Model System:

TBI

Reference Type:

Journal

Accession No.:

J74952

Journal:


Archives of Physical Medicine and Rehabilitation

Year, Volume, Issue, Page(s):

, 97, 12, 2045-2053

Publication Website:

Abstract:

Study investigated the effects of inpatient and outpatient treatment intensity on functional and emotional well-being outcomes at 1 year after severe traumatic brain injury (TBI). The outcomes of patients treated in a specialized TBI treatment center in the United States (US) were compared with those of patients in a Denmark (DK) center providing significantly greater intensity and duration of rehabilitation. Outcome Measures included the Functional Independence Measures, Glasgow Outcome Scale-Extended, Disability Rating Scale, Participation Assessment with Recombined Tools-Objective, Perceived Quality of Life, Medical Outcomes Study 12-Item Short-Form Health Survey, Brief Symptom Inventory--18-item version. Of the 274 participants enrolled, 246 (128 U.S and 118 DK) contributed functional outcomes data at 1 year. Despite identical inclusion criteria, patient severity on admission was greater at the DK site. After adjustment for patient/injury characteristics, there were no site differences in either functional or emotional outcome at 12 months. Significantly more inpatient plus outpatient treatment was administered to DK patients than to those in the US. For functional but not emotional treatments, more severely impaired patients received higher doses. One-year outcomes were predicted by admission severity, age, employment, and other baseline characteristics. Contrary to expectation, DK patients who received significantly more rehabilitation services during the year after severe TBI did not differ in outcome from their less intensively treated US counterparts, after adjusting for initial severity. The negative association of functional treatment dose with extent of early disability suggests that dose was driven by unmeasured factors reflecting need for services. Improved measures of injury-related factors driving treatment allocation are needed to model the independent effects of treatment on outcomes.

Author(s):


Hart, Tessa, Whyte, John, Poulsen, Ingrid, Kristensen, Karin S., Nordenbo, Annette M., Chervoneva, Inna, Vaccaro, Monica J.

Participating Centers: