Comparative Effectiveness of Traumatic Brain Injury Rehabilitation

Dahdah, Marie; Barisa, Mark; Schmidt, Kathryn; Barnes, Sunni A.; Dubiel, Rosemary; Dunklin, Cynthia; Harper, Caryn R.; Callender, Librada; Wilson, Amy E.; Shafi, Shahid

doi:10.1097/htr.0b013e3182a61983

Cited by 18 publications

(14 citation statements)

References 36 publications

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“…Consequently, there is notable variability in outcome measures across different facilities. 22 Considering this, the criteria of no benefit limitations allowed us to include patients who were able to fully undertake a comprehensive program.…”

Section: Post-acute Rehabilitation Improved Functional Outcomementioning

confidence: 99%

Post-Acute Traumatic Brain Injury Rehabilitation: Effects on Outcome Measures and Life Care Costs

Griesbach

Kreber²,

Harrington³

et al. 2015

Journal of Neurotrauma

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Rehabilitation is the predominant post-acute treatment for patients with traumatic brain injury (TBI). We retrospectively evaluated the effectiveness of post-acute TBI rehabilitation by comparing outcome measures and life care cost with that of patients with cerebrovascular accident (CVA) who underwent a multidisciplinary rehabilitation program within the same facility. To better assess the effects of rehabilitation, we only included patients with no benefit limitations from the insurance carrier. Functional effectiveness was determined by comparing outcome scales, which included the Disability Rating Scale, Mayo Portland Inventory, Occupational Status Scale, Living Status Scale, and the Centre for Neuro Skills Scale. Cost-effectiveness was determined by having certified life care planners create separate cost projections from the admission and discharge patient files. This allowed us to compare cost projections with and without rehabilitation for each patient. Significant decreases in the cost projections, i.e., rehabilitation savings (RS), were found after rehabilitation for TBI. These RS were equivalent to those of patients with CVA. Likewise, equivalent improvements were found on all of the outcome scales for both brain injury groups. We also evaluated if the latency from TBI to admission in the rehabilitation program had an influence on outcome. Cost and functional effectiveness was more marked when rehabilitation was initiated within the first year after TBI. The effects of age of TBI were also evaluated. Although RS were most marked in younger patients, improvements in outcome measures were observed in all age groups after post-acute rehabilitation.

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Section: Post-acute Rehabilitation Improved Functional Outcomementioning

confidence: 99%

Post-Acute Traumatic Brain Injury Rehabilitation: Effects on Outcome Measures and Life Care Costs

Griesbach

Kreber²,

Harrington³

et al. 2015

Journal of Neurotrauma

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“…This team includes trained specialists in occupational therapy (OT), physical therapy (PT), speech language pathology (SLP), psychology, and physical medicine and rehabilitation . Results of prior studies have shown that IR outcomes can be greatly influenced by patient characteristics, clinical features, and variation in rehabilitation facilities …”

Section: Introductionmentioning

confidence: 99%

“…Efforts to provide standard of care for patients with TBI have led to the development of practice guidelines for clinicians and care providers to optimize patient outcome. Some of these guidelines provide specific information on duration or amount of treatments and patient participation . However, most of them have been developed based on non‐Canadian data, while it is recognized that the process of care can be affected by a variety of health care practices in various jurisdictions.…”

Section: Introductionmentioning

confidence: 99%

Occupational and Physical Therapy Activities and Level of Effort in Patients With Traumatic Brain Injury: Association With Functional Outcomes

