Trajectories of functional recovery following inpatient rehabilitation for traumatic brain injury

Publication date: Available online 7 April 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Bret T. Howrey, James E. Graham, Monique R. Pappadis, Carl V. Granger, Kenneth J. Ottenbacher
ObjectiveTo examine trajectories of functional recovery following rehabilitation for Traumatic Brain Injury (TBI).DesignProspective study.SettingInpatient rehabilitation hospitals in the Uniform Data System for Medical Rehabilitation (UDSMR).ParticipantsA subset of Individuals receiving inpatient rehabilitation services for TBI in 2002-2010 who also had post-discharge measurement of functional independence (N=16,583).Interventions.Inpatient rehabilitation.Main Outcomes Measures.Admission, discharge, and follow-up data were obtained from the UDSMR. We used latent class mixture models to examine recovery trajectories for both cognitive and motor functioning, as measured by the Functional Independence Measure (FIM) instrument.ResultsLatent class models identified three different trajectories (low, medium, high) for both cognitive and motor FIM scales. Factors associated with membership in the low cognition trajectory group included younger age, male, racial/ethnic minority, Medicare or Medicaid (vs. commercial or other insurance), comorbid conditions, and greater duration from injury date to rehabilitation admission date. Factors associated with membership in the low motor trajectory group included older age, racial/ethnic minority, Medicare or Medicaid coverage, comorbid conditions, open head injury, and greater duration to admission.ConclusionStandard approaches to assessing recovery patterns following TBI obscure differences between subgroups with trajectories that differ from the overall mean. Select demographic and clinical characteristics can help classify patients with TBI into distinct functional recovery trajectories, which can enhance both patient-centered care and quality improvement efforts.



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