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Outcomes 1 and 2 Years After Moderate to Severe Traumatic Brain Injury: An International Comparative Study

  • Author Footnotes
    ∗ Ponsford and Harrison-Felix contributed equally to this work.
    Jennie Ponsford
    Correspondence
    Corresponding author Jennie Ponsford, PhD, School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton, Victoria, 3800, Australia.
    Footnotes
    ∗ Ponsford and Harrison-Felix contributed equally to this work.
    Affiliations
    Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia

    Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia
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  • Author Footnotes
    ∗ Ponsford and Harrison-Felix contributed equally to this work.
    Cynthia Harrison-Felix
    Footnotes
    ∗ Ponsford and Harrison-Felix contributed equally to this work.
    Affiliations
    Research Department, Craig Hospital, Englewood, Colorado
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  • Jessica M. Ketchum
    Affiliations
    Research Department, Craig Hospital, Englewood, Colorado
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  • Gershon Spitz
    Affiliations
    Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia

    Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia
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  • A. Cate Miller
    Affiliations
    National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), Administration for Community Living (ACL), Department of Health and Human Services (HHS), Washington, DC
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  • John D. Corrigan
    Affiliations
    Department of Physical Medicine & Rehabilitation, The Ohio State University, Columbus, Ohio
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  • Author Footnotes
    ∗ Ponsford and Harrison-Felix contributed equally to this work.
Published:October 21, 2020DOI:https://doi.org/10.1016/j.apmr.2020.09.387

      Abstract

      Objective

      This study compared traumatic brain injury (TBI) outcomes from 2 cohorts: the National Institute on Disability, Independent Living, and Rehabilitation Research Traumatic Brain Injury Model Systems (TBIMS) in the United States and Longitudinal Head Injury Outcome Study conducted in Victoria, Australia, by the Monash Epworth Rehabilitation Research Centre (MERRC).

      Design

      Cohort study with 1- and 2-year follow-up.

      Setting

      Acute trauma care and inpatient rehabilitation with follow-up.

      Participants

      Patients (N=1056) with moderate-severe TBI admitted in 2000-2012 to inpatient rehabilitation after motor vehicle–related collisions, who completed follow-up, were matched using 1:2 matching algorithm based on age at injury, days of posttraumatic amnesia, and years education, resulting in groups of 352 (MERRC) and 704 patients (TBIMS).

      Intervention

      The cohorts had received acute trauma care and inpatient rehabilitation for a median 38 (MERRC) or 33 days (TBIMS). The MERRC group also had routine access to community-based support and rehabilitation for return to work or school, attendant care, and home help as justified, funded by an accident compensation system, whereas the TBIMS cohort had variable access to these services.

      Main Outcome Measures

      Outcomes were assessed 1 and 2 years post injury in terms of employment, living situation, marital status, and Glasgow Outcome Scale-Extended (GOS-E) scores.

      Results

      At 2 years post injury, MERRC participants were more likely to be competitively employed. At both 1 and 2 years post injury, MERRC participants were more likely to be married and living independently. On GOS-E, the TBIMS group had higher percentages of patients in Lower Severe Disability/Vegetative State and Upper Good Recovery than MERRC participants, whereas the MERRC cohort had higher percentages of Lower Moderate Disability than TBIMS.

      Conclusions

      Findings may suggest that routine provision of community-based supports could confer benefits for long-term TBI outcomes. Further studies documenting rehabilitation services are needed to explore this.

      Keywords

      List of abbreviations:

      GCS (Glasgow Coma Scale), GOS-E (Glasgow Outcome Scale-Extended), MERRC (Monash Epworth Rehabilitation Research Centre), OR (odds ratio), PTA (posttraumatic amnesia), TAC (Transport Accident Commission), TBI (traumatic brain injury), TBIMS (Traumatic Brain Injury Model Systems)
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