Mind Over Matter

A Veteran-driven Roadmap to Research on Traumatic Brain Injury

Funding Information
This project was funded through a Patient Centered Outcomes Research Institute® (PCORI®) Eugene Washington PCORI Engagement Award (21037-FAU).

Disclaimer
The content presented in this roadmap are solely the responsibility of the author(s) and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute® (PCORI®), its Board of Governors or Methodology Committee.

Contact Information
This document may not be reproduced, in whole or in part, without written permission. Please send all inquiries to
cpaww@health.fau.edu.

Acknowledgements
This roadmap was developed in collaboration with the numerous veterans, mental health clinicians, and researchers who donated their time, feedback, and expertise in participation of this project.

Table of Contents
Introduction
Contributors
Methods
Participation
Evaluation Metrics
Team Retreat
CER Questions
Engagement Strategies
Reference Page

Introduction

Veterans who have deployed overseas are a population of special concern due to an increased incidence of a traumatic brain injury (TBI) diagnosis. Symptom clusters of mild traumatic brain injury (mTBI) usually fall within four categories: thinking/remembering, physical, emotional/mood, and sleep. Oftentimes these symptoms require relying on trusted caregivers and clinicians when making health care decisions. The impact of a mTBI on a person and their family can be devastating. Sound treatment options and healthcare decision-making require veterans with mTBI and their caregivers to have accurate, up to date, understandable, evidence-based information, and the decision-making capacity to use that information.

Mind Over Matter (M.O.M.) targets that by creating a platform for veterans with a mTBI and their caregivers, giving them an active voice in developing a clear pathway for increasing the relevance of mTBI research and outcomes. This is important to help them live their healthiest lives and serve as the foundation for a veteran-driven PCOR community.

Contributors

Cheryl A. Krause-Parello, PhD, RN, FAAN
M.O.M. Project Lead
Associate Vice President for Research (Interim), Associate Executive Director & Faculty Fellow, Institute for Humand Health and Disease Intervention (I-HEALTH) Director, C-P.A.W.W. Canines Providing Assistance to Wounded Warriors Health Research Initiative for Veterans Professor (Secondary), Christine E. Lynn College of Nursing, Florida Atlantic University

Elisa Borah, PhD, MSW
M.O.M. Project Co-lead
Director and Associate Professor Institute for Military & Veteran Family Wellness, Steve Hicks School of Social Work, University of Texas at Austin

Texas Unit

Florida Unit

Miriam Whitfield, DCN, MS, CPTDoctor of Clinical Nutrition, Teaching Assistant, University of Western States, Portland OR

Alicia Rossiter, DNP, APRN, FNP, PPCNP-BC, FAANP, FAAN
Lt Col USAFR NC (Retired)
Chief Officer Military and Veteran Affairs, Director V-CARE Veteran to BSN Pathway, Associate Professor University of South Florida

Anil Arora
Mr. Anil Arora, LCSW
Graduate Research Assistant at University of Texas at Austin
PhD Student at University of Houston

John T. Glenny III BSN, RN.
US Army Veteran. USF Nursing BSN-DNP AGPC NP Student. James A Haley VA Hospital ER Nurse.

Ohio Unit

Sgt. David A. Hibler M.S.
U.S. Army Veteran, 68W. PhD Candidate, Department of Evolution Ecology & Organismal Biology,
Military Community Advocate, Sesquicentennial Scholar, Ohio State University.Tillman Scholar. Military Research Consultant, C-P.A.W.W.

Joy L. Omslaer
Licensed Independent Social Worker-
Supervisor (LISW-S), Outpatient
Rehabilitation, The Ohio State
University.

South Carolina Unit

Consultants

Jane Garvin, PhD, APRN, FNP-BCContributing Faculty, College of Nursing, Walden University
& formerly Adjunct Faculty, College of Nursing, Augusta University

CPT (Ret) Brian M. GlibaU.S. Army, MBA, MS

John Lindsay
U.S. Army Veteran, Commander of American Legion Post (1971)

Mike Stemple, Inspirer Consultant Serially successful entrepreneur, author, and ideation expert.

