A 3-Week Intensive Outpatient Program for Patients With Persistent Neuropsychiatric Symptoms After Remote TBI

Alicia K Vose; Vaughn E Bryant; Jade Hannan; Jiang Bian; Hao Dai; Michael Sorna; Ramon Bautista; Scott Silliman

doi:10.1176/appi.neuropsych.20250116

A 3-Week Intensive Outpatient Program for Patients With Persistent Neuropsychiatric Symptoms After Remote TBI

J Neuropsychiatry Clin Neurosci. 2026 May 22:appineuropsych20250116. doi: 10.1176/appi.neuropsych.20250116. Online ahead of print.

Authors

Alicia K Vose¹, Vaughn E Bryant^{1

2}, Jade Hannan¹, Jiang Bian^{3

4}, Hao Dai⁴, Michael Sorna^{2

5}, Ramon Bautista¹, Scott Silliman¹

Affiliations

¹ Department of Neurology, University of Florida College of Medicine, Jacksonville.
² Department of Psychiatry, University of Florida College of Medicine, Jacksonville.
³ Regenstrief Institute, Indianapolis.
⁴ Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis.
⁵ Professionals Resource Network, Fernandina Beach, FL.

PMID: 42168808
DOI: 10.1176/appi.neuropsych.20250116

Abstract

Objective: The authors evaluated changes associated with a 3-week interdisciplinary intensive outpatient program that delivers integrated neuropsychiatric rehabilitation for veterans and first responders with persistent postconcussive and co-occurring symptoms after remote traumatic brain injury.

Methods: In this retrospective cohort study, 128 patients completed patient-reported measures, including the Neurobehavioral Symptom Inventory (NSI), PTSD Checklist for DSM-5 (PCL-5), and Life Satisfaction Questionnaire-11 (LiSat-11), and objective assessments, comprising Addenbrooke's Cognitive Examination-III (ACE-III), gait speed, computerized dynamic posturography (for conducting the Sensory Organization Test [SOT]), and Modified Clinical Test of Sensory Interaction in Balance (mCTSIB). Paired t tests were used to compare intake with discharge measures, and a linear mixed-effects model was used to examine NSI scores over time with covariate adjustment.

Results: The NSI total score decreased by 15.6 points (41%, Cohen's d=1.11); ACE-III scores improved by 6.8 points (Cohen's d=1.41); and forward and backward gait speeds, SOT composite scores, and mCTSIB condition 4 scores showed significant improvements (Cohen's d=0.68-0.87). The proportion of patients screening at or above a common PTSD threshold on the PCL-5 declined from 51% at intake to 20% at discharge, and higher baseline PCL-5 scores were associated with higher NSI scores across time points (p<0.001).

Conclusions: These findings are consistent with multidomain benefits of intensive, interdisciplinary neuropsychiatric rehabilitation in this population. These results support the potential of integrated care models to reduce symptom burden and improve cognitive, mobility, vestibular, and life satisfaction outcomes over 3 weeks, while underscoring the close linkage between posttraumatic stress severity and neurobehavioral symptom burden.

Keywords: Interdisciplinary Care; Outpatient Rehabilitation; Postconcussion Symptoms; Posttraumatic Stress Disorder; Traumatic Brain Injury; Veterans.