CITATION
Sander, A. M., Lequerica, A. H., Ketchum, J. M., Hammond, F. M., Gary, K. W., Pappadis, M. R., … Bushnik, T. (2018). Race/Ethnicity and Retention in Traumatic Brain Injury Outcomes Research. Journal of Head Trauma Rehabilitation, 33(4), 219–227. doi:10.1097/htr.0000000000000395
SUMMARY
This article is a retrospective data analysis that was conducted in the United States. This Traumatic Brain Injury Models Systems (TBIMS) study aimed to assess racial and ethnic disparities in rehabilitation retention. The authors examined how socio-demographic and injury related characteristics may have predicted drop out in rehabilitation service utilization. 5,548 White, 1,340 Black, and 790 Latinx (note: TBIMS language uses “Hispanic”) individuals with TBI were included in the study, and the completion of at least 1 measure at 1, 2, and 5 years follow-up was a proxy for retention. Data between October 1, 2002 and March 31, 2013 were reviewed for the current study.
The authors reported injury cause and severity, which was measured by duration of post-traumatic amnesia (PTA), functional independence, race, alcohol misuse, education, marital status, and residence at the time of rehabilitation. Preliminary study findings showed that the majority of the sample was White, single, with at least a high school education, and sustained moderate-to-severe TBI. They discovered that there were significant retention differences among the three racial groups included in the study. Significant differences in retention odds were observed between White and Latinx individuals, as was for Black and Latinx individuals. The authors also found that as participants aged, their odds of being retained decreased. Study findings also showed that retention odds were higher for those discharged to a private versus non-private residence and increases in education associated with greater odds of retention. Using these study findings, the authors suggested that rehabilitation retention rates differ among racial groups and may also associate with social and injury characteristics. Interaction effects between race and pre-injury substance misuse were observed and the findings showed that Latinx individuals with TBI and comorbid pre-injury substance use issues had lower odds of being retained in rehabilitation services compared to similar Black and White samples. The authors state that these findings underscore the importance of differentially assessing rehabilitation outcomes by race, rather than conducting White to non-White comparisons. These comparisons may miss how other social constructs, such as marital status or education, may contribute to specific rehabilitation outcomes differently by a function of race.
After addressing the study limitations, the researchers suggested that these findings underscore the nature of TBI rehabilitation retention for individuals with moderate to severe TBI. Most importantly, the authors addressed that other social constructs may contribute to lower retention rates among racial and ethnic minority groups that were not captured in the TBIMS database.
I CHOSE THIS ARTICLE in light of the #BlackLivesMatter protests. As a Black male PhD student, I aim to incorporate social justice principles in rehabilitation research and practice. My core values prompt me to eradicate systemic barriers of racial injustice that exist in the rehabilitation context.
THIS MONTH’S REHABILITATION SCIENCE SPOTLIGHT was chosen by Mike Pugh Jr, M.S., a fourth year Ph.D. student at Virginia Commonwealth University, specializing in Counseling Psychology and Rehabilitation Psychology. He serves on the Division 22 Science Committee as the tear sheets coordinator and Guest Editor for Rehabilitation Psychology, Division 22's flagship journal.