A Randomized Controlled Trial of Holistic Neuropsychologic Rehabilitation After Traumatic Brain Injury

Cicerone, Keith D.; Mott, Tasha; Azulay, Joanne; Sharlow-Galella, Mary; Ellmo, Wendy; Paradise, Susan; Friel, John C.

doi:10.1016/j.apmr.2008.06.017

Cited by 205 publications

(126 citation statements)

References 47 publications

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“…30 Also participation in comprehensive neuro-psychological rehabilitation after discharge from acute care has been associated with significant improvement in neurocognitive and social skills. 31,32 The observed disparities in access to inpatient rehabilitation and other post-discharge professional care suggest the possibility of worse functional outcomes and reduced long-term quality of life among non-white TBI victims. 33,34 Potential consequences of inadequate rehabilitation include unemployment and job instability.…”

Section: Discussionmentioning

confidence: 99%

Race and Insurance Disparities in Discharge to Rehabilitation for Patients with Traumatic Brain Injury

Asemota

George

Cumpsty-Fowler

et al. 2013

Journal of Neurotrauma

135

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Post-acute inpatient rehabilitation services are associated with improved functional outcomes among persons with traumatic brain injury (TBI). We sought to investigate racial and insurance-based disparities in access to rehabilitation. Data from the Nationwide Inpatient Sample from 2005-2010 were analyzed using standard descriptive methods and multivariable logistic regression to assess race-and insurance-based differences in access to inpatient rehabilitation after TBI, controlling for patient-and hospital-level variables. Patients with moderate to severe TBI aged 18-64 years with complete data on race and insurance status discharged alive from inpatient care were eligible for study. Among 307,675 TBI survivors meeting study criteria and potentially eligible for discharge to rehabilitation, 66% were white, 12% black, 15% Hispanic, 2% Asian, and 5% other ethnic minorities. Most whites (70%), Asians (70%), blacks (59%), and many Hispanics (49%) had insurance. Compared with insured whites, insured blacks had reduced odds of discharge to rehabilitation (odds ratio [OR] 0.84; 95% confidence interval [CI] 0.75-0.95). Also, insured Hispanics (OR 0.52; 95% CI 0.44-0.60) and insured Asians (OR 0.54; 95% CI 0.39-0.73) were less likely to be discharged to rehabilitation than insured whites. Compared with insured whites, uninsured whites (OR 0.57; 95% CI 0.51-0.63), uninsured blacks (OR 0.33; 95% CI 0.26-0.42), uninsured Hispanics (OR 0.27; 95% CI 0.22-0.33), and uninsured Asians (OR 0.40; 95% CI 0.22-0.73) were less likely to be discharged to rehabilitation. Race and insurance are strong predictors of discharge to rehabilitation among adult TBI survivors in the United States. Efforts are needed to understand and eliminate disparities in access to rehabilitation after TBI.

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Section: Discussionmentioning

confidence: 99%

Race and Insurance Disparities in Discharge to Rehabilitation for Patients with Traumatic Brain Injury

Asemota

George

Cumpsty-Fowler

et al. 2013

Journal of Neurotrauma

135

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“…Difficulty in blinding the patients and the therapists to treatment in complex rehabilitation studies is a common problem [47].…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Multidisciplinary outpatient treatment in patients with mild traumatic brain injury: A randomised controlled intervention study

et al. 2017

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Objective: To evaluate the efficacy of a multidisciplinary outpatient follow-up programme compared to follow-up by a general practitioner for patients being at risk or sick-listed with persistent post-concussion symptoms two months after a mild traumatic brain injury. Design: Randomised controlled trial.Patients: One hundred fifty-one patients, 16-56 years.Methods: Multidisciplinary outpatient rehabilitation with individual contacts and a psychoeducational group intervention at two outpatient rehabilitation clinics compared to follow-up by a general practitioner after a multidisciplinary examination. Primary outcome was sustainable return-to-work first year post-injury. Secondary outcomes were post-concussion symptoms, disability, the patient's impressions of change and psychological distress.Results: Days to sustainable return-to-work was 90 in the intervention and 71 in the control group (p=0.375). The number of post-concussion symptoms were fewer in the intervention (6) compared to the control group (8) at 12 months (p=0.041). No group differences were observed for disability (p=0.193), patients impression of change (p=0.285) or psychological distress (p=0.716).2 Conclusion:The multidisciplinary outpatient follow-up programme focusing on better understanding and reassurance of favourable outcome for mild traumatic brain injury did not improve return-to-work, but may have reduced the development of post-concussion symptoms.Additional studies should focus on which factors exhibit a direct impact on return-to-work.

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“…comprehensive, intensive and structured rehabilitation that integrates cognitive and psychological treatment [19][20][21] and emphasizing the importance of the whole and the interdependence of the different treatment parts in a therapeutic environment.…”

Section: Introductionmentioning

confidence: 99%

Long-term follow-up after comprehensive rehabilitation of persons with epilepsy, with emphasis on participation in employment or education

Wedlund

Erdner

Tomson

2012

Epilepsy & Behavior

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The objective was to describe current situation for patients with epilepsy after rehabilitation with emphasis on employment and education and to investigate if clinical factors at admission were associated with increase in employment or education. All patients that participated in a comprehensive rehabilitation were eligible. Data were collected from medical records at admission to the rehabilitation, at discharge and from a structured telephone interview at follow up 1-17 years after. In total 124 patients participated in the follow-up. Participation in employment or education improved from admission to follow-up in 38 patients. In univariable analysis active epilepsy with tonic-clonic seizures at admission was significantly associated with increased participation in employment or education at follow-up, so was decreased frequency of tonic-clonic seizures from admission to follow-up. The significance of the associations disappeared in adjusted multivariable analysis. Participation in employment or education was improved for many patients at follow up.

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A Randomized Controlled Trial of Holistic Neuropsychologic Rehabilitation After Traumatic Brain Injury

Cited by 205 publications

References 47 publications

Race and Insurance Disparities in Discharge to Rehabilitation for Patients with Traumatic Brain Injury

Race and Insurance Disparities in Discharge to Rehabilitation for Patients with Traumatic Brain Injury

Multidisciplinary outpatient treatment in patients with mild traumatic brain injury: A randomised controlled intervention study

Long-term follow-up after comprehensive rehabilitation of persons with epilepsy, with emphasis on participation in employment or education

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