A Pilot Project of Early Integrated Traumatic Brain Injury Rehabilitation in Singapore

Abstract

Objective. Document acute neurosurgical and rehabilitation parameters of patients of all traumatic brain injury (TBI) severities and determine whether early screening along with very early integrated TBI rehabilitation changes functional outcomes. Methods. Prospective study involving all patients with TBI admitted to a neurosurgical department of a tertiary hospital. They were assessed within 72 hours of admission by the rehabilitation team and received twice weekly rehabilitation reviews. Patients with further rehabilitation needs were then transferred to the attached acute inpatient TBI rehabilitation unit (TREATS) and their functional outcomes were compared against a historical group of patients. Demographic variables, acute neurosurgical characteristics, medical complications, and rehabilitation outcomes were recorded. Results. There were 298 patients screened with an average age of 61.8 ± 19.1 years. The most common etiology was falls (77.5%). Most patients were discharged home directly (67.4%) and 22.8% of patients were in TREATS. The TREATS group functionally improved (P < 0.001). Regression analysis showed by the intervention of TREATS, that there was a statistically significant FIM functional gain of 18.445 points (95% CI −30.388 to −0.6502, P = 0.03). Conclusion. Our study demonstrated important epidemiological data on an unselected cohort of patients with TBI in Singapore and functional improvement in patients who further received inpatient rehabilitation.

Effect of Early Interdisciplinary Rehabilitation for Trauma Patients: A Systematic Review

“… 19 , 21 , 22 Although Mackay 22 noted a trend toward a favorable outcome in the intervention group, the difference did not reach statistical significance. In the trial by Lui et al 21 that included 119 subjects, 68 in the intervention group and 51 in the control group, there was no statistically significant difference between groups regarding the total length of stay, as was the case for the trial by Andelic et al. 19 …”

“…We assessed 5 full-text articles. 3 , 19 , 20 , 21 , 22 Because 2 of the publications 3 , 19 concerned the same study, only 4 studies were included in this review. The studies varied considerably in design and inclusion/exclusion criteria.…”

“…Lui 21 also examined complications as an outcome. They could not find a statistically significant difference between the intervention and control groups for this outcome.…”

“…Three of the included studies 19 , 21 , 22 examined the effect of EIR in an inpatient setting, while 1 trial 20 examined the effect of EIR for mild TBI in an outpatient setting .…”

Functional outcomes in moderate-to-severe traumatic brain injury survivors

“…[ 14 ] In the present study, overall acute and rehabilitation LOS was relatively higher than those who were treated in acute inpatient TBI rehabilitation in Singapore. [ 19 ] This could be explained by the fact that these investigators also included mild TBI cases which were discharged early as compared to severe TBI group.…”