Effects of Timing and Intensity of Neurorehabilitation on Functional Outcome After Traumatic Brain Injury: A Systematic Review and Meta-Analysis

Objective

To systematically review evidence on the effects of timing and intensity of neurorehabilitation on the functional recovery of patients with moderate to severe traumatic brain injury (TBI) and aggregate the available evidence using meta-analytic methods.

Longitudinal Examination of Resilience After Traumatic Brain Injury: A Traumatic Brain Injury Model Systems Study

Objectives

To evaluate (1) the trajectory of resilience during the first year after a moderate-severe traumatic brain injury (TBI); (2) factors associated with resilience at 3, 6, and 12 months postinjury; and (3) changing relationships over time between resilience and other factors.

Health-Related Quality of Life 3 Years After Moderate to Severe Traumatic Brain Injury: A Prospective Cohort Study

Objectives

To evaluate the time course of health-related quality of life (HRQoL) after moderate to severe traumatic brain injury (TBI) and to identify its predictors.

Design

Prospective cohort study with follow-up measurements at 3, 6, 12, 18, 24, and 36 months after TBI.

Setting

Patients with moderate to severe TBI discharged from 3 level-1 trauma centers.

Participants

Patients (N=97, 72% men) with a mean age ± SD of 32.8±13.0 years (range, 18–65y), hospitalized with moderate (23%) or severe (77%) TBI.

Interventions

Not applicable.

Main Outcome Measures

HRQoL was measured with the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), functional outcomes with the Glasgow Outcome Scale (GOS), Barthel Index, FIM, and Functional Assessment Measure, and mood with the Wimbledon Self-Report Scale.

Results

The SF-36 domains showed significant improvement over time for Physical Functioning (P<.001), Role Physical (P<.001), Bodily Pain (P<.001), Social Functioning (P<.001), and Role Emotional (P=.024), but not for General Health (P=.263), Vitality (P=.530), and Mental Health (P=.138). Over time there was significant improvement in the Physical Component Summary (PCS) score, whereas the Mental Component Summary (MCS) score remained stable. At 3-year follow-up, HRQoL of patients with TBI was the same as that in the Dutch normative population. Time after TBI, hospital length of stay (LOS), FIM, and GOS were independent predictors of the PCS, whereas LOS and mood were predictors of the MCS.

Conclusions

After TBI, the physical component of HRQoL showed significant improvement over time, whereas the mental component remained stable. Problems of disease awareness seem to play a role in self-reported mental HRQoL. After TBI, mood status is a better predictor of the mental component of HRQoL than functional outcome, implying that mood should be closely monitored during and after rehabilitation.     

Mortality Over Four Decades After Traumatic Brain Injury Rehabilitation: A Retrospective Cohort Study

Harrison-Felix CL, Whiteneck GG, Jha A, DeVivo MJ, Hammond FM, Hart DM. Mortality over four decades after traumatic brain injury rehabilitation: a retrospective cohort study.

Objective

To investigate mortality, life expectancy, risk factors for death, and causes of death in persons with traumatic brain injury (TBI).

Design

Retrospective cohort study.

Setting

Used data from an inpatient rehabilitation facility, the Social Security Death Index, death certificates, and the U.S. population age-race-sex-specific and cause-specific mortality rates.

Participants

Persons with TBI (N=1678) surviving to their first anniversary of injury admitted to rehabilitation from an acute care hospital within 1 year of injury between 1961 and 2002.

Interventions

Not applicable.

Main Outcome Measures

Vital status, standardized mortality ratio, life expectancy, cause of death.

Results

Persons with TBI were 1.5 times more likely to die than persons in the general population of similar age, sex, and race, resulting in an estimated average life expectancy reduction of 4 years. Within the TBI population, the strongest independent risk factors for death after 1 year postinjury were being older, being male, having less education, having a longer hospitalization, having an earlier year of injury, and being in a vegetative state at rehabilitation discharge. After 1 year postinjury, persons with TBI were 49 times more likely to die of aspiration pneumonia, 22 times more likely to die of seizures, 4 times more likely to die of pneumonia, 3 times more likely to commit suicide, and 2.5 times more likely to die of digestive conditions than persons in the general population of similar age, sex, and race.

