Model System:

TBI

Reference Type:

Journal

Accession No.:

J76526

Journal:


Journal of Head Trauma Rehabilitation

Year, Volume, Issue, Page(s):

, 32, 4, E1-E10

Publication Website:

Abstract:

Study examined differences in patient outcomes across Traumatic Brain Injury Model Systems (TBIMS) rehabilitation centers and identified factors that influence these differences using hierarchical linear modeling (HLM) to analyze prospectively collected data. HLM is a multileveled, linear modeling approach that is especially useful when individuals are nested within centers. Data were obtained from a total of 2,056 individuals 16 years or older with moderate-to-severe traumatic brain injury (TBI) who received inpatient rehabilitation across 16 TBIMS centers Functional outcomes were measured using the Functional Independence Measure and Disability Rating Scale total scores at discharge and 1 year after TBI. Patient demographics and clinical factors that may influence functional outcomes were included in the modeling. Results revealed that duration of posttraumatic amnesia (PTA) demonstrated a significant inverse relationship with functional outcomes. However, the magnitude of this relationship (change in functional status for each additional day in PTA) varied among centers. Functional status at discharge from rehabilitation and at 1-year postinjury could be predicted using the slope and intercept of each TBIMS center for the duration of PTA, by comparing it against the average slope and intercept. HLM was able to demonstrate center effect due to variability in the relationship between PTA and functional outcomes of patients. This variability is not accounted for in traditional linear regression modeling. Future studies examining variations in patient outcomes between centers should utilize HLM to measure the impact of additional factors that influence patient rehabilitation functional outcomes.

Author(s):


Dahdah, Marie N., Hoffman,Melissa, Pretz, Christopher, An, Viktoriya, Barnes, Sunni A., Bennett, Monica, Dreer, Laura E., Bergquist, Thomas, Shafi, Shahid