Impact of Number of Drugs on Rehabilitation Outcomes in Patients after Traumatic Brain Injury: A Retrospective Cohort Study

Abstract

Objective To investigate the impact of the number of drugs on rehabilitation outcomes for patients with acute traumatic brain injury. Design Retrospective cohort study. Setting Hospital‐based database created by the Japan Medical Data Center. Participants Patients with acute traumatic brain injury admitted between April 2014 and November 2017. Methods Analysis of relationships among 1‐5 and ≥ 6 drugs as well as clinical outcomes in 2603 patients. Main Outcome Measurements The primary outcome was defined as the Barthel index efficiency, and the secondary outcome was Barthel index gain and length of hospital stay. Results Median Barthel index score on admission was 40. Barthel index efficiency and Barthel index gain were significantly higher in the group that had taken 1‐5 drugs than in the group that had taken ≥6 drugs on admission (median: 1.19 vs 0.50, 20.0 vs 10.0). Also, the group that had taken 1‐5 drugs had a significantly shorter length of hospital stay than in the group that had taken ≥6 drugs on admission (median 11.0 vs 14.0). Moreover, multiple linear regression analysis showed that having taken ≥6 drugs on admission was independently associated with Barthel index efficiency, Barthel index gain, and length of stay. Conclusions Taking≥6 drugs for acute traumatic brain injury was associated with lower Barthel index efficiency, lower Barthel index gain, and longer length of stay than taking 1‐5 drugs.

Pharmacotherapy and the Role of Pharmacists in Rehabilitation Medicine

“… 7 , 8 , 9 ) These prescribing practices are associated with significant costs and may have no obvious benefit to patients; however, they may have a significant impact on subsequent rehabilitation outcomes. Indeed, the association of polypharmacy and PIMs with decreased physical function and ADL, 10 , 11 , 12 , 13 ) cognitive decline, 14 ) and malnutrition 15 ) has been demonstrated in post-acute patients undergoing rehabilitation. 16 ) Therefore, pharmacotherapy needs to be performed in the rehabilitation medicine environment by a multidisciplinary team of medical professionals led by pharmacists.…”