Abstract
Objectives
To explore the patterns of cognitive and motor recovery at 4 time points from admission
to 9 months after discharge from inpatient rehabilitation (IR) and to investigate
the association of therapeutic factors and conditions before and after discharge with
long-term outcomes.
Design
Secondary analysis of traumatic brain injury (TBI) and practice-based evidence dataset.
Setting
IR in Ontario, Canada.
Participants
Patients with TBI consecutively admitted for IR between 2008 and 2011 who had data
available from admission to 9 months after discharge (N=85).
Interventions
Not applicable.
Main Outcome Measure
FIM-Rasch cognitive and motor scores at admission, discharge, 3 months after discharge,
and 9 months after discharge.
Results
Cognitive and motor recovery showed similar patterns of improvement with recovery
up to 3 months but no significant change from 3 to 9 months. Having fewer postdischarge
health conditions was associated with better long-term cognitive scores (95% confidence
interval, -13.06 to -1.2) and added 9.9% to the explanatory power of the model. More
therapy time in complex occupational therapy activities (95% confidence interval,
.02 to .09) and fewer postdischarge health conditions (95% confidence interval, -19.5
to -3.8) were significant predictors of better long-term motor function and added
14.3% and 7.2% to the explanatory power of the model, respectively.
Conclusion
Results of this study inform health care providers about the influence of the timing
of IR on cognitive and motor recovery. In addition, it underlines the importance of
making patients and families aware of residual health conditions following discharge
from IR.
Keywords
List of abbreviations:
ANOVA (analysis of variance), CSI (comprehensive severity index), ED (emergency department), IR (inpatient rehabilitation), LOE (level of effort), LOS (length of stay), OT (occupational therapy), PBE (practice-based evidence), PT (physical therapy), TBI (traumatic brain injury)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: integrated approaches to improve prevention, clinical care, and research.Lancet Neurol. 2017; 16: 987-1048
- Incidence of long-term disability following traumatic brain injury hospitalization, United States, 2003.J Head Trauma Rehabil. 2008; 23: 123-131
- Long-term outcome after severe traumatic brain injury: the McGill Interdisciplinary Prospective Study.J Head Trauma Rehabil. 2008; 23: 294-303
- The costs of traumatic brain injury: a literature review.Clinicoecon Outcomes Res. 2013; 5: 281-287
- Direct cost associated with acquired brain injury in Ontario.BMC Neurol. 2012; 12: 76
- Impact of rehabilitation on functional outcome during the first year of moderate and severe traumatic brain injury.Brain Inj. 2014; 28: 292-297
- Does an early onset and continuous chain of rehabilitation improve the long-term functional outcome of patients with severe traumatic brain injury?.J Neurotrauma. 2012; 29: 66-74
- Changes in neuropsychological performance after traumatic brain injury from inpatient rehabilitation to 1-year follow-up in predicting 2-year functional outcomes.Clin Neuropsychol. 2011; 25: 72-89
- Recovery of cognitive function after traumatic brain injury: a multilevel modeling analysis of Canadian outcomes.Arch Phys Med Rehabil. 2008; 89: S3-S15
- Inpatient rehabilitation for traumatic brain injury: The influence of age on treatments and outcomes.NeuroRehabilitation. 2013; 32: 233-252
- Traumatic brain injury patient, injury, therapy, and ancillary treatments associated with outcomes at discharge and 9 months postdischarge.Arch Phys Med Rehabil. 2015; 96: S304-S329
- Trajectories of functional change after inpatient rehabilitation for traumatic brain injury.Arch Phys Med Rehabil. 2017; 98: 1606-1613
- Cognitive and functional outcomes following inpatient rehabilitation in patients with acquired brain injury: a prospective follow-up study.J Neurosci Rural Pract. 2017; 8: 357-366
- Long-term maintenance of gains obtained in postacute rehabilitation by persons with traumatic brain injury.J Head Trauma Rehabil. 2001; 16: 356-373
- Neuropsychological recovery trajectories in moderate to severe traumatic brain injury: influence of patient characteristics and diffuse axonal injury.J Int Neuropsychol Soc. 2018; 24: 237-246
- Long-term motor recovery after severe traumatic brain injury: beyond established limits.J Head Trauma Rehabil. 2016; 31: E50-E58
- Outcome 3 to 5 years after moderate to severe traumatic brain injury.Arch Phys Med Rehabil. 2003; 84: 1449-1457
- Assessing traumatic brain injury outcome measures for long-term follow-up of community-based individuals.Arch Phys Med Rehabil. 2001; 82: 367-374
- Long-term recovery course after traumatic brain injury: a comparison of the functional independence measure and disability rating scale.J Head Trauma Rehabil. 2001; 16: 318-329
- Five years after traumatic brain injury: a study of individual outcomes and predictors of change in function.NeuroRehabilitation. 2004; 19: 25-35
- 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
- Factors associated with long-term functional and psychological outcomes in persons with moderate to severe traumatic brain injury.J Rehabil Med. 2016; 48: 442-448
- Long-term functional outcome of older adults after a traumatic brain injury.J Head Trauma Rehabil. 2012; 27: 379-390
- Long-term neuropsychological outcome after traumatic brain injury.J Head Trauma Rehabil. 2001; 16: 343-355
- Long-term neuropsychological outcome and loss of social autonomy after traumatic brain injury.Arch Phys Med Rehabil. 1997; 78: 1316-1320
- Longitudinal outcome of patients with disordered consciousness in the NIDRR TBI model systems programs.J Neurotrauma. 2012; 29: 59-65
- Association between cognitive performance and functional outcome following traumatic brain injury: a longitudinal multilevel examination.Neuropsychology. 2012; 26: 604-612
