Research Reports - Functional recovery after severe traumatic brain injury
Arch Phys Med Rehabil. 2014 Jul 7
Hart T(1), Kozlowski A(2), Whyte J(3), Poulsen I(4), Kristensen K(4), Nordenbo A(4), Heinemann AW(5)
OBJECTIVE: To examine person, injury, and treatment characteristics associated
with recovery trajectories of people with severe traumatic brain injury (TBI)
during inpatient rehabilitation.
DESIGN: Observational prospective longitudinal study.
SETTING: Two specialized inpatient TBI rehabilitation units, one in US and one in
PARTICIPANTS: 206 adults with severe non-penetrating TBI admitted directly to
inpatient rehabilitation from acute care; excluded for prior disability and
intentional etiology of injury.
INTERVENTIONS: Naturally occurring treatments delivered within comprehensive
multi-disciplinary teams were recorded daily in 15-minute units provided to
patients and family members, separately.
MAIN OUTCOME MEASURES: Motor and Cognitive FIM measured on admission, discharge,
and every 2 weeks in between, analyzed with Individual Growth Curve methodology.
RESULTS: Inpatient recovery was best modeled with linear, cubic, and quadratic
components: relatively steep recovery was followed by deceleration of
improvement, which attenuated prior to discharge. Slower recovery was associated
with older age, longer coma, and interruptions to rehabilitation. Patients
admitted at lower functional levels received more treatment and more treatment
was associated with slower recovery, presumably because treatment was allocated
according to need. Thus, effects of treatment on outcome could not be
disentangled from effects of case mix factors.
CONCLUSIONS: FIM gain during inpatient recovery from severe TBI is not a linear
process. In observational studies, the specific effects of treatment on
rehabilitation outcomes are difficult to separate from case mix factors that are
associated both with outcome and allocation of treatment.