Highlights
- •Rehabilitation (physical and cognitive) reduced the clinical worsening over time.
- •The difference between the groups that received treatment vs those that did not receive treatment was approximately 6.5 Disability Rating Scale points.
- •Cognitive rehabilitation was administered to patients who were less clinically impaired.
Abstract
Objective
To evaluate the effects of rehabilitation (physical and cognitive) treatments on the
diagnosis severity and Disability Rating Scale (DRS) scores, adjusted for a number
of potential confounders measured at baseline, in a large cohort of patients with
disorders of consciousness across time.
Design and Setting
An observational, longitudinal (2 evaluations), multicenter project was made in 90
Italian centers.
Participants
Patients (N=364) with a diagnosis of disorders of consciousness.
Main Outcome Measures
Primary outcome was the severity of diagnosis, expressed on an ordinal scale (Other<MCS<VS<death).
In the Other group were included patients who emerged from an MCS and recovered consciousness.
The secondary outcome was the DRS score (range of 0-30 with 30 being the worst value).
The DRS is a tool used to define the level of residual disability, commonly used to
classify the level of functional impairment in patients with acquired brain injury.
Both outcomes were measured for each wave.
Results
A total of 364 subjects having a complete set of demographic, clinical, and pharmacologic
data were included in the propensity score (PS) analysis. Results showed that the
rehabilitation treatments (physical and cognitive) reduced the clinical worsening
over time in both severity diagnosis and DRS (around 6.5 points) in patients with
disorders of consciousness across different propensity score strategies (ie, PS matching,
PS adjustment, and PS-weighted procedures). In addition, cognitive protocols seem
to be limited to patients with a median value of DRS=23.
Conclusions
Our propensity score analysis suggests that rehabilitation treatment protocols seem
effective and should be applied to a broader spectrum of patients with disorders of
consciousness.
Keywords
List of abbreviations:
CI (confidence interval), DOC (disorder of consciousness), DRS (Disability Rating Scale), IPTW (inverse probability of treatment weighting), IQR (interquartile range), MCS (minimally conscious state), OP (only physical), PPC (physical plus cognitive), PS (propensity score), VS (vegetative state)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
- Chronic disorders of consciousness.Lancet. 2006; 367: 1181-1192
- The vegetative and minimally conscious states.Handb Clin Neurol. 2008; 90: 99-111
- The minimally conscious state: definition and diagnostic criteria.Neurology. 2002; 58: 349-353
- The vegetative and minimally conscious states in children: spasticity, muscle contracture and issues for physiotherapy treatment.Brain Inj. 2002; 16: 217-230
- Intensive physiotherapy for vegetative and minimally conscious state patients: A retrospective audit and analysis of therapy intervention.Disabil Rehabil. 2013; 35: 1006-1014
- The influence of acoustic and tactile stimulation on vegetative parameters and EEG in persistent vegetative state.Funct Neurol. 2007; 22: 159-163
- Sensory stimulation for brain injured individuals in coma or vegetative state.Cochrane Database Syst Rev. 2002; CD001427
- Effectiveness of sensory stimulation to improve arousal and alertness of people in a coma or persistent vegetative state after traumatic brain injury: a systematic review.Am J Occup Ther. 2016; 70 (7003180030p1-8)
- Sertraline to improve arousal and alertness in severe traumatic brain injury secondary to motor vehicle crashes.Brain Inj. 2001; 15: 321-331
- Methylphenidate and amantadine to stimulate reawakening in comatose patients resuscitated from cardiac arrest.Resuscitation. 2013; 84: 818-824
- Placebo-controlled trial of amantadine for severe traumatic brain injury.N Engl J Med. 2012; 366: 819-826
- Update on pharmacotherapy for stroke and traumatic brain injury recovery during rehabilitation.Curr Opin Neurol. 2016; 29: 700-705
