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

Abstract

A better understanding of long-term functional recovery process for patients with traumatic brain injury (TBI) facilitates effective rehabilitations. The aim of this study was to classify and characterize patients with moderate-to-severe TBI based on their functional trajectories up to 5 years post-injury. The study included 121 patients with moderate-to-severe TBIs (International Classification of Diseases, Tenth Revision [ICD-10], S06.0-S06.9), 16-55 years of age, and admitted at Trauma Referral Hospital within 24 h of injury between 2005 and 2007. Demographics and injury characteristics were documented at the admission, and functional status was recorded at 3 months and 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 after 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.

Global Outcome Trajectories up to 10 Years After Moderate to Severe Traumatic Brain Injury

“…The present study analyzed data from the surviving population with complete GOSE data at the 1-year follow-up ( n = 97), with an attrition rate of 21% from the 1–10-year follow-up. A series of papers on functional outcome and health-related quality of life have previously been published based upon the same longitudinal cohort ( 15 , 31 , 42 – 51 ), please see Howe et al ( 43 ) for a detailed flowchart of the follow-up process up to 10 years after injury.…”

Long-Term Analysis of Functional Outcomes in Traumatic Brain Injury Patients

“…Improvements continued for up to 5 years after injury. 17 Wabl et al also found delayed functional recovery common beyond 6-12 months in a neurointensive care unit, including patients with severe stroke and TBI. 11 Andelic et al found that recovery may occur at intervals even further from injury.…”

“…[9][10][11][12][13][14][15] For those patients that do survive the initial hospitalization, a proportion will continue to improve for up to 10 years postdischarge. [16][17][18][19] While controversy exists with respect to which factors are associated with improved functional outcomes after discharge, age and severity of injury are common elements in many studies. 12,14,16,17,19 A lack of consistent functional outcome data can lead to a conundrum for the care team concerning the appropriate level of support for the patient with a severe TBI.…”

“…[16][17][18][19] While controversy exists with respect to which factors are associated with improved functional outcomes after discharge, age and severity of injury are common elements in many studies. 12,14,16,17,19 A lack of consistent functional outcome data can lead to a conundrum for the care team concerning the appropriate level of support for the patient with a severe TBI. Current critical care management can provide support and lifesustaining therapy for all but the most severe TBI; however, limited data exist about the efficacy of this aggressive approach regarding future outcomes in this population.…”

Trajectories of self-reported competency up to 10 years following moderate-to-severe traumatic brain injury

“…The current study is an extension of an existing longitudinal TBI research project (3,41,42). It is the first study to report on self-reported competency over a 10-year trajectory and investigate predictive demographic and injury-related factors for self-reported functional outcomes.…”