Content of inpatient rehabilitation for patients with traumatic brain injury: A comparison of Canadian and American facilities

ABSTRACT

Objective: To compare components of inpatient rehabilitation (IR) for patients with traumatic brain injury (TBI) between Canada and the US facilities.

Design: Secondary analysis of the TBI-practice-based evidence dataset.

Participants: Patients with TBI who had a higher Functional Independence Measure (FIM^TM) cognitive function score (≥21) that were admitted to 1 IR facility in Canada (n = 103) and 9 IR facilities in the US (n = 401).

Main measures: demographic and clinical characteristics, type and intensity of activities by discipline, discharge location, FIM-Rasch score, social participation and quality of life.

Results: Time from injury to rehabilitation admission was significantly longer in the Canadian cohort and they experienced a longer rehabilitation length of stay (p < .001, Cohen’s d > .8). Patients in Canada received a greater total time of individual therapy and lower intensity of interventions per week from all disciplines. They also showed a higher score at discharge in FIM components, while US patients had better cognitive recovery and community participation long-term post-discharge.

Conclusions: This study informs stakeholders of the large variation in service provision for patients who were treated in these two countries. These findings suggest the need for robust analyzes to investigate predictors of short and long-term outcomes considering the variation in health-care delivery.

List of abbreviations: TBI: traumatic brain injury, CSI: comprehensive severity index, LoS: length of stay, OT: occupational therapy, PT: physical therapy, SLP: speech language pathology, IR: inpatient rehabilitation

KEYWORDS:

• Brain injury
• rehabilitation
• treatments
• outcomes
• comparison

Acknowledgments

We would like to gratefully acknowledge the support of the Toronto Rehabilitation Institute-University Health Network that made the data available for the purposed study and thank to all clinicians and investigators of this project for making this work a reality.

Declaration of interest

The authors report no declarations of interest.

A small part of the study was presented at the International Brain Injury Association (IBIA) congress, March 2016, The Hague, Netherlands, and the American Congress Rehabilitation Medicine, October 2015, Dallas, TX, USA. The National Institutes of Health, National Center for Medical Rehabilitation Research (grant no. 1R01HD050439-01); National Institute on Disability and Rehabilitation Research [grant no. H133A080023]; and Ontario Neuro-trauma Foundation [grant no. 2007-ABI-ISIS-525]. SZ was supported by a Toronto Rehabilitation Institute Scholarship for graduate students (2017/18) and University of Toronto Fellowship (2017/2018), and AC was supported by a Canadian Institutes of Health Research, Research Chair in Gender, Work and Health [#CGW-126580]. The opinions contained in this article are those of the authors and should not be construed as an official statement from the National Institutes of Health, National Center for Medical Rehabilitation Research; National Institute on Disability and Rehabilitation Research; or Ontario Neuro-trauma Foundation.

Additional information

Funding

This work was supported by the National Institute on Disability and Rehabilitation Research [H133A080023]; the National Institutes of Health, National Center for Medical Rehabilitation Research [1R01HD050439-01]; Ontario Neuro-trauma Foundation [2007-ABI-ISIS-525].