Effect of Preexisting and Co-Occurring Comorbid Conditions on Recovery in the 5 Years After Rehabilitation for Traumatic Brain Injury

Abstract

Objective: To determine the relationship between comorbid health conditions and the trajectory of functional recovery 5 years following traumatic brain injury (TBI) rehabilitation. Setting: Two acute rehabilitation facilities. Participants: A total of 407 patients with primary diagnosis of TBI. Design: Prospective, observational. Main Measures: Functional Independence Measure Cognitive and Motor scores. Results: Female gender was negatively associated with the trajectory of motor recovery (P < .001). TBI severity was negatively associated with both motor and cognitive recovery and interacted with time after injury (both Ps < .0001). Hypertension was negatively associated with both motor (P < .0001) and cognitive (P = .0121) recovery, although this relationship diminished over time for motor function (P = .0447). Cardiac conditions were negatively associated with motor recovery (P = .0204), and rate of cognitive recovery was more rapid for patients with cardiac conditions (P = .0088). Depressed patients recovered cognitive function more quickly than those who were not depressed (P = .0196). Diabetes was negatively associated with motor function (P = .0088). Drug/alcohol use was positively associated with motor function (P = .0036). Conclusions: Injury severity remains an important predictor of long-term recovery; however, certain comorbid medical conditions are negatively associated with functional abilities over the first 5 years after injury. Patients being discharged from TBI rehabilitation with comorbid cardiac, hypertensive, diabetic, and/or depressive conditions may benefit from early and ongoing clinical surveillance.

Improving Care for Veterans with Traumatic Brain Injury Across the Lifespan

“…Estimates suggest that up to 25 percent of individuals who deployed in support of the wars in Iraq and Afghanistan likely have had a TBI (Lindquist, Love, and Elbogen, 2017). Although not all military-related TBIs are recorded, the U.S. Department of Defense (DoD) reports that more than 444,300 service members experienced a TBI between 2000 and 2021 (Corrigan et al, 2020;Military Health System, undated-a;Military Health System, undated-b;Traumatic Brain Injury Center of Excellence, 2021). Although some veterans with TBI recover completely, many have ongoing challenges related to their TBI.…”

Successful Community Discharge Among Older Adults With Traumatic Brain Injury Admitted to Inpatient Rehabilitation Facilities

“…Intensive and specialized rehabilitation is considered beneficial after brain injury. 20 , 21 , 22 However, age, 23 , 24 , 25 functional status, 23 , 24 , 26 comorbidity burden, 27 , 28 and injury severity 29 have the potential to affect patients’ rehabilitation outcomes. Older adults with TBI in IRF differ from their younger counterparts in several of these areas, specifically, they are more likely to have mild brain injuries, 30 multiple chronic conditions, 31 and may have pre-injury declines in health that contributed to sustaining a TBI.…”

Health Conditions Among Special Operations Forces Versus Conventional Military Service Members: A VA TBI Model Systems Study

“…1,2 A large civilian literature has demonstrated that the cumulative burden of health comorbidities after TBI is associated with increased functional decline, rehospitalization, and mortality. [1][2][3] Studies of long-term health outcomes after TBI in military veterans are inconclusive. Some studies report poorer overall health among veterans, [4][5][6][7] particularly those who experienced combat, [8][9][10] while others suggest that veterans have comparable or better health at the time of retirement 7,[11][12][13] and a lower risk of mortality 13 than nonveterans.…”

“…PERSONS WITH TRAUMATIC BRAIN INJURY (TBI) are at an increased risk for poor long-term health outcomes, including comorbid health conditions and multimorbidity 1,2. A large civilian literature has demonstrated that the cumulative burden of health comorbidities after TBI is associated with increased functional decline, rehospitalization, and mortality 1–3. Studies of long-term health outcomes after TBI in military veterans are inconclusive.…”

“…PERSONS WITH TRAUMATIC BRAIN INJURY (TBI) are at an increased risk for poor long-term health outcomes, including comorbid health conditions and multimorbidity 1,2. A large civilian literature has demonstrated that the cumulative burden of health comorbidities after TBI is associated with increased functional decline, rehospitalization, and mortality 1–3.…”