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Family Involvement in Traumatic Brain Injury Inpatient Rehabilitation: A Propensity Score Analysis of Effects on Outcomes During the First Year After Discharge

      Abstract

      Objective

      To evaluate the effect of family attendance at inpatient rehabilitation therapy sessions on traumatic brain injury (TBI) patient outcomes at discharge and up to 9 months postdischarge.

      Design

      Propensity score methods are applied to the TBI Practice-Based Evidence database, a database consisting of multisite, prospective, longitudinal, and observational data.

      Setting

      Nine inpatient rehabilitation centers in the United States.

      Participants

      Patients (N=1835) admitted for first inpatient rehabilitation after an index TBI.

      Intervention

      Family attendance during therapy sessions.

      Main Outcome Measures

      Participation Assessment for Recombined Tools-Objective-17 (Total scores and subdomain scores of Productivity, Out and About, and Social Relations), Functional Independence Measure, Satisfaction with Life Scale, and Patient Health Questionnaire-9.

      Results

      Participants whose families were in attendance for at least 10% of the treatment time were more out and about in their communities at 3 and 9 months postdischarge than participants whose families attended treatment less than 10% of the time. Although findings varied by propensity score method, improved functional independence in the cognitive area at 9 months was also associated with increased family attendance.

      Conclusions

      Family involvement during inpatient rehabilitation may improve community participation and cognitive functioning up to 9 months after discharge. Rehabilitation teams should engage patients’ families in the rehabilitation process to maximize outcomes.

      Keywords

      List of abbreviations:

      95% CI (95% confidence interval), ASD (absolute standardized difference), CSI (Comprehensive Severity Index), FI (family involvement), PART-O (Participation Assessment with Recombined Tools-Objective), PHQ-9 (Patient Health Questionnaire-9), POC (point of care), TBI (traumatic brain injury), TBI-PBE (Traumatic Brain Injury Practice-Based Evidence study)
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