Research Reports - Risk factors for institutionalization after traumatic brain injury inpatient rehabilitation

J Head Trauma Rehabil. 2016 Jul 21. [Epub ahead of print]

Eum RS(1), Brown AW, Watanabe TK, Zasler ND, Goldstein R, Seel RT, Roth EJ,
Zafonte RD, Glenn MB.

OBJECTIVE: To create a profile of individuals with traumatic brain injury (TBI)
who received inpatient rehabilitation and were discharged to an institutional
setting using characteristics measured at rehabilitation discharge.
METHODS: The Traumatic Brain Injury Model Systems National Database is a
prospective, multicenter, longitudinal database for people with moderate to
severe TBI. We analyzed data for participants enrolled from January 2002 to June
2012 who had lived in a private residence before TBI. This cross-sectional study
used logistic regression analyses to identify sociodemographic factors, lengths
of stay, and cognitive and physical functioning levels that differentiated
patients discharged to institutional versus private settings.
RESULTS: Older age, living alone before TBI, and lower levels of function at
rehabilitation discharge (independence in locomotion, bladder management,
comprehension, and social interaction) were significantly associated with higher
institutionalization rates and provided the best models identifying factors
associated with institutionalization. Institutionalization was also associated
with decreased independence in bed-chair-wheelchair transfers and increased
duration of posttraumatic amnesia.
CONCLUSIONS: Individuals institutionalized after inpatient rehabilitation for TBI
were older, lived alone before injury, had longer posttraumatic amnesia
durations, and were less independent in specific functional characteristics.
Research evaluating the effect of increasing postdischarge support and improving
treatment effectiveness in these functional areas is recommended. 

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