners practicing in military settings and a foundation for the development of future interventions to be evaluated in efficacy trials. The views expressed in this abstract are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or U.S. government.

References

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