Complementary and Integrative Health Approaches to Improve TBI Outcomes in Veterans

Project Summary/Abstract Background. Traumatic brain injury (TBI) is one of the most Veteran-centric conditions with few interventions with sufficient evidence and is a top research priority for the VA. The 2021 VA-DOD guidelines recommend a non-pharmacologic approach to manage symptoms and avoid medications, which Veterans also prefer.

Significance. As a part of VA’s cutting-edge Whole Health approach to healthcare, the VA has embraced Complementary and Integrative Health (CIH) as a major tool for non-pharmacologic approaches and has approved several CIH approaches including acupuncture, biofeedback, clinical hypnosis, meditation, and yoga

for either treatment or well-being. However, the VA-DOD TBI guideline has determined that there is insufficient evidence to recommend CIH approaches for TBI. Generating new evidence that will ultimately improve the quality and outcomes of care of Veterans with TBI is the primary objective of this proposal. Because patients

with TBI often suffer from post-traumatic stress disorder (PTSD), we will specifically examine the effectiveness of CIH in Veterans with both TBI and PTSD. Innovation and Impact. This proposal is innovative in that it capitalizes on the unique VA data on CIH and TBI and make VA data work for Veterans. Being organized according to the learning health system paradigm, our

Aim 1 will be rooted in current clinical practice and seek the insights from stakeholders. Aim 2 will utilize state- of-the-art statistical methods, and Aim 3 will leverage novel AI and AI explanation methods developed by our team. The proposed study will support the implementation of VA’s cutting-edge Whole Health approach by

providing clinicians and Veterans with the much-needed sufficient evidence about the role of CIH in TBI. Specific Aims. Our Specific Aims are (1) To understand the perspectives of Veterans with TBI (with and without PTSD), clinicians, and administrators about the barriers and facilitators in providing CIH care to

Veterans with TBI and strategies to enhance the well-being of Veterans with TBI via CIH approaches, through focus groups and interviews. (2) To test the hypothesis that initiation of VA-approved CIH approaches is associated with a lower risk of combined endpoint of all-cause mortality or all-cause hospitalization in Veterans

with TBI, overall and stratified by PTSD, using new-user design and propensity score approaches. (3) Aim 3: To assess the impact of individual CIH approaches in individual Veterans with TBI, with or without PTSD, on the risk of combined endpoint of death or hospitalization, by developing explainable deep machine learning

prediction models. The deep learning analyses will be able to account for complex treatment patterns including the duration, sequence, and combination of different modalities. Next Steps/Implementation. In addition to presentations and publications, the study findings will be disseminated and implemented locally as well as nationally through collaboration and sponsorship of

operational partners including leadership at the Washington DC VAMC, VA National AI Center, VA Office of Physical Medicine and Rehabilitation, and VA Office of Patient Centered Care & Cultural Transformation.