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Trajectories of Functional Change After Inpatient Rehabilitation for Traumatic Brain Injury

Published:April 06, 2017DOI:https://doi.org/10.1016/j.apmr.2017.03.009

      Highlights

      • Substantial heterogeneity exists in recovery patterns after traumatic brain injury.
      • Lower gains in motor and cognitive FIM ratings were associated with black and Hispanic ethnicities.
      • Increased days from onset to inpatient rehabilitation admission were associated with reduced motor and cognitive FIM ratings.

      Abstract

      Objective

      To examine trajectories of functional recovery after rehabilitation for traumatic brain injury (TBI).

      Design

      Prospective study.

      Setting

      Inpatient rehabilitation hospitals in the Uniform Data System for Medical Rehabilitation.

      Participants

      A subset of individuals receiving inpatient rehabilitation services for TBI from 2002 to 2010 who also had postdischarge measurement of functional independence (N=16,583).

      Interventions

      Inpatient rehabilitation.

      Main Outcomes Measures

      Admission, discharge, and follow-up data were obtained from the Uniform Data System for Medical Rehabilitation. We used latent class mixture models to examine recovery trajectories for both cognitive and motor functioning as measured by the FIM instrument.

      Results

      Latent class models identified 3 trajectories (low, medium, high) for both cognitive and motor FIM subscales. Factors associated with membership in the low cognition trajectory group included younger age, male sex, racial/ethnic minority, Medicare or Medicaid (vs commercial or other insurance), comorbid conditions, and greater duration from injury date to rehabilitation admission date. Factors associated with membership in the low motor trajectory group included older age, racial/ethnic minority, Medicare or Medicaid coverage, comorbid conditions, open head injury, and greater duration to admission.

      Conclusions

      Standard approaches to assessing recovery patterns after TBI obscure differences between subgroups with trajectories that differ from the overall mean. Select demographic and clinical characteristics can help classify patients with TBI into distinct functional recovery trajectories, which can enhance both patient-centered care and quality improvement efforts.

      Keywords

      List of abbreviations:

      CI (confidence interval), CMS (Centers for Medicare & Medicaid Services), OR (odds ratio), TBI (traumatic brain injury), UDSMR (Uniform Data System for Medical Rehabilitation)
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