Functional outcomes following post-acute rehabilitation for moderate-to-severe traumatic brain injury

ABSTRACT

Objective: The objective of this study was to examine the benefits of long-term inpatient rehabilitation for individuals with moderate-to-severe traumatic brain injuries (TBIs).

Methods: Retrospective database review of 67 individuals with moderate-to-severe TBI admitted to a specialised inpatient TBI program. Outcome measures are as follows: (1) functional independence measure + functional assessment measure (FIM+FAM; admission, discharge, change scores); (2) discharge designation (community vs. long-term care (LTC)).

Results: There was a mean improvement on FIM+FAM of 54.19 points (SD = 35.63) or 67% between admission and discharge (t(66) = −12.45, p < 0.001). Mean time post-injury upon completion of therapy was 409.59 days (SD = 343.93). Upon completion of rehabilitation, 50 (75%) participants were discharged to community and 17 to LTC. Among those returning to community, those with longer length of stays were more severely disabled on admission (t(35.9) = −4.86, p < 0.001). Controlling for admission functional status, individuals returning to community following >90 days of therapy required a mean of 378.94 days (SD = 298.86) to achieve comparable gains to those less impaired who received shorter periods of rehabilitation (F(1) = 0.530, p = 0.47).

Conclusion: Continued specialised inpatient services following acute inpatient rehabilitation for individuals with moderate-to-severe TBI can reduce the level of dependency and enhance the likelihood of return to community living.

KEYWORDS:

• Traumatic brain injury
• subacute rehabilitation
• outcome assessment

Acknowledgements

We gratefully acknowledge Liat Rabinowitz, M.S. CCC-SLP (Department of Speech Language Pathology, NYU Langone Medical Center Rusk Rehabilitation, New York, NY), Laura Legaspi, PT, DPT (Department of Physical Therapy, Park Terrace Care Center, Rego Park, NY) and Diana Chen Wong, OTR/L (Department of Rehabilitation, Manorcare, New Providence, NJ) for their assistance with the collection of data and review of articles, Douglas Kawka, Ph.D. for his assistance reviewing the articles and managing the database, Ethan Kassimir (Department of Traumatic Brain Injury, Park Terrace Care Center, Rego Park, NY) for his assistance in updating the literature review, revising the tables and figure and reviewing the final revised manuscript, Valerie Shapiro for her assistance with the literature review, Steven Flanagan, M.D. (Department of Rehabilitation Medicine, NYU Langone Medical Center Rusk Rehabilitation, New York, NY) for his assistance editing the manuscript and Michelle Jaffe, Ph.D. (Department of Traumatic Brain Injury, Park Terrace Care Center, Rego Park, NY) for her assistance in preparing the final manuscript for publication.

Declaration of interest

We certify that no party having a direct interest in the results of the research supporting this article has or will confer a benefit on us or on any organisation with which we are associated.