Conclusions

This study demonstrated life expectancy after TBI rehabilitation is reduced and associated with specific risk factors and causes of death.     

Association of Posttraumatic Stress Symptom Severity With Health-Related Quality of Life and Self-Reported Functioning Across 12 Months After Severe Traumatic Brain Injury

Objective

To investigate the relation between posttraumatic stress (PTS) symptom severity and health-related quality of life (HRQoL) after severe traumatic brain injury (TBI).

Feasibility and Preliminary Validation of an Online Version of the Ohio State University Traumatic Brain Injury Identification Method

Objective

To test the feasibility and validity of an online version of an established interview designed to determine a lifetime history of traumatic brain injury (TBI).

Racial Differences in Discharge Location After a Traumatic Brain Injury Among Older Adults

ObjectiveTo determine if there were racial differences in discharge location among older adults treated for traumatic brain injury (TBI) at a level 1 trauma center.DesignRetrospective cohort study.SettingR Adams Cowley Shock Trauma Center.ParticipantsBlack and white adults aged ≥65 years treated for TBI between 1998 and 2012 and discharged to home without services or inpatient rehabilitation (N=2902).Main Outcome MeasuresWe assessed the association between race and discharge location via logistic regression. Covariates included age, sex, Abbreviated Injury Scale-Head score, insurance type, Glasgow Coma Scale score, and comorbidities.ResultsThere were 2487 (86%) whites and 415 blacks (14%) in the sample. A total of 1513 (52%) were discharged to inpatient rehabilitation and 1389 (48%) were discharged home without services. In adjusted logistic regression, blacks were more likely to be discharged to inpatient rehabilitation than to home without services compared to whites (odds ratio 1.34, 95% confidence interval, 1.06-1.70).ConclusionsIn this group of Medicare-eligible older adults, blacks were more likely to be discharged to inpatient rehabilitation compared to whites.     

Diagnostic Accuracy of the Veteran Affairs' Traumatic Brain Injury Screen

Objective

To comprehensively estimate the diagnostic accuracy and reliability of the Department of Veterans Affairs (VA) Traumatic Brain Injury (TBI) Clinical Reminder Screen (TCRS).

Economic Evaluation of Activities of Daily Living Retraining During Posttraumatic Amnesia for Inpatient Rehabilitation Following Severe Traumatic Brain Injury

Objective

To evaluate the cost-effectiveness of structured activities of daily living (ADL) retraining during posttraumatic amnesia (PTA) plus treatment as usual (TAU) vs TAU alone for inpatient rehabilitation following severe traumatic brain injury (TBI).

The Burden of Traumatic Spinal Cord Injury in the United States: Disability-Adjusted Life Years

Objective

To quantify the burden of traumatic spinal cord injury (SCI) as defined by nonfatal health loss and premature mortality among a large sample of participants over a 44-year period, and estimate the national burden of SCI in the United States for the year 2010.

Minimal Clinically Important Difference for the Rasch Neuropsychiatric Inventory Irritability and Aggression Scale for Traumatic Brain Injury

Objective

To determine the minimal clinically important difference (MCID) for a Rasch measure derived from the Irritability/Lability and Agitation/Aggression subscales of the Neuropsychiatric Inventory (NPI)—the Rasch NPI Irritability and Aggression Scale for Traumatic Brain Injury (NPI-TBI-IA).

Social Competence Treatment After Traumatic Brain Injury: A Multicenter,Randomized Controlled Trial of Interactive Group Treatment Versus Noninteractive Treatment

Objective

To evaluate the effectiveness of a replicable group treatment program for improving social competence after traumatic brain injury (TBI).

Role of Character Strengths in Outcome After Mild Complicated to Severe Traumatic Brain Injury: A Positive Psychology Study

Objective

To examine the effects of character strengths on psychosocial outcomes after mild complicated to severe traumatic brain injury (TBI).

Design

Prospective study with consecutive enrollment.

Setting

A Midwestern rehabilitation hospital.

Participants

Persons with mild complicated to severe TBI (N=65).

Interventions

Not applicable.

Main Outcome Measures

Community Integration Measure, Disability Rating Scale, Modified Cumulative Illness Rating Scale, Positive and Negative Affect Schedule, Satisfaction with Life Scale, Values in Action Inventory of Strengths, and Wechsler Test of Adult Reading.

