Abstract
Objective
To determine the effects of inpatient and outpatient treatment intensity on functional
and emotional well-being outcomes at 1 year after severe traumatic brain injury (TBI).
Design
Prospective, quasiexperimental study comparing outcomes in a U.S. TBI treatment center
with those in a Denmark (DK) center providing significantly greater intensity and
duration of rehabilitation.
Setting
Inpatient and outpatient TBI rehabilitation.
Participants
Persons with severe TBI (N=274).
Interventions
Inpatient rehabilitation interventions were counted daily by discipline. Outpatient
treatments were estimated per discipline using a structured interview administered
to patients, caregivers, or both, at 12 months.
Main Outcome Measures
FIM, Glasgow Outcome Scale–Extended, Disability Rating Scale, Participation Assessment
with Recombined Tools–Objective, Perceived Quality of Life, Medical Outcomes Study
12-Item Short-Form Health Survey, Brief Symptom Inventory–18-item version.
Results
Despite identical inclusion criteria, patient severity on admission was greater at
the DK site. After adjustment for patient/injury characteristics, there were no site
differences in either functional or emotional outcome at 12 months. Significantly
more inpatient plus outpatient treatment was administered to DK patients than to those
in the U.S. For functional but not emotional treatments, more severely impaired patients
received higher doses. One-year outcomes were predicted by admission severity, age,
employment, and other baseline characteristics.
Conclusions
Contrary to expectation, DK patients who received significantly more rehabilitation
services during the year after severe TBI did not differ in outcome from their less
intensively treated U.S. counterparts, after adjusting for initial severity. The negative
association of functional treatment dose with extent of early disability suggests
that dose was driven by unmeasured factors reflecting need for services. Improved
measures of injury-related factors driving treatment allocation are needed to model
the independent effects of treatment on outcomes.
Keywords
List of abbreviations:
BSI-18 (Brief Symptom Inventory–18-item version), DK (Denmark), DRS (Disability Rating Scale), GOS-E (Glasgow Outcome Scale–Extended), PART-O (Participation Assessment with Recombined Tools–Objective), PQOL (Perceived Quality of Life Scale), SF-12 (Medical Outcomes Study 12-Item Short-Form Health Survey), 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: August 03, 2016
Footnotes
Supported by the Department of Education, National Institute on Disability and Rehabilitation Research (grant nos. H133A070040, H133A120037). However, these contents do not necessarily represent the policy of the Department of Education, and you should not assume endorsement by the Federal Government. Also supported by the Danish Nurses Association and the Novo Nordisk Foundation. The funders had no role in the design and conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript, and decision to submit the manuscript for publication.
Disclosures: none.
Identification
Copyright
© 2016 by the American Congress of Rehabilitation Medicine