Organizations

Malayka Gormally and Conor Gormally
Concussion Alliance Liasons

Methods

Four state units
1. Florida
2. Texas
3. South Carolina
4. Ohio

Two members in each unit
1. Veteran/Concerned Significant Others (CSOs)
2. Collaborative Academic Research Members (CARMs)

Four domains
1. Attention
2. Memory Sequencing
3. Problem Solving
4. Executive Functioning

Four field note templates
- One field note template was created by the full M.O.M. team for each domain, these templates were used in each think tank meeting

Think Tank Meetings
- Two think tank meetings were held by each unit for each domain
- Each meeting comprised of Veterans, CSOs, and community stakeholders

Synthesis of main themes
- Lead by the Texas unit, the M.O.M. team synthesized all the main themes and topics recorded in the think tank meetings

CER Question Completion

Participation Metrics

Attention Meetings

pie chart of Attention meetings - data: Stakeholders (e.g. CSOs, service providers, etc.) 15, Vietnam War Veterans 5, Korean War Veterans 0, Gulf War Veterans 6, Post 9/11 Veterans 8

Memory Sequencing Meetings

pie chart of Memory Sequencing Meetings, data: Stakeholders (e.g. CSOs, service providers, etc.) 20, Vietnam War Veterans 8, Korean War Veterans 3, Gulf War Veterans 5, Post 9/11 Veterans 13

Problem Solving Meetings

pie chart of Problem Solving Meetings, data: Stakeholders (e.g. CSOs, service providers, etc.) 19, Vietnam War Veterans 6, Korean War Veterans 3, Gulf War Veterans 3, Post 9/11 Veterans 10

Executive Functioning Meetings

pie chart of Executive Functioning Meetings, data: Stakeholders (e.g. CSOs, service providers, etc.) 18, Vietnam War Veterans 13, Korean War Veterans 5, Gulf War Veterans 3, Post 9/11 Veterans 13

Formative Group Evaluation Metrics

The members of the project team have established a good understanding of the Mind Over Matter project objectives.

The members of this project team are working towards mutually agreed upon goals.

I believe the engagement methods in this project are beneficial to the development of a veteran-centered research agenda related to TBI.

horizontal bar graph of I believe the engagement methods in this project are beneficial to the development of a veteran-centered research agenda related to TBI.

My participation in the project team gives me new ways of looking at traumatic brain injury research in collaboration with the veteran and concerned significant other population.

horizontal bar graph of My participation in the project team gives me new ways of looking at traumatic brain injury research in collaboration with the veteran and concerned significant other population.

Stakeholder Evaluation Metrics

I plan to attend another Think Tank Meeting in the future.

I felt that others listened to me and appreciated my contributions.

I felt that the Think Tank Meeting format allowed for open discussion on how to improve research on TBI.

horizontal bar graph of Stakeholder Evaluation Metrics - I felt that the Think Tank Meeting format allowed for open discussion on how to improve research on TBI.

The group provided me with an opportunity to explore patient-centered research topics on traumatic brain injury.

horizontal bar graph of Stakeholder Evaluation Metrics - The group provided me with an opportunity to explore patient-centered research topics on traumatic brain injury.

Team Retreat

On July 14th and 15th 2023, the Mind Over Matter project team came together for a collaborative retreat. Over the course of the two day retreat the team brainstormed CER questions and engagement strategies based on the common topics that were synthesized from the Think Tank Meetings hosted throughout the project.

Retreat Agenda:

Breakout groups to construct CER Questions
Brainstorm engagement strategies
Complete PCORI Evaluation Reporting Tool
Complete PCORI MOM Team Evaluation

illustration of three people at a table with a large lightbulb centered above them

CER Questions

CER Process Infographic - see full description below this image

Infographic visually outlines the flow and impact of CER. Click for a detailed description.

1. Far Left - Light Blue Box:
Vertical stack of five dark blue ovals and text, in order as follows:

Topic Capture and Research Prioritization
Merit Review
Infrastructure for Patient-Centered CER
Development of PCOR Community
Research on Methods for PCOR and CER

The light blue box has an arrow pointing to a green box to the right, and a second arrow pointing down and right to an orange box.

2. Center-left - Green Box:
Labeled "Patient-Centered CER." It contains two light green ovals with the following text:

Engagement in Research (top half of the green box), has arrows pointing to two orange boxes to the right, labeled "Useful Information" and "Use of Information."
Methods Standards (bottom half), has an arrow pointing to the orange boxes to the right, labeled "Useful Information."

3. Bottom Center-left:

Dark blue oval labeled "Intensive Portfolio Management," with arrow pointing to green box above.
Orange box labeled "Influence Others," that receives arrow from left light blue box and has a two-way arrow between itself and the green box above.

4. Dark blue oval labeled "Dissemination and Implementation Efforts" (bottom center-right) that has arrow pointing to the "Use of Information" orange box above.

