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.
Participants
Adults (N=206) with severe nonpenetrating TBI admitted directly to inpatient rehabilitation
from acute care. Participants 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.
Keywords
List of abbreviations:
GCS (Glasgow Coma Scale), IGC (individual growth curve), LOS (length of stay), SCI (spinal cord injury), TBI (traumatic brain injury), TFC (time to follow commands)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: July 07, 2014
Footnotes
Supported by the Department of Education, National Institute on Disability and Rehabilitation Research (grant no. H133A070040); Danish Nursing Organization; and Novo Nordisk Foundation for Nursing Research.
Content of this article does not necessarily represent the policy of the Department of Education, and you should not assume endorsement by the Federal Government.
Disclosures: none.
Identification
Copyright
© 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
