Article

OBJECTIVE: To examine person, injury, and treatment characteristics associated
with recovery trajectories of people with severe traumatic brain injury (TBI)
during inpatient rehabilitation. DESIGN: Observational prospective longitudinal
study. SETTING: TBI rehabilitation units. PARTICIPANTS: Adults (N=206) with
severe nonpenetrating TBI admitted directly to inpatient rehabilitation from
acute care. Participants were excluded for prior disability and intentional
etiology of injury. INTERVENTIONS: Naturally occurring treatments delivered
within comprehensive multidisciplinary teams were recorded daily in 15-minute
units provided to patients and family members, separately. MAIN OUTCOME MEASURES:
Motor and cognitive FIM were measured on admission, discharge, and every 2 weeks
in between and were analyzed with individual growth curve methodology. RESULTS:
Inpatient recovery was best modeled with linear, cubic, and quadratic components:
relatively steep recovery was followed by deceleration of improvement, which
attenuated prior to discharge. Slower recovery was associated with older age,
longer coma, and interruptions to rehabilitation. Patients admitted at lower
functional levels received more treatment, and more treatment was associated with
slower recovery, presumably because treatment was allocated according to need.
Therefore, effects of treatment on outcome could not be disentangled from effects
of case mix factors. CONCLUSIONS: FIM gain during inpatient recovery from severe
TBI is not a linear process. In observational studies, the specific effects of
treatment on rehabilitation outcomes are difficult to separate from case mix
factors that are associated with both outcome and allocation of treatment.
CI - Copyright (c) 2014 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS