Article

OBJECTIVE: To determine the effects of inpatient and outpatient treatment
intensity on functional and emotional well-being outcomes at 1 year after severe
traumatic brain injury (TBI). DESIGN: Prospective, quasiexperimental study
comparing outcomes in a U.S. TBI treatment center with those in a Denmark (DK)
center providing significantly greater intensity and duration of rehabilitation.
SETTING: Inpatient and outpatient TBI rehabilitation. PARTICIPANTS: Persons with
severe TBI (N=274). INTERVENTIONS: Inpatient rehabilitation interventions were
counted daily by discipline. Outpatient treatments were estimated per discipline
using a structured interview administered to patients, caregivers, or both, at 12
months. MAIN OUTCOME MEASURES: FIM, Glasgow Outcome Scale-Extended, Disability
Rating Scale, Participation Assessment with Recombined Tools-Objective, Perceived
Quality of Life, Medical Outcomes Study 12-Item Short-Form Health Survey, Brief
Symptom Inventory-18-item version. RESULTS: Despite identical inclusion criteria,
patient severity on admission was greater at the DK site. After adjustment for
patient/injury characteristics, there were no site differences in either
functional or emotional outcome at 12 months. Significantly more inpatient plus
outpatient treatment was administered to DK patients than to those in the U.S.
For functional but not emotional treatments, more severely impaired patients
received higher doses. One-year outcomes were predicted by admission severity,
age, employment, and other baseline characteristics. CONCLUSIONS: Contrary to
expectation, DK patients who received significantly more rehabilitation services
during the year after severe TBI did not differ in outcome from their less
intensively treated U.S. counterparts, after adjusting for initial severity. The
negative association of functional treatment dose with extent of early disability
suggests that dose was driven by unmeasured factors reflecting need for services.
Improved measures of injury-related factors driving treatment allocation are
needed to model the independent effects of treatment on outcomes.
CI - Copyright A(c) 2016 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS