Functional level during sub-acute rehabilitation after traumatic brain injury: Course and predictors of outcome

Abstract

Objectives: To describe the functional level during sub-acute rehabilitation after moderate and severe traumatic brain injury (TBI) and to evaluate the impact of pre-injury and injury-related factors as predictors of early recovery.

Material and methods: A prospective study of 55 patients with moderate (n = 21) and severe (n = 34) TBI who received specialized, inpatient rehabilitation. Functional level was assessed by the FIM. Possible predictors were analysed in a regression model using FIM total score at discharge as outcome.

Results: At discharge from sub-acute rehabilitation, on average 53 (±24) days post-injury, 57% of moderate TBI patients and 91% of severe TBI patients were still disabled with a FIM score < 126. The disability was mild (FIM 109–126) in 95% with moderate TBI and in 62% with severe TBI. The disability was severe (FIM < 72) in 24% with severe TBI. Only one patient did not improve. Predictors of functional level at discharge from rehabilitation were Glasgow Coma Scale (GCS) score at rehabilitation admission (B = 5.991), FIM total score at rehabilitation admission (B = 0.393), length of stay (LOS) in the rehabilitation unit (B = 0.264) and length of Post-Traumatic Amnesia (PTA) (B = −0.120). Together, these predictors explained 86% of variance of FIM total scores at discharge.

Conclusion: Less than half of moderate TBI patients reached a normal functional level at discharge from sub-acute rehabilitation. A short PTA period, a high GCS score and FIM score at admission to rehabilitation and a longer stay in the rehabilitation unit were positive predictors of functional level at discharge.

• Level of function
• functional independence measure
• rehabilitation
• traumatic brain injury

Acknowledgement

This study was supported by a project grant from Health Region South-East in Norway. We would like to thank statisticians Are Hugo Pripp and Mari Vårdal at Oslo University Hospital, for their supervision in statistics. To Professor Ellen-Cecilie Røe at Oslo University Hospital, Ulleval for comments and contribution in the development of the study design. And to neuropsychologist Eli Torland for performing GOAT tests on our patients. Thanks to ward leader Lars-Otto Nome, team co-ordinators Anne Johansen and Svein A. Berntsen, physiatrist Rein Knoph and their team colleagues at Clinic for Rehabilitation, Sørlandet Hospital, Kristiansand, for co-operation and data collection.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.