Prevalence, Patterns, and Predictors of Multimorbidity in Adults With Acquired Brain Injury at Admission to Staged Community-Based Rehabilitation

Abstract

Objectives To describe the prevalence, patterns, and predictors of multimorbidity in adults with an acquired brain injury (ABI) on presentation to a community-based neurorehabilitation service. Design Retrospective cohort study using routinely collected admissions and clinical data. Setting Community-based neurorehabilitation. Participants Individuals (N=263) with non-traumatic brain injury (NTBI; n=187 [71.1%]) versus traumatic brain injury (TBI; n=76 [28.9%]). Interventions Not applicable. Main Outcome Measures Comorbidity was defined as the co-occurrence of at least one chronic condition in conjunction with a primary diagnosis of ABI. Multimorbidity was defined as the co-occurrence of 2 or more chronic conditions across 2 or more body systems, in conjunction with a primary diagnosis of ABI. Results Comorbidity was present in 72.2% of participants overall, whereas multimorbidity was present in 35.4% of the cohort. The prevalence of comorbidity (76% vs 63%; P =.036) and multimorbidity (40% vs 24%; P =.012) was higher in NTBI compared with participants with TBI. Participants with NTBI had a higher prevalence of physical health multimorbidities, including cardiovascular (44% vs 6%; P <.001) and endocrine (34% vs 10%; P =.002) disease, whereas participants with TBI had a higher prevalence of mental health conditions (79% vs 48%; P <.001). Depression (36.3%) and hypertension (25.8%) were the most common diagnoses. Increasing age was the only significant predictor of multimorbidity. Conclusions Most participants experienced multimorbidity. Effective management of multimorbidity should be included as part of individual rehabilitation for ABI and planning of resource allocation and service delivery. The results of this study can help guide the provision of treatment and services for individuals with ABI in community-based rehabilitation. Our study highlights access to mental health, cardiovascular, endocrine, and neurology services as essential components of rehabilitation for ABI.

The influence of personal factors, unmet need and service obstacles on the relationship between health service use and outcome after brain injury

“…Participants were generally male (71%), married or in a de facto relationship (46%) and held full- or part-time employment before their injury (68%). These age [ 43 , 44 ], gender [ 43 , 44 ] and employment [ 45 ] rates are typical of a brain injury population, however, there was a higher proportion of participants who were married or in a de facto relationship than what might be expected [ 46 ]. Severe traumatic injuries were most common (61%) and the median length of hospital stay was 47 days—both slightly higher than what might be expected of an Australian sample [ 46 ].…”

“…These age [ 43 , 44 ], gender [ 43 , 44 ] and employment [ 45 ] rates are typical of a brain injury population, however, there was a higher proportion of participants who were married or in a de facto relationship than what might be expected [ 46 ]. Severe traumatic injuries were most common (61%) and the median length of hospital stay was 47 days—both slightly higher than what might be expected of an Australian sample [ 46 ]. As expected, [ 46 ] 27% of participants had no comorbidities.…”

“…Severe traumatic injuries were most common (61%) and the median length of hospital stay was 47 days—both slightly higher than what might be expected of an Australian sample [ 46 ]. As expected, [ 46 ] 27% of participants had no comorbidities. Participants were generally discharged to a private residence (85%).…”

The Effectiveness of Community-Based Interventions in Improving Activities of Daily Living and Quality of Life Outcomes in Persons Living with Stroke: a Systematic Review

“…CBR is focused on approaches that are developed in low-resource, capacity-constrained settings, especially LMICs (WHO, 2010). However, this term has been used throughout the literature to be synonymous with CBI within or outside the context of the CBR programme itself, whether it is developed within high-income countries (Bettger et al, 2019;Graven et al, 2011;Handberg, Mygind, & Johansen, 2019;Jackson, Troeung, & Martini, 2020;Jeong & Kim, 2007) or low-and middle-income countries (Iemmi et al, 2015;Yan et al, 2016).This makes searching for CBIs applicable to LMICs a tedious process.…”

Cohort profile: the Acquired Brain Injury Community REhabilitation and Support Services OuTcomes CohoRT (ABI-RESTaRT), Western Australia, 1991–2020

“… 41 43 Prior research using a retrospective convenience sample of 263 ABI-RESTaRT members admitted to the service from 2009 to 2018 found that mental health comorbidities were present in 55.8% of the sample (n=106), representing the most common comorbidity. 44 ABI-RESTaRT provides the opportunity to examine the prevalence of mental illness, specific mental health needs and its impact on rehabilitation outcomes to inform policy and services for mental health and ABI.…”