5. Impact (far right - light purple column):
Vertical stack of three dark purple boxes labeled in order as follows:

Health Decisions
Health Care
Health Outcomes

Each has an arrow that points down to the next.

The infographic uses arrows to show direction and influence.

Information flows from left to right.

What is CER?

What does CER do?

CER stands for Comparative Clinical Effectiveness Research

Findings assist clinicians, patients, and other stakeholders in making informed decisions that improve health care

PCORI. (2023, July 14). Research we support. PCORI. https://www.pcori.org/research/about-ourresearch/ research-we-support

CER Questions: Attention

For veterans with mTBI, how does having a peer facilitator, family member/caregiver/care partner, or support animal compare in terms of improving clinical outcomes with attention?

Peer facilitator v. family member/caregiver/care partner
Family v. support animal
Peer facilitator v. support animal

For veterans with mTBI, how does a personalized nutrition focused dietary pattern compare to a Standard American Diet impact the clinical outcomes of attention?

What are the comparative benefits and risks of individual therapy compared to group therapy on clinical outcomes of attention in veterans with mTBI?

For veterans with mTBI, how do time periods of 15, 30, or 45 minutes compare to improvements on attentionfocused tasks such as writing a letter, reading a book, or managing daily schedules?

For veterans with mTBI, how does having a traumainformed environment compare to a hospitality-oriented environment affect the clinical outcomes of attention?

CER Questions: Memory Sequencing

What are the comparative benefits and risks of using nonpharmacological sleep modalities (smart phone apps for white noise, CBTI) compared to pharmacological modalities (OTC, marijuana, prescription medications) on clinical outcomes of memory sequencing in veterans with mTBI?

What are the comparative benefits and risks of oral versus written versus digital communication approaches related to memory sequencing for veterans with mTBI?

For veterans with mTBI, how does a personalized nutrition focused dietary pattern compare to a Standard American Diet impact the clinical outcomes of memory sequencing?

For veterans with mTBI, how does having a traumainformed environment compare to a hospitalityoriented environment on the clinical outcomes of memory sequencing?

What are the comparative benefits and risks of inoffice visits (speech therapy, OT), virtual visits, and home visits for veterans with mTBI who experience memory sequencing challenges?

icons of brain, hazard sign, puzzle pieces

CER Questions: Problem Solving

hands of six people on table assembling a white puzzle

What is more effective for improving problem solving for veterans with mTBI, using a military framework or a civilian after action review (AAR) framework?

What are the comparative benefits and risks of using a job coach, support animal, or supervisor for effectively managing problem solving at work?

What are the comparative benefits and risks of using individual technology (clinical cue card, biometric feedback) versus a care partner in creating conditions of problem solving?

icon lighbulb comprised of puzzle pieces with one piece off to the side with a check mark

What are the comparative benefits and risks of virtual gamification with peers online versus in-person peer support for improving clinical outcomes of problem solving?

CER Questions: Executive Functioning

For veterans with mTBI, what are the comparative benefits and risks of individual CBT versus CBT with peer support/family/care partner on improvements of executive functioning?

For veterans with mTBI, how does civilian-framed treatment compare to military-framed treatment in terms of executive functioning across gender and sexual identities?

icon person surrounded by gear, clock, clipboard

For veterans with mTBI, how does having a traumainformed environment compare to a hospitality-oriented environment on the clinical outcomes of executive functioning?

For veterans with mTBI, how does psychoanalytic therapy compare to mindfulness practices in terms of improving executive functioning outcomes across gender and sexual identities?

What are the comparative benefits and risks of using psychoeducation to normalize and adapt to current brain state versus using missionfocused methods to improve executive functioning outcomes for veterans with mTBI?

Engagement Strategies

Utilizing College Campuses

Reaching out to local support groups on campus (e.g. Neuro Nights program)
Using campus based military organizations

Utilizing the Community and Other Organizations

Partnering with clinics that have veteran programs
Reach out to the members of related organizations

Multiple Ways to Participate

icon letters A, B, C and cursor fingor pointing

Have both individualized and group based opportunities
Utilize multiple platforms for participation to reach a greater variety of people

Mind Over Matter

A Veteran-driven Roadmap to Research on Traumatic Brain Injury

To Reference this Roadmap see suggested citation below:

Krause-Parello, C.A., Borah, E., Kremer, A.M. et al., (2023). Mind Over Matter: A Veteran-Driven Roadmap to Research on Traumatic Brain Injury PCORI. https://www.pcori.org/researchresults/ 2021/mind-over-matter-veteran-driven-roadmapresearch- traumatic-brain-injury