- Review of motor recovery in patients with traumatic brain injury.NeuroRehabilitation. 2009; 24: 349-353
- Functional level during the first 2 years after moderate and severe traumatic brain injury.Brain Inj. 2015; 29: 1431-1438
- Postrecovery cognitive decline in adults with traumatic brain injury.Arch Phys Med Rehabil. 2008; 89: S25-S34
- Longitudinal cognitive changes in traumatic brain injury: a 30-year follow-up study.Neurology. 2006; 66: 187-192
- Methodological issues in longitudinal research on cognitive recovery after traumatic brain injury: evidence from a systematic review.Brain Impair. 2013; 14: 450-474
- Long-term cognitive outcome in moderate to severe traumatic brain injury: a meta-analysis examining timed and untimed tests at 1 and 4.5 or more years after injury.Arch Phys Med Rehabil. 2008; 89: S69-S76
- Verbal learning deficits following severe head injury.J Neurosurg. 1991; 75: 50-58
- Cognitive recovery and predictors of functional outcome 1 year after traumatic brain injury.J Int Neuropsychol Soc. 2009; 15: 740-750
- Does intensive rehabilitation improve the functional outcome of patients with traumatic brain injury (TBI)? A randomized controlled trial.Brain Inj. 2007; 21: 681-690
- Interventions to increase engagement with rehabilitation in adults with acquired brain injury: a systematic review.Neuropsychol Rehabil. 2017; 27: 959-982
- Patient engagement and satisfaction with goal planning: impact on outcome from rehabilitation.Int J Ther Rehabil. 2015; 22: 210-216
- Comparisons of health care systems in the United States, Germany and Canada.Mater Sociomed. 2012; 24: 112-120
- The U.S. health care system: an international perspective.(Available at:) (Accessed May 18, 2018)
- Effects of timing and intensity of neurorehabilitation on functional outcome after traumatic brain injury: a systematic review and meta-analysis.Arch Phys Med Rehabil. 2018; 99: 1149-1159
- Canada’s universal health-care system: achieving its potential.Lancet. 2018; 391: 1718-1735
- Occupational therapy practice framework: domain & process.Am J Occup Ther. 2014; 68: S1-S48
- Profile of occupational therapy practice in Canada (2012).(Available at:) (Accessed September 20, 2018)
- Exploration of individual and family factors related to community reintegration in veterans with traumatic brain injury.J Am Psychiatr Nurses Assoc. 2015; 21: 195-211
- Prevalence of depression after TBI in a prospective cohort: the SHEFBIT study.Brain Inj. 2018; 32: 84-90
- Traumatic brain injury-practice based evidence study: design and patients, centers, treatments, and outcomes.Arch Phys Med Rehabil. 2015; 96: S178-S196
- 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
- Measuring medical complexity during inpatient rehabilitation after traumatic brain injury.Arch Phys Med Rehabil. 2005; 86: 1108-1117
- Patient effort in traumatic brain injury inpatient rehabilitation: course and associations with age, brain injury severity, and time postinjury.Arch Phys Med Rehabil. 2015; 96: S235-S244
- It's more than a blackbox; it's a Russion doll:defining rehabilitation treatments.Am J Phys Med Rehabil. 2003; 82: 639-652
- The reliability of the Functional Independence Measure: a quantitative review.Arch Phys Med Rehabil. 1996; 77: 1226-1232
- Applying the Rasch model: fundamental measurement in the human sciences.2nd ed. Lawrence Erlbaum Associates, Mahwah, NJ2007
- Prediction of functional and employment outcome 1 year after traumatic brain injury: a structural equation modelling approach.J Neurol Neurosurg Psychiatry. 2011; 82: 936-941
- Age at injury is associated with the long-term cognitive outcome of traumatic brain injuries.Alzheimers Dement (Amst). 2017; 6: 196-200
- Higher anxiety symptoms predict progressive hippocampal atrophy in the chronic stages of moderate to severe traumatic brain injury.Neurorehabil Neural Repair. 2017; 31: 1063-1071
- Inpatient rehabilitation following stroke: amount of therapy received and associations with functional recovery.Disabil Rehabil. 2012; 34: 2132-2138
- Late functional changes post-severe traumatic brain injury are related to community reentry support: results from the PariS-TBI Cohort.J Head Trauma Rehabil. 2017; 32: E26-E34
- Sex-specific predictors of inpatient rehabilitation outcomes after traumatic brain injury.Arch Phys Med Rehabil. 2016; 97: 772-780
- Outcomes from inpatient rehabilitation following traumatic brain injury in Canada.(Available at:) (Accessed September 14, 2018)
- Canada Health Act - links to provincial and territorial health care web resources.(Available at:) (Accessed August 16, 2018)
- Canadian healthcare perspective in traumatic brain injury rehabilitation.J Head Trauma Rehabil. 2007; 22: 214-220
- A review of the Australian healthcare system: a policy perspective.SAGE Open Med. 2018; 6 (2050312118769211)
Article info
Publication history
Published online: December 31, 2018
Footnotes
Supported by the National Institutes of Health, National Center for Medical Rehabilitation Research (grant no. 1R01HD050439-01); the National Institute on Disability and Rehabilitation Research (grant no. H133A080023); and the Ontario Neurotrauma Foundation (grant no. 2007-ABI-ISIS-525).
Disclosures: Sareh Zarshenas was supported by a Toronto Rehabilitation Institute Scholarship for graduate students (2017-2018) and a University of Toronto Fellowship (2017-2018). Angela Colantonio was supported by a Canadian Institutes of Health Research Research Chair in Gender, Work and Health (#CGW-126580). Susan Jaglal is supported by the Toronto Rehabilitation Chair-University Health Network at the University of Toronto. The other authors have nothing to disclose.
Identification
Copyright
Crown Copyright © 2019 Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
