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
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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
