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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 01, 2019
Footnotes
Supported by Patient-Centered Outcomes Research Institute (award no. CER-1403-13476). The statements presented in this work are solely the responsibility of the author(s) and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute, its Board of Governors or Methodology Committee. Funding for the databases used in this study came from the National Institutes of Health, National Center for Medical Rehabilitation Research (grant no. 1R01HD050439-01), the National Institute on Disability, Independent Living and Rehabilitation Research (grant H133A080023), and the Ontario Neurotrauma Foundation (grant no. 2007-ABI-ISIS-525).
Disclosures: none.
Identification
Copyright
© 2019 by the American Congress of Rehabilitation Medicine