Zarshenas

Colantonio

Horn

et al. 2019

PM&R

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Background Although some attention has been given to the association of functional outcomes with rehabilitation intensity, the evidence is still sparse in this field. Objective To investigate the effect of inpatient rehabilitation (IR) on discharge cognitive and motor function and the association of time spent in occupational and physical therapy and level of effort with cognitive and motor function in patients with traumatic brain injury (TBI). Design Secondary analysis of TBI‐Practice Based Evidence dataset. Settings Inpatient rehabilitation. Participants One hundred forty‐nine patients with TBI who were consecutively admitted for IR between 2008 and 2011 in Ontario, Canada. Interventions Not applicable. Main Outcome Measurements Admission and discharge Functional Independence Measure‐Rasch Cognitive and Motor Scores. Results Patients showed significant improvement in cognitive and motor function from admission to discharge (P < .0001). After controlling for confounding factors, discharge FIM‐Rasch cognitive and motor scores were not associated with either level of effort or time spent in physical therapy activities. Discharge motor, but not cognitive function, was associated with more time spent in the complex (β = 0.20, confidence interval [CI] 0.005, 0.05) and less time spent in simple OT activities (β = −0.13, CI −0.13, −0.01). Conclusion This study provides valuable information for clinicians about the effectiveness of IR on the improvement of motor and cognitive outcomes and the importance of considering the amount of time spent in activities based on their level of complexity rather than the total time of therapy to improve motor outcomes in this population. Level of Evidence III

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“…However, there is a growing recognition that there is variability in application of evidence-based guidelines, demonstrating a need for a standard treatment approach [4]. For example, amongst TBI Model System (TBIMS) rehabilitation centers, which provide a state-of-the-art multidisciplinary system of rehabilitation care [5], significant differences in risk-adjusted functional outcomes of TBI patients have been observed [5–7]. In the Traumatic Brain Injury-Practice Based Evidence study, it was determined that variations in care among TBIMS centers are due to differences in hospital characteristics, patient characteristics, and the experience of the clinicians [6–8].…”

Section: Introductionmentioning

confidence: 99%

“…In the Traumatic Brain Injury-Practice Based Evidence study, it was determined that variations in care among TBIMS centers are due to differences in hospital characteristics, patient characteristics, and the experience of the clinicians [6–8]. Differential patient outcomes across inpatient TBIMS centers may also relate to processes of care (e.g., goal and treatment planning, selection of therapeutic interventions) [5, 6, 9]. These variations in care may result from suboptimal adoption of evidence-based best practices in routine clinical care, with a little over half of adult patients in the U.S. receiving recommended preventative, acute, and chronic disease care [10, 11].…”

Section: Introductionmentioning

confidence: 99%

Process for developing rehabilitation practice recommendations for individuals with traumatic brain injury

et al. 2017

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BackgroundAttempts at measuring quality of rehabilitation care are hampered by a gap in knowledge translation of evidence-based approaches and lack of consensus on best practices. However, adoption of evidence-based best practices is needed to minimize variations and improve quality of care. Therefore, the objective of this project was to describe a process for assessing the quality of evidence of clinical practices in traumatic brain injury (TBI) rehabilitative care.MethodsA multidisciplinary team of clinicians developed discipline-specific clinical questions using the Population, Intervention, Control, Outcome process. A systematic review of the literature was conducted for each question using Pubmed, CINAHL, PsychInfo, and Allied Health Evidence databases. Team members assessed the quality, level, and applicability of evidence utilizing a modified Oxford scale, the Agency for Healthcare Research and Quality Methods Guide, and a modified version of the Grading of Recommendations, Assessment, Development, and Evaluation scale.ResultsDraft recommendations for best-practice were formulated and shared with a Delphi panel of clinical representatives and stakeholders to obtain consensus.ConclusionEvidence-based practice guidelines are essential to improve the quality of TBI rehabilitation care. By using a modified quality of evidence assessment tool, we established a process to gain consensus on practice recommendations for individuals with TBI undergoing rehabilitation.

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Comparative Effectiveness of Traumatic Brain Injury Rehabilitation

Abstract: There are significant differences in functional outcomes of TBI patients across rehabilitation centers.

Cited by 18 publications

References 36 publications

Post-Acute Traumatic Brain Injury Rehabilitation: Effects on Outcome Measures and Life Care Costs

Post-Acute Traumatic Brain Injury Rehabilitation: Effects on Outcome Measures and Life Care Costs

Occupational and Physical Therapy Activities and Level of Effort in Patients With Traumatic Brain Injury: Association With Functional Outcomes

Process for developing rehabilitation practice recommendations for individuals with traumatic brain injury

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