OBJECTIVES To identify areas of most restricted self-reported participation among Veterans with traumatic brain injury (TBI), explore associations among participation restriction and clinical characteristics, and examine differences in participation restrictions by sex. DESIGN Retrospective cross-sectional design. SETTING National VA Polytrauma System of Care outpatient settings. PARTICIPANTS Veterans with a confirmed TBI event (N = 6,065). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) Mayo-Portland Participation Index (M2PI), a five-point Likert-type scale with eight items. Total score was converted to standardized T-score for analysis. RESULTS The sample consisted of 5,679 male and 386 female veterans with one or more clinically confirmed TBI events (69% Caucasian; 74% with blast exposure). The M2PI items with greatest perceived restrictions were social contact, leisure, and initiation. There were no significant differences between males and females on M2PI standardized T-scores. Wilcoxon rank-sum analyses showed significant differences by sex on four items: leisure, residence, employment, and financial management (all P < 0.01). In multinomial logistic regression on each item controlling for demographics, injury characteristics, and comorbidities, female Veterans had significantly greater relative risk for part time work and unemployment on the employment item and significantly less risk for impairment on the residence and financial management item. CONCLUSIONS There was no significant difference between male and female Veterans on M2PI standardized T-scores, which masks differences in response patterns to individual items. Clinical teams should be encouraged to discuss perceived restrictions with patients and target these areas in treatment planning. Future work is needed to investigate the psychometric properties of the M2PI by biological sex.

中文翻译：

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退伍军人健康管理局门诊多发伤计划中患有创伤性脑损伤的男性和女性退伍军人自我报告的参与限制

目的 确定创伤性脑损伤 (TBI) 退伍军人自我报告参与最受限的领域，探索参与限制与临床特征之间的关联，并检查不同性别参与限制的差异。设计 回顾性横断面设计。设置国家 VA 多发创伤护理系统门诊设置。参与者 确认 TBI 事件的退伍军人（N = 6,065）。干预 不适用。主要结果测量（S）梅奥-波特兰参与指数（M2PI），一个五点李克特型量表，包含八个项目。总分被转换为标准化的 T 分数以供分析。结果 样本由 5,679 名男性和 386 名女性退伍军人组成，他们有一次或多次临床证实的 TBI 事件（69% 白人；74% 有爆炸暴露）。感知限制最大的 M2PI 项目是社交接触、休闲和启蒙。在 M2PI 标准化 T 分数上，男性和女性之间没有显着差异。Wilcoxon 秩和分析显示在休闲、居住、就业和财务管理四个项目上按性别存在显着差异（均 P < 0.01）。在控制人口统计、伤害特征和合并症的每个项目的多项逻辑回归中，女性退伍军人在就业项目上的兼职工作和失业的相对风险显着更高，而在居住和财务管理项目上的受损风险则显着降低。结论 男性和女性退伍军人在 M2PI 标准化 T 分数上没有显着差异，这掩盖了对个别项目的反应模式的差异。应鼓励临床团队与患者讨论感知限制，并在治疗计划中针对这些领域。未来的工作需要通过生物性别来研究 M2PI 的心理测量特性。