Results

Character virtues and strengths were moderately associated with subjective outcomes, such that there were fewer and less strong associations between character virtues/strengths and objective outcomes than subjective outcomes. Specifically, positive attributes were associated with greater life satisfaction and perceived community integration. Fewer and less strong associations were observed for objective well-being; however, character strengths and virtues showed unique value in predicting physical health and disability. Positive affectivity was not meaningfully related to objective outcomes, but it was significantly related to subjective outcomes. In contrast, negative affectivity was related to objective but not subjective outcomes.

Conclusions

Given the strength of the associations between positive aspects of character or ways of perceiving the world and positive feelings about one's current life situation, treatments focused on facilitating these virtues and strengths in persons who have experienced TBI may result in better perceived outcomes and potentially subsequently lower comorbidities.     

Health Conditions: Effect on Function,Health-Related Quality of Life,and Life Satisfaction After Traumatic Spinal Cord Injury. A Prospective Observational Registry Cohort Study

Objective

To analyze relations among injury, demographic, and environmental factors on function, health-related quality of life (HRQoL), and life satisfaction in individuals with traumatic spinal cord injury (SCI).

Practice Guideline Update Recommendations Summary: Disorders of Consciousness: Report of the Guideline Development,Dissemination, and Implementation Subcommittee of the American Academy of Neurology; the American Congress of Rehabilitation Medicine; and the National Institute on Disability,Independent Living,and Rehabilitation Research

Objective

To update the 1995 American Academy of Neurology (AAN) practice parameter on persistent vegetative state and the 2002 case definition on minimally conscious state (MCS) and provide care recommendations for patients with prolonged disorders of consciousness (DoC).

Advanced Therapy in Traumatic Brain Injury Inpatient Rehabilitation: Effects on Outcomes During the First Year After Discharge

ObjectiveTo use causal inference methods to determine if receipt of a greater proportion of inpatient rehabilitation treatment focused on higher level functions, for example, executive functions, ambulating over uneven surfaces (advanced therapy [AdvTx]), results in better rehabilitation outcomes.DesignA cohort study using propensity score methods applied to the traumatic brain injury practice-based evidence (TBI-PBE) database, a database consisting of multisite, prospective, longitudinal observational data.SettingAcute inpatient rehabilitation facilities.ParticipantsPatients enrolled in the TBI-PBE study (N=1843), aged 14 years or older, who sustained a severe, moderate, or complicated mild TBI, receiving their first inpatient rehabilitation facility admission to 1 of 9 sites in the United States, and consented to follow-up 3 and 9 months postdischarge from inpatient rehabilitation.InterventionsNot applicable.Main Outcome MeasuresParticipation Assessment with Recombined Tools-Objective-17, FIM motor and cognitive scores, Satisfaction with Life Scale, and Patient Health Questionnaire-9.ResultsControlling for measured potential confounders, increasing the percentage of AdvTx during inpatient TBI rehabilitation was found to be associated with better community participation, functional independence, life satisfaction, and decreased likelihood of depression during the year after discharge from inpatient rehabilitation. Participants who began rehabilitation with greater disability experienced larger gains on some outcomes than those who began rehabilitation with more intact abilities.ConclusionsIncreasing the proportion of treatment targeting higher level functions appears to have no detrimental and a small, beneficial effect on outcome. Caution should be exercised when inferring causality given that a large number of potential confounders could not be completely controlled with propensity score methods. Further, the extent to which unmeasured confounders influenced the findings is not known and could be of particular concern due to the potential for the patient’s recovery trajectory to influence therapists’ decisions to provide a greater amount of AdvTx.     

Challenges to the Standardization of Trauma Data Collection in Burn,Traumatic Brain Injury,Spinal Cord Injury,and Other Trauma Populations: A Call for Common Data Elements for Acute and Longitudinal Trauma Databases

Objective

Common data elements (CDEs) promote data sharing, standardization, and uniform data collection, which facilitate meta-analyses and comparisons of studies. Currently, there is no set of CDEs for all trauma populations, but their creation would allow researchers to leverage existing databases to maximize research on trauma outcomes. The purpose of this study is to assess the extent of common data collection among 5 trauma databases.