Trajectories of Functional Change After Inpatient Rehabilitation for Traumatic Brain Injury

Abstract

Objective To examine trajectories of functional recovery following rehabilitation for Traumatic Brain Injury (TBI). Design Prospective study. Setting Inpatient rehabilitation hospitals in the Uniform Data System for Medical Rehabilitation (UDSMR). Participants A subset of Individuals receiving inpatient rehabilitation services for TBI in 2002–2010 who also had post-discharge measurement of functional independence (N=16,583). Interventions Inpatient rehabilitation. Main Outcomes Measures Admission, discharge, and follow-up data were obtained from the UDSMR. We used latent class mixture models to examine recovery trajectories for both cognitive and motor functioning, as measured by the Functional Independence Measure (FIM) instrument. Results Latent class models identified three different trajectories (low, medium, high) for both cognitive and motor FIM scales. Factors associated with membership in the low cognition trajectory group included younger age, male, 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. Conclusion Standard approaches to assessing recovery patterns following 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.

Trajectory of Functional Independent Measurements during First Five Years after Moderate and Severe Traumatic Brain Injury

“…However, it is worth mentioning that our study population received standard acute care and in-hospital rehabilitation services 40 during the acute and post-acute phase, and that those services have been provided in our hospital consistently during the last 10 years. Moreover, our study results were compatible with the recent study finding from a largesize U.S. patient population 35 and used a similar analytical approach, albeit with different lengths of follow-up. Our study results further supplemented long-term typical and atypical functional recovery processes after moderate and severe TBI.…”

“…Comparisons of techniques and usages among these modeling approaches are discussed in detail by Daniel S. Nagin and Candice L. Odgers. 37 In addition to the modeling approach, compared with the study by Howrey and colleagues, 35 our study found that acute GCS score, CT classification of injury severity, longer PTA time, and lengthy hospital stays (ICU, trauma center, and rehabilitation units) were the most important factors associated with long-term motor and cognitive function trajectories. However, age and sex were not found to be significantly associated with function trajectories in the present study.…”

“…Another recent U.S. national study 35 applied latent class mixture modeling (or GBTM) 29,36 to describe the FIM motor and cognitive trajectories among 16,583 individuals who received inpatient rehabilitation services for TBI. The study identified three unique trajectories for both motor and cognitive FIM scores across the period of inpatient rehabilitation admission, discharge, and study follow-up.…”

“…Similar to the modeling approach by Howrey and colleagues, 35 our study also applied GBTM to identify the trajectories of FIM-M and FIM-C measures up to 5-years post-injury. Comparing with the GCMs, an important distinction of GBTMs is that the model does not assume a one-size-fits-all model for characterizing the development change over time.…”

Examining age‐related differences in functional domain impairment following traumatic brain injury

“…In the present report, older adults showed significantly and consistently worse functional performance than younger adults in the following functions: mobility, ability to travel, home maintenance, and overall functional status to one year post-injury. These results are consistent with other studies that show older adults tend to have worse physical outcomes after a TBI due to a decreased ability to recover from neural insult; this is compounded by decreased physical activity in the immediate/acute recovery phase (Cuthbert, Harrison-Felix, Corrigan, et al 2015; Howrey, Graham, Pappadis, Granger & Ottenbacher, in press). Our results suggest that early intervention and rehabilitation should focus on improving older adults’ mobility.…”