Research Reports - Trajectories of functional change after inpatient rehabilitation for traumatic brain injury

Arch Phys Med Rehabil. 2017 Aug;98(8):1606-1613. doi: 10.1016/j.apmr.2017.03.009.
Epub 2017 Apr 7.

Howrey BT(1), Graham JE(2), Pappadis MR(2), Granger CV(3), Ottenbacher KJ(2).

OBJECTIVE: To examine trajectories of functional recovery after rehabilitation
for traumatic brain injury (TBI).
DESIGN: Prospective study.
SETTING: Inpatient rehabilitation hospitals in the Uniform Data System for
Medical Rehabilitation.
PARTICIPANTS: A subset of individuals receiving inpatient rehabilitation services
for TBI from 2002 to 2010 who also had postdischarge measurement of functional
independence (N=16,583).
INTERVENTIONS: Inpatient rehabilitation.
MAIN OUTCOMES MEASURES: Admission, discharge, and follow-up data were obtained
from the Uniform Data System for Medical Rehabilitation. We used latent class
mixture models to examine recovery trajectories for both cognitive and motor
functioning as measured by the FIM instrument.
RESULTS: Latent class models identified 3 trajectories (low, medium, high) for
both cognitive and motor FIM subscales. Factors associated with membership in the
low cognition trajectory group included younger age, male sex, racial/ethnic
minority, Medicare or Medicaid (vs commercial or other insurance), comorbid
conditions, and greater duration from injury date to rehabilitation admission
date. Factors associated with membership in the low motor trajectory group
included older age, racial/ethnic minority, Medicare or Medicaid coverage,
comorbid conditions, open head injury, and greater duration to admission.
CONCLUSIONS: Standard approaches to assessing recovery patterns after TBI obscure
differences between subgroups with trajectories that differ from the overall
mean. Select demographic and clinical characteristics can help classify patients
with TBI into distinct functional recovery trajectories, which can enhance both
patient-centered care and quality improvement efforts. 

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