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)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Traumatic brain injury in the United States: emergency department visits, hospitalizations and deaths 2002-2006.Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Atlanta2010: 2-70
- Traumatic brain injury in the United States: emergency department visits, hospitalizations, and deaths.Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Atlanta2006
- Variations in inpatient rehabilitation functional outcomes across centers in the traumatic brain injury model systems study and the influence of demographics and injury severity on patient outcomes.Arch Phys Med Rehabil. 2016; 97: 1821-1831
- Functional recovery after severe traumatic brain injury: an individual growth curve approach.Arch Phys Med Rehabil. 2014; 95: 2103-2110
- Functional outcome after rehabilitation for severe traumatic brain injury.Arch Phys Med Rehabil. 1995; 76: 1103-1112
- Long-term outcomes after moderate to severe traumatic brain injury.Disabil Rehabil. 2004; 26: 253-261
- Long-term outcome after severe traumatic brain injury: the McGill interdisciplinary prospective study.J Head Trauma Rehabil. 2008; 23: 294-303
- The CDC traumatic brain injury surveillance system: characteristics of persons aged 65 years and older hospitalized with a TBI.J Head Trauma Rehabil. 2005; 20: 215-228
- Psychosocial consequences of mild traumatic brain injury in children: results of a systematic review by the International Collaboration on Mild Traumatic Brain Injury Prognosis.Arch Phys Med Rehabil. 2014; 95: S192-S200
- Outcome and predictors of functional recovery 5 years following pediatric traumatic brain injury (TBI).J Pediatr Psychol. 2008; 33: 707-718
- Thirty month outcome from early childhood head injury: a prospective analysis of neurobehavioural recovery.Brain. 2004; 127: 2608-2620
- Functional outcomes of older adults with traumatic brain injury: a prospective, multicenter analysis.Arch Phys Med Rehabil. 1996; 77: 883-888
- Traumatic brain injury: predicting course of recovery and outcome for patients admitted to rehabilitation.Arch Neurol. 1994; 51: 661-670
- Traumatic brain injury in the elderly: increased mortality and worse functional outcome at discharge despite lower injury severity.J Trauma. 2002; 53 (discussion 223-224): 219-223
- Patient age and outcome following severe traumatic brain injury: an analysis of 5600 patients.J Neurosurg. 2003; 99: 666-673
- Walking speed threshold for classifying walking independence in hospitalized older adults.Phys Ther. 2010; 90: 1591-1597
- Ethnic disparities in long-term functional outcomes after traumatic brain injury.J Trauma Acute Care Surg. 2007; 63: 1364-1369
- Ethnic disparities exist in trauma care.J Trauma. 2007; 63: 1138-1142
- Racial and ethnic disparities in discharge to rehabilitation following traumatic brain injury.J Neurosurg. 2015; 122: 595-601
- Racial disparities in outcomes of persons with moderate to severe traumatic brain injury.Med Care. 2007; 45: 686-690
- Institutional variation in traumatic brain injury acute rehabilitation practice.Arch Phys Med Rehabil. 2015; 96: S197-S208
- Finite mixture modeling with mixture outcomes using the EM algorithm.Biometrics. 1999; 55: 463-469
- Analyzing developmental trajectories: a semiparametric, group-based approach.Psychol Methods. 1999; 4: 139
- Intermodal agreement of follow-up telephone functional assessment using the Functional Independence Measure in patients with stroke.Arch Phys Med Rehabil. 1996; 77: 431-435
- The Uniform Data System for Medical Rehabilitation: report of follow-up information on patients discharged from inpatient rehabilitation programs in 2002-2010.Am J Phys Med Rehabil. 2014; 93: 231-244
- Validity of the Functional Independence Measure for persons with traumatic brain injury.Arch Phys Med Rehabil. 1997; 78: 828-834
- The reliability of the Functional Independence Measure: a quantitative review.Arch Phys Med Rehabil. 1996; 77: 1226-1232
Centers for Medicare & Medicaid Services. Appendix C—List of comorbidities. Available at: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/InpatientRehabFacPPS/Data-Files.html. Accessed December 1, 2016.
- A SAS procedure based on mixture models for estimating developmental trajectories.Sociol Methods Res. 2001; 29: 374-393
- A Note on a Stata plugin for estimating group-based trajectory models.Sociol Methods Res. 2013; 42: 608-613
- Bayesian model selection and model averaging.J Math Psychol. 2000; 44: 92-107
- Aging effect on psychosocial outcome in traumatic brain injury.Arch Phys Med Rehabil. 1998; 79: 881-887
- Prognostic value of demographic characteristics in traumatic brain injury: results from the IMPACT study.J Neurotrauma. 2007; 24: 259-269
- Epidemiology of adults receiving acute inpatient rehabilitation for a primary diagnosis of traumatic brain injury in the United States.J Head Trauma Rehabil. 2015; 30: 122-135
- Geographic variation in health care spending in the United States: insights from an Institute of Medicine report.JAMA. 2013; 310: 1227-1228
- Disparities in postacute rehabilitation care for stroke: an analysis of the state inpatient databases.Arch Phys MedRehabil. 2011; 92: 1220-1229
- How much is postacute care use affected by its availability?.Health Serv Res. 2005; 40: 413-434
- Traumatic brain injury and functional outcomes: does minority status matter?.Brain Inj. 2007; 21: 701-708
- Perceptions of communication abilities for persons with traumatic brain injury: validity of the La Trobe Communication Questionnaire.Brain Inj. 2008; 22: 940-951
- Racial differences in caregiving patterns, caregiver emotional function, and sources of emotional support following traumatic brain injury.J Head Trauma Rehabil. 2007; 22: 122-131
- The effect of insurance status, race, and gender on ED disposition of persons with traumatic brain injury.Am J Emerg Med. 2004; 22: 465-473
- Ethnic differences in discharge destination among older patients with traumatic brain injury.Arch Phys Med Rehabil. 2008; 89: 231-236
- Ethnographic analysis of traumatic brain injury patients in the national Model Systems database.Arch Phys Med Rehabil. 2003; 84: 263-267
- Impact of minority status on functional outcome and community integration following traumatic brain injury.J Head Trauma Rehabil. 1996; 11: 40-57
- Influence of major depression on 1-year outcome in patients with traumatic brain injury.J Neurosurg. 1994; 81: 726-733
- Comparison of FIM™ communication ratings for English versus non-English speakers in the traumatic brain injury model systems (TBIMS) national database.Brain Inj. 2015; 29: 1445-1451
- Measurement characteristics of the Functional Independence Measure.Top Stroke Rehabil. 1994; 1: 1-15
- Impact of transfer delays to rehabilitation in patients with severe trauma.Arch Phys Med Rehabil. 2004; 85: 184-191
- Assessment of coma and impaired consciousness: a practical scale.Lancet. 1974; 304: 81-84
Article Info
Publication History
Published online: April 06, 2017
Footnotes
Supported in part by the National Institutes of Health (grant nos. R01 HD069443 and R24 HD065702).
Disclosures: none.
Identification
Copyright
© 2017 Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
