Traumatic Brain Injury Patient, Injury, Therapy, and Ancillary Treatments Associated With Outcomes at Discharge and 9 Months Postdischarge

• Published in: Archives of physical medicine and rehabilitation Vol. 96; no. 8; pp. S304 - S329
• Main Authors: Horn, Susan D., PhD, Corrigan, John D., PhD, Beaulieu, Cynthia L., PhD, Bogner, Jennifer, PhD, Barrett, Ryan S., MS, Giuffrida, Clare G., PhD, OTR/L, FAOTA, Ryser, David K., MD, Cooper, Kelli, PT, DPT, NCS, Carroll, Deborah M., MS, CCC-ST, Deutscher, Daniel, PT, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2015
• Subjects: Adult; Brain injuries; Brain Injuries - rehabilitation; Canada; Craniocerebral trauma; Evidence-Based Practice - statistics & numerical data; Female; Follow-Up Studies; Humans; Length of Stay - statistics & numerical data; Longitudinal Studies; Male; Outcome assessment (health care); Outcome Assessment, Health Care - statistics & numerical data; Patient Discharge - statistics & numerical data; Physical Medicine and Rehabilitation; Physical Therapy Modalities - statistics & numerical data; Prospective Studies; Recovery of Function; Rehabilitation; Rehabilitation Centers - statistics & numerical data; Speech Therapy - statistics & numerical data; Treatment Outcome; United States; Canada; United States; ST; PT; OT; speech therapy; ICC; traumatic brain injury; Brain injuries; LOS; PBE; Comprehensive Severity Index; CSI; length of stay; intraclass correlation coefficient; physical therapy; TBI; Rehabilitation; Craniocerebral trauma; practice-based evidence; Outcome assessment (health care); occupational therapy
• ISSN: 0003-9993; 1532-821X
• DOI: 10.1016/j.apmr.2014.11.030

Abstract Objective To examine associations of patient and injury characteristics, inpatient rehabilitation therapy activities, and neurotropic medications with outcomes at discharge and 9 months postdischarge for patients with traumatic brain injury (TBI). Design Prospective, longitudinal observational study. Setting Inpatient rehabilitation centers. Participants Consecutive patients (N=2130) enrolled between 2008 and 2011, admitted for inpatient rehabilitation after an index TBI injury. Interventions Not applicable. Main Outcome Measures Rehabilitation length of stay, discharge to home, and FIM at discharge and 9 months postdischarge. Results The admission FIM cognitive score was used to create 5 relatively homogeneous subgroups for subsequent analysis of treatment outcomes. Within each subgroup, significant associations were found between outcomes and patient and injury characteristics, time spent in therapy activities, and medications used. Patient and injury characteristics explained on average 35.7% of the variation in discharge outcomes and 22.3% in 9-month outcomes. Adding time spent and level of effort in therapy activities and percentage of stay using specific medications explained approximately 20% more variation for discharge outcomes and 12.9% for 9-month outcomes. After patient, injury, and treatment characteristics were used to predict outcomes, center differences added only approximately 1.9% additional variance explained. Conclusions At discharge, greater effort during therapy sessions, time spent in more complex therapy activities, and use of specific medications were associated with better outcomes for patients in all admission FIM cognitive subgroups. At 9 months postdischarge, similar but less pervasive associations were observed for therapy activities, but not classes of medications. Further research is warranted to examine more specific combinations of therapy activities and medications that are associated with better outcomes.