Functional motor improvement during inpatient rehabilitation among older adults with traumatic brain injury.

This was an observational administrative cohort, not a trial, so it cannot show that inpatient rehabilitation, length of stay, or any treatment caused motor improvement. The sample was older Medicare fee-for-service patients discharged to inpatient rehabilitation after trauma-center care at burn-bed hospitals, so results may not apply to younger patients, Medicare Advantage enrollees, patients not admitted to inpatient rehabilitation, or patients treated at lower-level trauma centers. Records were linked probabilistically, and the analysis used 29 linked datasets to account for linkage uncertainty, but some links may still be wrong. The 9-point and 17-point motor change thresholds came from published sources rather than this sample, and the terciles and length-of-stay groups were created from the sample distribution rather than tested cutoffs. The study measured only motor function and did not assess cognition, behavior, communication, swallowing, discharge destination, or long-term community outcomes. Shorter stay was associated with lower improvement among low and middle baseline motor groups, but the study cannot tell whether staying longer would have produced more improvement. The sample had limited representation of dual Medicare-Medicaid enrollees and racial or ethnic minority patients, so findings may not generalise to those groups.

Do not read the 84.1% and 68.6% improvement rates as proof that longer inpatient rehabilitation stays cause better motor recovery. This was an observational cohort, and patients who stayed longer may have differed in injury severity, comorbidity, or other factors not fully measured.