Trajectories of Functional Change After Inpatient Rehabilitation for Traumatic Brain Injury.

Only patients with follow-up FIM data were analysed, and they were not representative of all TBI patients; those excluded had lower FIM ratings and longer stays, so the low gaining group may be under-represented. The study had no direct measure of injury severity, such as Glasgow Coma Scale, post-traumatic amnesia, or time to follow commands. Follow-up was only one assessment, with mean 103 days, so longer-term recovery could not be estimated. Follow-up collection varied by region, from 6% of TBI cases in Boston to 23% in Seattle, and included and excluded patients differed by region, race/ethnicity, insurance, and baseline function. The authors could not adjust for care received prior to inpatient rehabilitation. The FIM's cross-cultural validity was not established in this literature, and possible bias in communication and other FIM items for non-English speakers cannot be excluded. The authors note that unmeasured factors, such as social support and physical environment, may explain differences.

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Do not read the 8% low trajectory or age, ethnicity, and admission delay links as proof that specific therapy caused better or worse recovery. The study is observational, only includes patients with follow-up, and did not measure injury severity or prior acute care.