Research Reports - Trajectory of functional independent measurements during first 5-years following traumatic brain injury

Dr. Juan Lu, Dr. Cecilie Roe, Dr. Solrun Sigurdardottir, Dr. Nada Andelic, and Ms. Marit Vindal Forslund.

Journal of Neurotrauma. February 2018, ahead of print.

A better understanding of long-term functional recovery process for patients with traumatic brain injury (TBI) facilitates effective rehabilitations. The objective of this study was to classify and characterize patients with moderate-to-severe TBI based on their functional trajectories up to 5-years following injury. The study included 121 patients with moderate-to-severe TBIs (ICD-10: S06.0–S06.9), aged 16-55 years and admitted at Trauma Referral Hospital within 24-hours of injury between 2005 and 2007. Demographics and injury characteristics were documented at the admission, and functional status was recorded at 3 months, 1 and 5 years post injury using Functional Independence Measure motor (FIM-M) and cognitive (FIM-C) subscales. We used group-based trajectory models to classify patients’ functional trajectories over a 5-year period. For FIM-M, three trajectories were identified: 8.2% of patients showed stable low recovery (13.6±1.5, 17.9±8.8 and 21.0±17.9), 9.2% elevated good recovery (35.8±14.5, 75.5±12.4 and 85.5±8.1), and 82.6% stable good recovery (89.0±3.6, 90.3±1.9 and 90.8±1.0) at the three follow-up points, respectively. For FIM-C, four trajectories were revealed: 4.1% of patients showed stable low recovery (5.0±0, 5.0±0 and 5.0±0), 12.6% delayed moderate recovery (8.9±3.5, 20.6±4.6 and 28.3±3.8), 28.7% elevated good recovery (27.0±3.8, 30.4±7.3 and 31.1±2.3) and 54.6% stable good recovery (32.8±2.3, 34.6±1.0 and 34.7±1.0). The results suggest that three FIM-M and four FIM-C trajectories described various patterns of functional recovery 5-years following moderate-to-severe TBI, with stable good recovery being the most common trajectory. Identifying and characterizing the trajectory memberships should enable targeted rehabilitation programs, inform patient-centered care and improve long-term outcomes. 

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