Traumatic brain injury-practice based evidence study: Design and patients, centers, treatments, and outcomes
Model System:
TBIReference Type:
JournalAccession No.:
J72083Journal:
Archives of Physical Medicine and Rehabilitation
Year, Volume, Issue, Page(s):
, 96, 8, Supplement 3, S178-S196, S196.e1-S196.e15Publication Website:
Abstract:
Article provides an overview of the study design, patients, centers, treatments, and outcomes of a traumatic brain injury (TBI) practice-based evidence (PBE) study and examines the generalizability of the findings to the United States TBI inpatient rehabilitation population. Data were obtained from 2,130 patients admitted to 10 acute inpatient rehabilitation centers as part of a comparative effectiveness study in which patient characteristics, environmental factors, and interventions were evaluated to identify factors associated with key TBI inpatient rehabilitation outcomes. This study developed treatment taxonomies for each rehabilitation discipline to document the interventions occurring each time a clinician had a treatment session with a consented patient, or a nurse interacted with or on behalf of the patient. Extensive medical record abstracting documented patient and injury characteristics, severity of principal and comorbid conditions, and ancillary treatments (e.g., medications, nutritional support) to augment in-formation collected on therapy sessions. In addition, in-depth follow-up interviews were conducted at 3 and 9 months postdischarge to capture outcomes in the first year postinjury for most participants. Outcomes examined at discharge included return to acute care during rehabilitation, rehabilitation length of stay, Functional Independence Measure (FIM) score at discharge, and discharge destination. In addition, outcomes examined at 9 months postdischarge included rehospitalization, FIM, participation, and subjective well-being. The level of admission FIM cognitive score was found to create relatively homogeneous subgroups for the subsequent analysis of best treatment combinations. There were significant differences in patient and injury characteristics, treatments, rehabilitation course, and outcomes by admission FIM cognitive subgroups.
Author(s):
Horn, Susan D., Corrigan, John D., Bogner, Jennifer, Hammond, Flora M., Seel, Ronald T., Smout, Randall J., Barrett, Ryan S., Dijkers, Marcel P., Whiteneck, Gale G.