Long-term follow-up of use of therapy services for patients with moderate-to-severe traumatic brain injury

Abstract

Long-term disabilities are common after traumatic brain injury. Consequently, many patients need healthcare services following injury. This study followed 97 individuals with traumatic brain injury until 10 years after injury, and found that the use of physical therapy, occupational therapy and speech therapy decreased substantially over time. Approximately 1 in 6 individuals used physical therapy at 10 years, whereas the use of occupational and speech therapy was much lower. Higher use of services was associated with more severe injury, female sex, and being employed before injury. The low level of service use at 10 years after injury might indicate unmet needs in this patient population. Objectives: To examine the probabilities and baseline predictors of the use of physical therapy, occupational therapy and speech therapy over a period of 10 years after traumatic brain injury. Design: Longitudinal prospective follow-up at 1, 2, 5 and 10 years after traumatic brain injury. Participants: A total of 97 patients with moderateto-severe traumatic brain injury recruited from Oslo University Hospital, Norway, during acute hospital admission in 2005-2007. Methods: Socio-demographics and injury characteristics were recorded at baseline. Use of physical therapy, occupational therapy and speech therapy were recorded at follow-ups. Hierarchical linear modelling was applied to examine service use probabilities across the 4 time-points. Results: Service use decreased substantially over time, with physical therapy being the main service utilized at the 10-year follow-up (physical therapy 16%, occupational therapy 1%, speech therapy 3%). Use of services was related to severity of injury (CT head severity scores and post-traumatic amnesia), female sex, and pre-injury employment. In addition, in this sample, time since injury was associated with use of occupational therapy and speech therapy. Conclusion: This study presents a novel model for the long-term probability of use of physical therapy, occupational therapy and speech therapy following traumatic brain injury. The use of services was much lower than the expected problem profile of severe traumatic brain injuries, suggesting an insufficient long-term provision of traditional traumatic brain injury rehabilitation services.

Functional Recovery, Symptoms, and Quality of Life 1 to 5 Years After Traumatic Brain Injury

“…Other studies point to depression, physical comorbidities, cognitive functioning, and age as prognostic of long-term functional and quality of life outcomes after TBI . In light of the relative dearth of rehabilitation services and community supports beyond the first several months postinjury, our findings justify intensifying efforts to provide longer-term rehabilitation, mental health treatment, and community services for persons with TBI. The elevated rates of incomplete recovery among mTBI participants demonstrates the need for more comprehensive systems of care for level I trauma center patients irrespective of TBI severity and time since injury.…”

“…Other studies point to depression, physical comorbidities, cognitive functioning, and age as prognostic of long-term functional and quality of life outcomes after TBI. 8,11,35,38,39 In light of the relative dearth of rehabilitation services and community supports beyond the first several months postinjury, 12 our findings justify intensifying efforts to provide…”

“…The multicenter Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study revealed that, contrary to popular belief that mild TBI (mTBI) (ie, Glasgow Coma Scale [GCS] score, [13][14][15] is a time-limited condition, the majority of level I trauma center patients with mTBI continue to report symptoms and injury-related problems with daily function at 1 year postinjury. 15,17 Persons with moderate-severe TBI (msTBI) (GCS score, [3][4][5][6][7][8][9][10][11][12] in the TRACK-TBI sample have displayed varied outcomes, often achieving functional independence and returning to work but rarely making a complete recovery. 5 Unlike functional outcomes, which show a clear doseresponse association with TBI severity, TBI-related symptoms show elevated rates of persistence in all level I trauma center patients with TBI, with weak and sometimes conflicting associations with TBI severity.…”

Unmet Rehabilitation Needs after Traumatic Brain Injury across Europe: Results from the CENTER-TBI Study

“…Furthermore, some studies report that younger individuals more often received rehabilitation after TBI [ 10 , 12 , 13 ], while others report that older individuals more often received such services [ 14 , 15 ]. More frequent service utilization has been reported to be more frequent among patients after severe TBI [ 7 , 16 , 17 ], among those with more severe overall trauma [ 7 ] and in those with more severe disabilities [ 16 ]. Other studies report that unmet rehabilitation needs were significantly higher in individuals with a less severe disability outcome [ 10 ].…”

Health and Well-Being of Persons of Working Age up to Seven Years after Severe Traumatic Brain Injury in Northern Sweden: A Mixed Method Study

“…Repeated TBI is known as a risk factor for outcome [ 35 ]. Most follow-up studies on STBI have used a quantitative design with validated instruments [ 36 ], although there have also been qualitative studies [ 37 , 38 ]. The use of both surveys and interviews for a more complete evaluation of the outcome is recommended because validated instruments used by the injured person and proxy have a different input on what a good outcome is.…”