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)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: September 28, 2018
Footnotes
Supported by the Transport Accident Commission, through the Institute for Safety, Compensation and Recovery Research (grant no: N-13-089); a Epworth Research Institute Grant; and a William Buckland Foundation Grant. The supporting institutions did not participate in design or write-up of the study.
Clinical Trial Registration No.: ACTRN12616001468415.
Identification
Copyright
© 2018 by the American Congress of Rehabilitation Medicine
