Traumatic brain injury: Patient experience and satisfaction with discharge from trauma hospital

Tverdal, Cathrine; Howe, Emilie Isager; Røe, Cecilie; Helseth, Eirik; Lü, Juan; Tenovuo, Olli; Anđelić, Nada

doi:10.2340/16501977-2332

Cited by 22 publications

(10 citation statements)

References 24 publications

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“…A substantial number of patients received PT at least up to 5 years post-injury in line with other studies of service provision in the post-acute phase of TBI, showing that PT is the most frequently used rehabilitation service (8). TBI with accompanying extracranial injuries was frequently present in this study, in line with other studies conducted in trauma hospitals (30). Hence, PT services may have been used for treatment of accompanying orthopaedic injuries at least during the first year after the injury.…”

Section: Discussionsupporting

confidence: 90%

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

Anđelić¹,

Forslund²,

Perrin³

et al. 2020

J Rehabil Med

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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.

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Section: Discussionsupporting

confidence: 90%

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

Anđelić¹,

Forslund²,

Perrin³

et al. 2020

J Rehabil Med

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“…49 In terms of future research, further international studies are warranted to corroborate the presents findings, and to better understand the reasons for the lack of rehabilitation in a high proportion of patients with TBI (eg, poor geographic access, financial barriers, lack of patient adherence, fragmented pathways of care). Moreover, since there are important differences between European neurotrauma centers in terms of structural and process characteristics of in-hospital acute rehabilitation and referral to postacute rehabilitation facilities, 50,51 more studies are needed to better understand these differences and their potential impact on rehabilitation outcomes. Recent evidence suggests that rehabilitation following TBI should be early and intensive, while it should be undergone in specialized units.…”

Section: Implications and Directions For Future Researchmentioning

confidence: 99%

Predictors of Access to Rehabilitation in the Year Following Traumatic Brain Injury: A European Prospective and Multicenter Study

Jacob

Cogné²,

Tenovuo

et al. 2020

Neurorehabil Neural Repair

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Background Although rehabilitation is beneficial for individuals with traumatic brain injury (TBI), a significant proportion of them do not receive adequate rehabilitation after acute care. Objective Therefore, the goal of this prospective and multicenter study was to investigate predictors of access to rehabilitation in the year following injury in patients with TBI. Methods Data from a large European study (CENTER-TBI), including TBIs of all severities between December 2014 and December 2017 were used (N = 4498 patients). Participants were dichotomized into those who had and those who did not have access to rehabilitation in the year following TBI. Potential predictors included sociodemographic factors, psychoactive substance use, preinjury medical history, injury-related factors, and factors related to medical care, complications, and discharge. Results In the year following traumatic injury, 31.4% of patients received rehabilitation services. Access to rehabilitation was positively and significantly predicted by female sex (odds ratio [OR] = 1.50), increased number of years of education completed (OR = 1.05), living in Northern (OR = 1.62; reference: Western Europe) or Southern Europe (OR = 1.74), lower prehospital Glasgow Coma Scale score (OR = 1.03), higher Injury Severity Score (OR = 1.01), intracranial (OR = 1.33) and extracranial (OR = 1.99) surgery, and extracranial complication (OR = 1.75). On contrast, significant negative predictors were lack of preinjury employment (OR = 0.80), living in Central and Eastern Europe (OR = 0.42), and admission to hospital ward (OR = 0.47; reference: admission to intensive care unit) or direct discharge from emergency room (OR = 0.24). Conclusions Based on these findings, there is an urgent need to implement national and international guidelines and strategies for access to rehabilitation after TBI.

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“…However, this goal may not be achievable in all patients. It appears that only 41-50% of patients with severe TBI are referred directly from regional acute care to brain injury rehabilitation units [7][8][9]. Furthermore, direct pathway interruptions may have a negative effect on functional outcomes for individuals with severe TBI [8,10].…”

Section: Introductionmentioning

confidence: 99%

In the Aftermath of Acute Hospitalization for Traumatic Brain Injury: Factors Associated with the Direct Pathway into Specialized Rehabilitation

Tverdal

Anđelić

Helseth

et al. 2021

JCM

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Previous research has demonstrated that early initiation of rehabilitation and direct care pathways improve outcomes for patients with severe traumatic brain injury (TBI). Despite this knowledge, there is a concern that a number of patients are still not included in the direct care pathway. The study aim was to provide an updated overview of discharge to rehabilitation following acute care and identify factors associated with the direct pathway. We analyzed data from the Oslo TBI Registry—Neurosurgery over a five-year period (2015–2019) and included 1724 adults with intracranial injuries. We described the patient population and applied multivariable logistic regression to investigate factors associated with the probability of entering the direct pathway. In total, 289 patients followed the direct pathway. For patients with moderate–severe TBI, the proportion increased from 22% to 35% during the study period. Significant predictors were younger age, low preinjury comorbidities, moderate–severe TBI and disability due to TBI at the time of discharge. In patients aged 18–29 years, 53% followed the direct pathway, in contrast to 10% of patients aged 65–79 years (moderate–severe TBI). This study highlights the need for further emphasis on entering the direct pathway to rehabilitation, particularly for patients aged >64 years.

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Traumatic brain injury: Patient experience and satisfaction with discharge from trauma hospital

Abstract: Patient's involvement in healthcare decision-making and co-ordination of care is important for self-reported satisfaction with transition and quality of care transition.

Cited by 22 publications

References 24 publications

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

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

Predictors of Access to Rehabilitation in the Year Following Traumatic Brain Injury: A European Prospective and Multicenter Study

In the Aftermath of Acute Hospitalization for Traumatic Brain Injury: Factors Associated with the Direct Pathway into Specialized Rehabilitation

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