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Economic Evaluation of Activities of Daily Living Retraining During Posttraumatic Amnesia for Inpatient Rehabilitation Following Severe Traumatic Brain Injury

  • Duncan Mortimer
    Correspondence
    Corresponding author Duncan Mortimer, PhD, Centre for Health Economics, Monash Business School, Monash University, Level 2, Building 75, Clayton Campus, Monash University, Clayton VIC 3800 Australia.
    Affiliations
    Centre for Health Economics, Monash Business School, Monash University, Melbourne, Australia
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  • Jessica Trevena-Peters
    Affiliations
    Monash Institute of Cognitive & Clinical Neurosciences and School of Psychological Sciences, Monash University, Clayton, VIC, Australia

    Monash Epworth Rehabilitation Research Centre, Richmond, VIC, Australia
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  • Adam McKay
    Affiliations
    Monash Institute of Cognitive & Clinical Neurosciences and School of Psychological Sciences, Monash University, Clayton, VIC, Australia

    Monash Epworth Rehabilitation Research Centre, Richmond, VIC, Australia

    Epworth HealthCare, Richmond, VIC, Australia
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  • Jennie Ponsford
    Affiliations
    Monash Institute of Cognitive & Clinical Neurosciences and School of Psychological Sciences, Monash University, Clayton, VIC, Australia

    Monash Epworth Rehabilitation Research Centre, Richmond, VIC, Australia
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Published:September 28, 2018DOI:https://doi.org/10.1016/j.apmr.2018.08.184

      Abstract

      Objective

      To evaluate the cost-effectiveness of structured activities of daily living (ADL) retraining during posttraumatic amnesia (PTA) plus treatment as usual (TAU) vs TAU alone for inpatient rehabilitation following severe traumatic brain injury (TBI).

      Design

      Trial-based economic evaluation from a health-system perspective.

      Setting

      Inpatient rehabilitation center.

      Participants

      Participants (N=104) admitted to rehabilitation and in PTA for >7 days following severe TBI.

      Interventions

      Structured ADL retraining during PTA plus TAU vs TAU alone. Structured ADL retraining was manualized to minimize the risk of agitation and maximize functional improvement, following principles of errorless and procedural learning and targeting individualized therapy goals. TAU included physiotherapy and/or speech therapy during PTA plus ADL retraining after PTA emergence.

      Main Outcome Measures

      FIM total scores at baseline, PTA emergence, hospital discharge, or final follow-up (2mo postdischarge) where FIM total scores were calculated as the sum of 5 FIM motor self-care items and a FIM meal-preparation item.

      Results

      Structured ADL retraining during PTA significantly increased functional independence at PTA emergence (mean difference: 4.90, SE: 1.4, 95% confidence interval [CI]: 1.5, 8.3) and hospital discharge (mean difference: 5.22, SE: 1.4, 95% CI: 1.8, 8.7). Even in our most pessimistic scenario, structured ADL retraining was cost-saving as compared to TAU (mean: -$7762; 95% CI: -$8105, -$7419). Together, these results imply that structured ADL retraining dominates (less costly but no less effective) TAU when effectiveness is evaluated at PTA emergence and hospital discharge.

      Conclusions

      Structured ADL retraining during PTA yields net cost-savings to the health system and offers a cost-effective means of increasing functional independence at PTA emergence and hospital discharge.

      Keywords

      List of abbreviations:

      ADL (activities of daily living), CI (confidence interval), CEAC (cost-effectiveness acceptability curve), LOS (length of stay), OT (occupational therapist), PTA (posttraumatic amnesia), TAU (treatment as usual), TBI (traumatic brain injury), WPTAS (Westmead Post Traumatic Amnesia Scale), WTP (willingness to pay)
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