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Contextualized Treatment in Traumatic Brain Injury Inpatient Rehabilitation: Effects on Outcomes During the First Year After Discharge

Published:February 01, 2019DOI:https://doi.org/10.1016/j.apmr.2018.12.037

      Abstract

      Objective

      To evaluate the effect of providing a greater percentage of therapy as contextualized treatment on acute traumatic brain injury (TBI) rehabilitation outcomes.

      Design

      Propensity score methods are applied to the TBI Practice-Based Evidence (TBI-PBE) database, a database consisting of multi-site, prospective, longitudinal observational data.

      Setting

      Acute inpatient rehabilitation.

      Participants

      Patients enrolled in the TBI-PBE study (N=1843), aged 14 years or older, who sustained a severe, moderate, or complicated mild TBI, received their first inpatient rehabilitation facility admission in the US, and consented to follow-up 3 and 9 months post discharge from inpatient rehabilitation.

      Interventions

      Not applicable.

      Main Outcome Measures

      Participation Assessment with Recombined Tools-Objective (PART-O)-17, FIM Motor and Cognitive scores, Satisfaction with Life Scale, and Patient Health Questionnaire-9.

      Results

      Increasing the percentage of contextualized treatment during inpatient TBI rehabilitation leads to better outcomes, specifically in regard to community participation.

      Conclusions

      Increasing the proportion of treatment provided in the context of real-life activities appears to have a beneficial effect on outcome. Although the effect sizes are small, the results are consistent with other studies supporting functional-based interventions effecting better outcomes. Furthermore, any positive findings, regardless of size or strength, are endorsed as important by consumers (survivors of TBI). While the findings do not imply that decontextualized treatment should not be used, when the therapy goal can be addressed with either approach, the findings suggest that better outcomes may result if the contextualized approach is used.

      Keywords

      List of abbreviations:

      ASD (absolute standardized difference), CSI (Comprehensive Severity Index), CI (confidence interval), HTE (heterogeneity of treatment), IPW (inverse probability weighting), OT (occupational therapy), PART-O (Participation Assessment with Recombined Tools-Objective), PHQ-9 (Patient Health Questionnaire-9), POC (point of care), PSM (propensity score methodology), PT (physical therapy), RCT (randomized controlled trial), ST (speech therapy), TBI (traumatic brain injury), TBI-PBE (Traumatic Brain Injury Practice-Based Evidence)
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