Advertisement

Long-Term Functional Outcomes in Military Service Members and Veterans After Traumatic Brain Injury/Polytrauma Inpatient Rehabilitation

Published:August 30, 2017DOI:https://doi.org/10.1016/j.apmr.2017.08.465

      Abstract

      Objective

      To determine the effect of the established polytrauma/traumatic brain injury (TBI) infrastructure on immediate posttreatment functional gains, the long-term sustainability of any gains, and participation-related community reintegration outcomes in a baseline cohort of patients 8 years postadmission.

      Design

      Retrospective review and prospective repeated measures of an inception cohort.

      Setting

      Polytrauma rehabilitation center (PRC).

      Participants

      Patients consecutively admitted to the PRC inpatient rehabilitation unit during its first full fiscal year, 2006 (N=44).

      Interventions

      The PRC infrastructure and formalized rehabilitation for polytrauma/TBI.

      Main Outcome Measures

      FIM scores at admission, discharge, 3 months, and 8 years postdischarge; participation-related socioeconomic factors reflecting community reintegration 8 years after admission.

      Results

      Functional gains were statistically significantly increased from admission to discharge. Improvements were maintained at both 3 months postdischarge and 8 years postdischarge. The socioeconomic data collected at 8-year follow-up showed >50% either competitively employed or continuing their education and 100% living in a noninstitutionalized setting.

      Conclusions

      This study addresses a concern regarding the long-term functional outcomes of rehabilitation patients treated by the established infrastructure of the Polytrauma System of Care inpatient rehabilitation centers. The results suggest that polytrauma/TBI rehabilitation care using a comprehensive, integrated approach is effective and durable in achieving functional gains and successful community reintegration within our initial PRC cohort. Follow-up of subsequent fiscal year cohorts would add to the validity of these outcome findings.

      Keywords

      List of abbreviations:

      FY (fiscal year), PRC (polytrauma rehabilitation center), PSC (Polytrauma System of Care), TBI (traumatic brain injury), VA (Department of Veterans Affairs)
      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 access
      One-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 Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Defense and Veterans Brain Injury Center
        DoD worldwide numbers for TBI.
        2016 (Available at:) (Accessed December 2016)
        • Fischer H.
        United States military casualty statistics: Operation Iraqi Freedom and Operation Enduring Freedom.
        Congressional Research Service, Washington (DC)2009
        • Sayer N.A.
        • Chiros C.E.
        • Sigford B.
        • et al.
        Characteristics and rehabilitation outcomes among patients with blast and other injuries sustained during the global war on terror.
        Arch Phys Med Rehabil. 2008; 89: 163-170
        • Sayer N.A.
        • Cifu D.X.
        • McNamee S.
        • Chiros C.E.
        • Sigford B.J.
        • Scott S.
        Rehabilitation needs of combat-injured service members admitted to the VA polytrauma rehabilitation centers: the role of PM&R in the care of wounded warriors.
        PM R. 2009; 1: 23-28
        • Lew H.L.
        Rehabilitation needs of an increasing population of patients: traumatic brain injury, polytrauma, and blast-related injuries.
        J Rehabil Res Dev. 2005; 42: XIII-XVI
        • MacGregor A.
        • Dougherty A.
        • Tang J.
        • Galarneau M.
        Postconcussive symptom reporting among US combat veterans with mild traumatic brain injury from Operation Iraq Freedom.
        J Head Trauma Rehabil. 2013; 28: 59-67
        • U.S. Department of Veterans Affairs
        Polytrauma/TBI system of care - definitions.
        2015 (Available at:) (Accessed May 19, 2017)
        • Sigford B.J.
        To care for him who shall have borne the battle and for his widow and his orphan (Abraham Lincoln): The Department of Veterans Affairs Polytrauma System of Care.
        Arch Phys Med Rehabil. 2008; 89: 160-162
        • Benedict S.
        • Scholten J.
        The Veterans Health Administration's Polytrauma System of Care: rehabilitation for today's and tomorrow's veterans.
        Generations. 2010; 2: 106-108
        • Brasure M.
        • Lamberty G.J.
        • Sayer N.A.
        • et al.
        Participation after multidisciplinary rehabilitation for moderate to severe traumatic brain injury in adults: a systematic review.
        Arch Phys Med Rehabil. 2013; 94: 1398-1420
        • McGreary D.
        • Moore M.
        • Vriend C.A.
        • Peterson A.L.
        • Gatchel R.J.
        The evaluation and treatment of comorbid pain and PTSD in a military setting: an overview.
        J Clin Psychol Med Settings. 2011; 18: 155-163
        • Gatchel R.
        • McGerry D.
        • Peterson A.
        • et al.
        Preliminary findings of a randomized controlled trial of an interdisciplinary military pain program.
        Mil Med. 2009; 174: 270-277
        • Hoofien D.
        • Gilboa A.
        • Vakil E.
        • Donovick P.J.
        Traumatic brain injury (TBI) 10-20 years later: a comprehensive outcome study of psychiatric symptomatology, cognitive abilities and psychosocial functioning.
        Brain Inj. 2001; 15: 189-209
        • Engberg A.W.
        • Teasdale T.W.
        Psychosocial outcome following traumatic brain injury in adults: a long-term.
        Brain Inj. 2004; 18: 533-545
        • Jacobsson J.L.
        • Westerberg M.
        • Malec F.
        • Lexell J.
        Sense of coherence and disability and the relationship with life satisfaction 6-15 years after traumatic brain injury in northern Sweden.
        Neuropsychol Rehabil. 2011; 21: 383-400
        • Lew H.
        • Otis J.
        • Tun C.
        • Kerns R.
        • Clark M.
        • Cifu D.
        Prevalence of chronic pain, posttraumatic stress disorder and persistent postconcussive symptoms in OIF/OEF veterans: polytrauma clinical triad.
        J Rehabil Res Dev. 2009; 46: 697-702
        • Belanger H.G.
        • Kretzmer T.
        • Vanderploeg R.D.
        • French L.M.
        Symptom complaints following combat-related traumatic brain injury: relationship to traumatic brain injury severity and posttraumatic stress disorder.
        J Int Neuropsychol Soc. 2010; 16: 194-199
        • Brickell T.A.
        • Lange R.T.
        • French L.M.
        Health related quality of life within the first 5 years following military-related concurrent mild traumatic brain injury and polytrauma.
        Mil Med. 2014; 179: 827-838
        • Eastvold A.
        • Walker W.C.
        • Curtiss G.
        • Schwab K.
        • Vanderploeg R.
        The differential contributions of posttraumatic amnesia duration and time since injury in prediction of functional outcomes following moderate-to-severe traumatic brain injury.
        J Head Trauma Rehabil. 2013; 28: 48-58
        • MacDonald C.L.
        • Johnson A.M.
        • Nelson E.C.
        • et al.
        Functional status after blast-plus-impact complex concussive traumatic brain injury in evacuated United States military personnel.
        J Neurotrauma. 2014; 31: 889-898
        • Heinemann A.W.
        • Linacre J.M.
        • Wright B.D.
        • Hamilton B.
        • Granger C.
        Prediction of rehabilitation outcomes with disability measures.
        Arch Phys Med Rehabil. 1994; 75: 133-143
        • Donaghy S.
        • Wass P.J.
        Interrater reliability of the Functional Assessment Measure in a brain injury rehabilitation program.
        Arch Phys Med Rehabil. 1998; 79: 1231-1236
        • Hobart J.C.
        • Lamping D.L.
        • Freeman J.A.
        • et al.
        Evidence-based measurement: which disability scale for neurologic rehabilitation?.
        Neurology. 2001; 57: 639-644