Research Reports - Traumatic brain injury patient, injury, therapy, and ancillary treatments associated with outcomes at discharge and 9 months postdischarge

Arch Phys Med Rehabil. 2015 Aug;96(8 Suppl):S304-29. doi:
10.1016/j.apmr.2014.11.030.

Horn SD(1), Corrigan JD(2), Beaulieu CL(3), Bogner J(2), Barrett RS(4), Giuffrida
CG(5), Ryser DK(6), Cooper K(6), Carroll DM(6), Deutscher D(7).

OBJECTIVE: To examine associations of patient and injury characteristics,
inpatient rehabilitation therapy activities, and neurotropic medications with
outcomes at discharge and 9 months postdischarge for patients with traumatic
brain injury (TBI).
DESIGN: Prospective, longitudinal observational study.
SETTING: Inpatient rehabilitation centers.
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 FIM
at discharge and 9 months postdischarge.
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 and percentage of stay using specific medications
explained approximately 20% 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 postdischarge, 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. 

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