Research Reports - Functional recovery after severe traumatic brain injury: an individual growth curve approach
Arch Phys Med Rehabil. 2014 Nov;95(11):2103-10
Hart T(1), Kozlowski AJ(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: TBI rehabilitation units.
PARTICIPANTS: Adults (N=206) with severe nonpenetrating TBI admitted directly to
inpatient rehabilitation from acute care. Participants were excluded for prior
disability and intentional etiology of injury.
INTERVENTIONS: Naturally occurring treatments delivered within comprehensive
multidisciplinary teams were recorded daily in 15-minute units provided to
patients and family members, separately.
MAIN OUTCOME MEASURES: Motor and cognitive FIM were measured on admission,
discharge, and every 2 weeks in between and were analyzed with individual growth
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. Therefore, 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 with both outcome and allocation of treatment.