Archives of Physical Medicine and Rehabilitation
Volume 89, Issue 12, Supplement , Pages S69-S76, December 2008

Long-Term Cognitive Outcome in Moderate to Severe Traumatic Brain Injury: A Meta-Analysis Examining Timed and Untimed Tests at 1 and 4.5 or More Years After Injury

  • Lesley Ruttan, PhD, CPsych

      Affiliations

    • Toronto Rehabilitation Institute, Toronto, ON, Canada
    • Corresponding Author InformationReprint requests to Lesley Ruttan, PhD, Toronto Rehabilitation Institute, 345 Rumsey Rd, Toronto, ON, M4G 1R7, Canada
  • ,
  • Krystle Martin, MA

      Affiliations

    • Ontario Institute for Studies in Education, University of Toronto, Toronto, ON, Canada
  • ,
  • Anita Liu, HBSc

      Affiliations

    • Toronto Rehabilitation Institute, Toronto, ON, Canada
  • ,
  • Brenda Colella, MA

      Affiliations

    • Toronto Rehabilitation Institute, Toronto, ON, Canada
  • ,
  • Robin E. Green, PhD, CPsych

      Affiliations

    • Toronto Rehabilitation Institute, Toronto, ON, Canada
    • Graduate Department of Rehabilitation Sciences, University of Toronto, Toronto, ON, Canada

Abstract 

Ruttan L, Martin K, Liu A, Colella B, Green RE. Long-term cognitive outcome in moderate to severe traumatic brain injury: a meta-analysis examining timed and untimed tests at 1 and 4.5 or more years after injury.

Objectives

To examine long-term outcome of moderate to severe traumatic brain injury (TBI) on timed and untimed cognitive tests using meta-analysis.

Design

Meta-analysis examining outcome at 2 epochs, 6 to 18 months postinjury (epoch 1) and 4.5 to 11 years postinjury (epoch 2).

Setting

Data source was published articles (1966–2007) identified through electronic and manual search.

Participants

A total of 1380 subjects with moderate to severe TBI participated in the 16 studies meeting inclusion criteria.

Interventions

Not applicable.

Main Outcome Measures

Timed and untimed neuropsychologic tests with quantitative results (means, SDs, t, and df tests) from studies containing a healthy comparison group and a mean time since injury falling within 1 of the 2 epochs.

Results

Patient versus control weighted effect sizes were medium to large at epoch 1 for both untimed tasks (r=−.46; confidence interval [CI], −.32 to −.65) and timed tasks (r=−.46; CI, −.35 to −.59). At epoch 2, effect sizes were slightly smaller for untimed tasks (r=−.38; CI, −.25 to −.60) and timed tasks (r=−.40; CI, −.32 to −.62).

Conclusions

Patients showed robust, persisting impairments on both timed and untimed tests at recovery plateau (ie, 6–18mo postinjury) and many years later. These findings converge with previous studies, though using an alternative approach that obviates some of the methodologic problems of longitudinal studies, such as selective attrition.

Key Words: Brain injuries, Neuropsychology, Rehabilitation

List of Abbreviations: CI, confidence interval, ES, effect size, GCS, Glasgow Coma Scale, LOC, loss of consciousness, PASAT, Paced Auditory Serial Addition Test, PTA, posttraumatic amnesia, TBI, traumatic brain injury, TSI, time since injury

 

 No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

PII: S0003-9993(08)01476-7

doi:10.1016/j.apmr.2008.07.007

Archives of Physical Medicine and Rehabilitation
Volume 89, Issue 12, Supplement , Pages S69-S76, December 2008