Research Reports - Late functional changes post-severe traumatic brain injury are related to community reentry support

J Head Trauma Rehabil. 2017 Sep/Oct;32(5):E26-E34. doi:

Jourdan C(1), Bayen E, Vallat-Azouvi C, Ghout I, Darnoux E, Azerad S, Charanton
J, Aegerter P, Pradat-Diehl P, Ruet A, Azouvi P.

OBJECTIVES: To explore late functional changes after a traumatic brain injury and
their relation to patients' characteristics and reentry support.
DESIGN: Prospective follow-up of an inception cohort of adults with severe
traumatic brain injury recruited in 2005-2007 in the Parisian area, France. One
and 4-year assessments were performed by trained neuropsychologists.
One-to-4-year change in the Glasgow Outcome Scale-Extended defined 3 groups:
"improvement," "stability," and "worsening." Relationships between these groups
and patients' characteristics were analyzed.
RESULTS: Among 504 recruited patients and 245 four-year survivors, 93
participated in both evaluations. Overall Glasgow Outcome Scale-Extended improved
by 0.4. Forty percent of the sample improved, 44% were stable, and 16% worsened.
Being in a more unfavorable group was related to preinjury alcohol abuse and to
higher anxiety and depression at 4 years. Attendance to a specialized community
reentry unit was related to higher chances of being in the "improvement" group in
univariate analyses and after adjustment for age, time to follow command,
preinjury alcohol and occupation, and mood disorders (adjusted odds ratio [OR] =
4.6 [1.1-20]).
CONCLUSION: Late functional changes were related to psychosocial variables and to
reentry support. The effect of reentry support on late recovery needs to be
confirmed by further investigations. 

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