Article

OBJECTIVE: To evaluate functional improvement following a traumatic brain injury
(TBI) after admission to a postacute treatment facility, focusing on the time
since injury and analysis of recovery by degree of impairment at admission.
A retrospective study of patients who received treatment at a postacute
rehabilitation facility. SETTING: Postacute rehabilitation for persons with
acquired brain injury that involved transdisciplinary teams. PATIENTS: Patients
(n = 1274) were admitted for treatment less than 5 years after TBI and were
assessed on our outcome measures at least 3 times. The patients were then grouped
by the time since injury and the severity of impairment at admission. METHODS:
Patients received comprehensive multidisciplinary treatment 5 days per week, 6
hours per day. MAIN OUTCOME MEASUREMENTS: Function was assessed by using the Pate
Environmentally Relevant Program Outcome System (PERPOS) scale at admission,
discharge, and approximately every 2 weeks during treatment. By using these
assessment scores, the rate and degree of improvement were monitored. RESULTS:
Postacute rehabilitation yielded significant gains in functioning, with 69% of
all patients who demonstrated clinically meaningful gains. The time since injury
had a significant impact on gains made in rehabilitation (Ftime x
time-since-treatment group interaction = 17.75; P < .001), with the 0-3 months
post injury group outperforming each other group (P < .001 for each comparison).
This effect was statistically significant (P < .001) for each of the 3
severity-at-intake subgroups analyzed but was stronger for the severe (F314 =
9.05) and moderate-to-severe (F425 = 7.32) than for the mild-to-moderate (F533 =
2.95) severity-at-intake groups. CONCLUSIONS: Postacute rehabilitation is
associated with functional gains for individuals with TBI beyond what can be
explained by undirected recovery. These findings provide evidence for postacute
rehabilitation as effective care after TBI.
CI - Copyright (c) 2013 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS