Functional independence trajectories over 5 years in older veterans with traumatic brain injury: A model systems study.
Mia E Dini, Rachel E Wallace, Daniel W Klyce and 10 others
PMID 39868833WHAT IT FOUND
Functional independence declined over five years in older veterans with TBI.
Those with longer posttraumatic amnesia or preinjury substance use had lower scores and steeper drops. Clinicians should monitor these high-risk groups closely, as their recovery trajectory is worse than average.
Key findings
01Motor and cognitive functional independence scores decreased linearly over the 5-year follow-up period.
02Greater injury severity, indicated by longer duration of posttraumatic amnesia, predicted both lower overall functional scores and a steeper rate of decline over time.
03Preinjury problematic substance use was associated with lower cognitive functional independence trajectories, while preinjury limitations in leaving the home were associated with lower motor trajectories.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The sample was predominantly White (73.9%) and male (96.7%), limiting generalizability to women and racial/ethnic minority veterans. Data completeness dropped significantly by the 5-year mark, with only about 35% of participants having FIM scores, though statistical methods were used to account for missing data. The study did not account for the effects of interventions, social support, or comorbid health conditions that may influence long-term trajectories. Injury severity was assessed only by duration of posttraumatic amnesia, without other measures like Glasgow Coma Scale or imaging findings as primary predictors in the model.
Declared interests
The authors report no conflicts of interest. The study was funded by the National Institute on Disability, Independent Living, and Rehabilitation Research and the Defense Health Agency.
The easy way to misread this
Do not assume that functional independence stabilizes after inpatient rehabilitation. This study found that both motor and cognitive function continued to decline over the 5-year period in this population, particularly for those with severe injuries.