Abstract
Objective To examine person, injury, and treatment characteristics associated with recovery trajectories of people with severe traumatic brain injury (TBI) during inpatient rehabilitation.
Design Observational prospective longitudinal study.
Setting TBI rehabilitation units.
Participantsg Adults (N=206) with severe nonpenetrating TBI admitted directly to inpatient rehabilitation from acute care.
Participantsg were excluded for prior disability and intentional etiology of injury.
Interventions Naturally occurring treatments delivered within comprehensive multidisciplinary teams were recorded daily in 15-minute units provided to patients and family members, separately.
Main Outcome Measures Motor and cognitive FIM were measured on admission, discharge, and every 2 weeks in between and were analyzed with individual growth curve methodology.
Results Inpatient recovery was best modeled with linear, cubic, and quadratic components: relatively steep recovery was followed by deceleration of improvement, which attenuated prior to discharge. Slower recovery was associated with older age, longer coma, and interruptions to rehabilitation. Patients admitted at lower functional levels received more treatment, and more treatment was associated with slower recovery, presumably because treatment was allocated according to need. Therefore, effects of treatment on outcome could not be disentangled from effects of case mix factors.
Conclusions FIM gain during inpatient recovery from severe TBI is not a linear process. In observational studies, the specific effects of treatment on rehabilitation outcomes are difficult to separate from case mix factors that are associated with both outcome and allocation of treatment.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 2103-2110 |
| Number of pages | 8 |
| Journal | Archives of physical medicine and rehabilitation |
| Volume | 95 |
| Issue number | 11 |
| DOIs | |
| State | Published - Nov 1 2014 |
Funding
To ensure similar data collection in the 2 sites, we developed a detailed syllabus and conducted frequent phone, Internet, and face-to-face communications. Demographic and injury data were extracted from medical records by trained research personnel. Information on education and premorbid function were obtained by interviewing patients or relatives if patients were unable to communicate. Patient/family treatment data were collected using forms developed for the study and completed by all treating therapists in real time. FIM data were compiled by members of the treatment team completing items relevant to each discipline. Participants provided informed consent directly or by proxy of a legally authorized representative. When legally authorized representatives provided consent, patients were reconsented if they became able to authorize their own participation. The study was approved and overseen by the institutional review board at the United States site and the ethical committee at the Denmark site and the Danish Data Protection Agency (J. No. 2010-41 4791).
Keywords
- Brain injuries
- Rehabilitation
ASJC Scopus subject areas
- Physical Therapy, Sports Therapy and Rehabilitation
- Rehabilitation