Functional Outcome Trajectories Following Inpatient Rehabilitation for TBI in the United States: A NIDILRR TBIMS and CDC Interagency Collaboration.
Kristen Dams-O'Connor, Jessica M Ketchum, Jeffrey P Cuthbert and 5 others
PMID 31033744WHAT IT FOUND
On average, survivors of complicated mild to severe TBI improved between 1 and 2 years after injury, then declined by 5 years, though many kept improvements.
Age, insurance, discharge function and rehabilitation stay shaped different long-term disability and supervision paths.
Key findings
01The weighted sample showed improvement between Years 1 and 2, followed by decline between Years 2 and 5.
02Older age, non-white race or ethnicity, lower education, Medicare or Medicaid payer, lower discharge Functional Independence Measure scores, higher discharge Disability Rating Scale score and longer rehabilitation stay were associated with worse disability trajectories and lower probability of independence.
03Individual trajectories varied widely, and many survivors maintained improvements for years.
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 analysis required follow-up data for at least three assessment intervals and excluded people missing two or three assessments. Missing exactly one year of outcome data was filled in by statistical imputation, so some results depend on estimated scores. Disability and supervision scores were based on self-report or proxy report, not objective measures. The trajectory shapes are the best-fitting models for the available data, not guaranteed patterns for any individual. Many factors that may influence positive long-term outcomes were not in the database and could not be modeled. The unweighted database sample was younger and more racially diverse than the wider U.S. inpatient TBI rehabilitation population, although weights were used to improve representativeness.
Declared interests
The article text does not state author conflicts of interest. The publication types list NIH and U.S. government research support.
The easy way to misread this
Do not read the average decline between 2 and 5 years as inevitable for every patient. The study found substantial variation, and many survivors maintained or continued improving after the early recovery period.