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

Abstract

Objective To examine associations of patient and injury characteristics, inpatient rehabilitation therapy activities, and neurotropic medications with outcomes at discharge and 9 months post-discharge for patients with traumatic brain injury (TBI) Design Prospective, longitudinal observational study Setting 10 inpatient rehabilitation centers (9 US, 1 Canada) 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 Functional Independence Measure (FIM) at discharge and 9 months post-discharge 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, as well as percent of stay using specific medications, explained approximately 20.0% 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 post-discharge, 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.

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

“…Our study showed that level of effort was not a significant predictor of discharge cognitive and motor scores. This finding is not consistent with the results of a study by Horn et al This might be due to differences of admission cognitive scores between patients in these studies and the small sample size of the current study. Further investigation is needed to explore the interaction of admission level of disability with level of effort and engagement in rehabilitation activities and its effect on discharge outcome in patients with TBI.…”

“…The study on a U.S. population revealed that higher level of effort was a significant predictor of discharge motor function only in patients with lower admission FIM cognitive scores (≤20) . Therefore, the lack of correlation between level of effort and motor outcome in the current study might be explained by relatively high admission FIM cognitive scores (≥21).…”

“…Moreover, none of these studies investigated the independent contribution of therapy time spent in specific types of activities by their level of complexity to explain the variation in outcomes in patients who were treated in Canadian facilities particularly. A study of patients with TBI who were admitted to U.S. facilities demonstrated that discharge functional outcomes were influenced by receiving more time in specific activities in OT, PT, and SLP sessions per week after controlling for demographic characteristics, clinical factors, and a variety of rehabilitation centers …”

“…Level of effort is one of the key elements that facilitates the process of patient engagement in rehabilitation . An attempt to examine the effect of patient level of effort in therapy sessions on functional outcomes showed that this variable was significantly associated with better cognitive and motor outcomes in patients with TBI who were treated in U.S. IR settings …”

Group Therapy Use and Its Impact on the Outcomes of Inpatient Rehabilitation After Traumatic Brain Injury: Data From Traumatic Brain Injury–Practice Based Evidence Project

“…“Group therapy” is not a single phenomenon but includes a wide variety of treatment activities to address many different functional deficits. Prior analyses have shown that total hours/week of individual therapy is not predictive of outcomes, 22 but that variation in outcome can be explained when times spent in specific therapy activities are examined. Our analysis of group therapy time showed a similar pattern of findings, but with even less variation explained by group therapy activity time.…”