- Levodopa treatment for patients in persistent vegetative or minimally conscious states.Neuropsychol Rehabil. 2005; 15: 414-427
- Pharmacological modulation of the state of awareness in patients with disorders of consciousness: an overview.Curr Pharm Des. 2014; 20: 4121-4139
- An Italian population study on 600 persons in vegetative state and minimally conscious state.Brain Inj. 2013; 27: 473-484
- National Consortium Functioning and Disability in Vegetative and in Minimal Conscious State Patients. ICF-DOC: the ICF dedicated checklist for evaluating functioning and disability in people with disorders of consciousness.Int J Rehabil Res. 2014; 37: 197-204
- Disability rating scale for severe head trauma: coma to community.Arch Phys Med Rehabil. 1982; 63: 118-123
- ATC/DDD index 2019.(Available at:) (Accessed February 20, 2019)
- The central role of the propensity score in observational studies for causal effects.Rubin Biometrika. 1983; 70: 41-55
- An introduction to propensity score methods for reducing the effects of confounding in observational studies.Multivariate Behav Res. 2011; 46: 399-424
- Splines as a useful and convenient statistical tool.Am Stat. 1979; 33: 57-62
- Variable selection for propensity score models.Am J Epidemiol. 2006; 163: 1149-1156
- Propensity score estimation with boosted regression for evaluating causal effects in observational studies.Psychol Methods. 2004; 9: 403-425
- Propensity score analysis: statistical methods and applications.2nd ed. Sage Publications, Inc, Thousand Oaks2015
- A comparison of 12 algorithms for matching on the propensity score.Stat Med. 2014; 33: 1057-1069
- Multilevel modeling using R.CRC Press Taylor & Francis Group, Boca Raton2014
- Long-term survival in laparoscopic vs open resection for colorectal liver metastases: inverse probability of treatment weighting using propensity scores.HPB (Oxford). 2016; 18: 183-191
- MatchIt: nonparametric preprocessing for parametric causal inference.J Stat Softw. 2011; 42: 1-28
- Toolkit for Weighting and Analysis of Nonequivalent Groups. R package version 1.5, twang2017 (Available at: https://CRAN.R-project.org/package=twang. Accessed October 11, 2019.)
- Ipw: an R package for inverse probability weighting.J Stat Softw. 2011; 43: 1-23
- Package ‘ordinal.(Available at:) (Accessed March 28, 2019)
- Fitting linear mixed-effects models using lme4.J Stat Softw. 2015; 67: 1-48
- Package ‘boot.(Available at:) (Accessed March 28, 2019)
- Marginal structural models to estimate the causal effect of zidovudine on the survival of HIV-positive men.Epidemiology. 2000; 11: 561-570
- Constructing inverse probability weights for marginal structural models.Am J Epidemiol. 2008; 168: 656-664
- Triage of intensive care patients: identifying agreement and controversy.Intensive Care Med. 2013; 39: 1916-1924
- The Italian National Registry of severe acquired brain injury: epidemiological, clinical and functional data of 1469 patients.Eur J Phys Rehabil Med. 2013; 49: 611-618
- Evaluation of technology-assisted learning setups for undertaking assessment and providing intervention to persons with a diagnosis of vegetative state.Dev Neurorehabil. 2009; 12: 411-420
- Sensory stimulation of brain-injured individuals in coma or vegetative state: results of a Cochrane systematic review.Clin Rehabil. 2002; 16: 464-472
- Late recovery after traumatic, anoxic, or hemorrhagic long-lasting vegetative state.Neurology. 2010; 75: 239-245
- The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility.Arch Phys Med Rehabil. 2004; 85: 2020-2029
Article info
Publication history
Published online: August 26, 2019
Footnotes
Supported by the Italian Ministry of Health Center for Disease Control and Prevention in the framework of the Italian national project “Functioning and Disability in Patients in Vegetative State and Minimally Conscious State” (grant no. DGPREV/P/145021/F.3.a.d/282 – 2008) and “PRECIOUS—Taking Care of People With Acquired Severe Brain Injury” (grant no. DGPREV/I/F.3.a.d/2010/411 – 2010).
Disclosures: none.
Identification
Copyright
© 2019 by the American Congress of Rehabilitation Medicine
