Variations in Inpatient Rehabilitation Functional Outcomes Across Centers in the Traumatic Brain Injury Model Systems Study and the Influence of Demographics and Injury Severity on Patient Outcomes

Dahdah, Marie; Barnes, Sunni A.; Buros, Amy; Dubiel, Rosemary; Dunklin, Cynthia; Callender, Librada; Harper, Caryn R.; Wilson, Amy E.; Diaz‐Arrastia, Ramon; Bergquist, Thomas F.; Sherer, Mark; Whiteneck, Gale G.; Pretz, Christopher R.; Vanderploeg, Rodney D.; Shafi, Shahid

doi:10.1016/j.apmr.2016.05.005

Cited by 31 publications

(23 citation statements)

References 50 publications

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“…Individuals with similar trauma may not experience similar functional gains over time. 3, 4 While inpatient rehabilitation following TBI results in improvements in functional independence, 5 survivors are often left with lasting deficits in cognitive, emotional and physical functioning; 6, 7 moderate to severe disability is common. 8 Factors associated with differences in functional recovery include age, race/ethnicity and variations in the intensity of post-acute care.…”

Section: Introductionmentioning

confidence: 99%

Trajectories of Functional Change After Inpatient Rehabilitation for Traumatic Brain Injury

Howrey

Graham

Pappadis

et al. 2017

Archives of Physical Medicine and Rehabilitation

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Objective To examine trajectories of functional recovery following rehabilitation for Traumatic Brain Injury (TBI). Design Prospective study. Setting Inpatient rehabilitation hospitals in the Uniform Data System for Medical Rehabilitation (UDSMR). Participants A subset of Individuals receiving inpatient rehabilitation services for TBI in 2002–2010 who also had post-discharge measurement of functional independence (N=16,583). Interventions Inpatient rehabilitation. Main Outcomes Measures Admission, discharge, and follow-up data were obtained from the UDSMR. We used latent class mixture models to examine recovery trajectories for both cognitive and motor functioning, as measured by the Functional Independence Measure (FIM) instrument. Results Latent class models identified three different trajectories (low, medium, high) for both cognitive and motor FIM scales. Factors associated with membership in the low cognition trajectory group included younger age, male, racial/ethnic minority, Medicare or Medicaid (vs. commercial or other insurance), comorbid conditions, and greater duration from injury date to rehabilitation admission date. Factors associated with membership in the low motor trajectory group included older age, racial/ethnic minority, Medicare or Medicaid coverage, comorbid conditions, open head injury, and greater duration to admission. Conclusion Standard approaches to assessing recovery patterns following TBI obscure differences between subgroups with trajectories that differ from the overall mean. Select demographic and clinical characteristics can help classify patients with TBI into distinct functional recovery trajectories, which can enhance both patient-centered care and quality improvement efforts.

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Section: Introductionmentioning

confidence: 99%

Trajectories of Functional Change After Inpatient Rehabilitation for Traumatic Brain Injury

Howrey

Graham

Pappadis

et al. 2017

Archives of Physical Medicine and Rehabilitation

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“…As such, TBI places a massive burden on society and the economy, a situation further compounded by its rising incidence [ 1 ]. Current surgical and rehabilitative interventions are limited in their ability to improve outcomes caused by TBI, and a large proportion of survivors endure debilitating neurological deficits as a consequence [ 2 ]. With limited efficacious treatment options, the development of an effective neuroprotective agent would be of great clinical significance in terms of reducing the impact of TBI on patients and the wider community.…”

Section: Introductionmentioning

confidence: 99%

Assessment of R18, COG1410, and APP96-110 in excitotoxicity and traumatic brain injury

Chiu

Anderton

Cross

et al. 2017

Translational Neuroscience

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Cationic arginine-rich and poly-arginine peptides (referred to as CARPs) have potent neuroprotective properties in in vitro excitotoxicity and in vivo models of stroke. Traumatic brain injury (TBI) shares many pathophysiological processes as stroke, including excitotoxicity. Therefore, we evaluated our lead peptide, poly-arginine R18, with the COG1410 and APP96-110 peptides, which have neuroprotective actions following TBI. In an in vitro cortical neuronal glutamic acid excitotoxicity injury model, R18 was highly neuroprotective and reduced neuronal calcium influx, while COG1410 and APP96-110 displayed modest neuroprotection and were less effective at reducing calcium influx. In an impact-acceleration closed-head injury model (Marmarou model), R18, COG1410, and APP96-110 were administered intravenously (300 nmol/kg) at 30 minutes after injury in male Sprague-Dawley rats. When compared to vehicle, no peptide significantly improved functional outcomes, however the R18 and COG1410 treatment groups displayed positive trends in the adhesive tape test and rotarod assessments. Similarly, no peptide had a significant effect on hippocampal neuronal loss, however a significant reduction in axonal injury was observed for R18 and COG1410. In conclusion, this study has demonstrated that R18 is significantly more effective than COG1410 and APP96-110 at reducing neuronal injury and calcium influx following excitotoxicity, and that both R18 and COG1410 reduce axonal injury following TBI. Additional dose response and treatment time course studies are required to further assess the efficacy of R18 in TBI.

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“…The quality of the studies was rated 7.00 (SD 2.11) and 6.61 (SD 2.02) by the two raters, with a high correlation between the raters ( r = 0.94). At the single item level, the assessors had different scores on 5.43% (15) of the items, (concealment 3, co-intervention 8, compliance 4). See Appendix 2 for the consensus based quality ratings for each study and items.…”

Section: Resultsmentioning

confidence: 99%

“…The data were summarized descriptively, and agreement between researchers was assessed by Pearson's correlation coefficient (r). The frequency of described dimensions and categories of service provision according to ICSO-R (15), with the predefined selection of descriptors suggested by Røe et al (26), are reported. Service provision was categorized regarding Location (i.e., country), Organization (public or private), Context (hospital or community), Facility (rehabilitation or general medical) and Profit orientation (yes/no).…”

Section: Data Analysis and Statisticsmentioning

confidence: 99%

“…Less is known about effective rehabilitation service delivery in the postacute and later phases, at least for the general TBI population (12, 13) and reviews focusing on this issue are warranted (14). Furthermore, the structure and process of care are seldom described, although they clearly impact the outcomes of TBI (15). The lack of a framework for depicting differences in service delivery could contribute to the scarce knowledge regarding optimal rehabilitation service delivery.…”

Section: Introductionmentioning

confidence: 99%

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Randomized Controlled Trials of Rehabilitation Services in the Post-acute Phase of Moderate and Severe Traumatic Brain Injury – A Systematic Review

et al. 2019

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Background and aims: There is a gap in knowledge regarding effective rehabilitation service delivery in the post-acute phase after traumatic brain injury (TBI). Recently, Gutenbrunner et al. proposed a classification system for health-related rehabilitation services (International Classification System for Service Organization in Health-related Rehabilitation, ICSO-R) that could be useful for contrasting and comparing rehabilitation services. The ICSO-R describes the dimensions of Provision (i.e., context of delivered services), Funding (i.e., sources of income and refunding), and Delivery (i.e., mode, structure and intensity) at the meso-level of services. We aim to: -Provide an overview of randomized, controlled trials (RCTs) with rehabilitation service relevance provided to patients with moderate and severe TBI in the post-acute phase using the ICSO-R as a framework; and -Evaluate the extent to which the provision, funding and delivery dimensions of rehabilitation services were addressed and differed between the intervention arms in these studies. Materials and methods: A systematic literature search was performed in OVID MEDLINE, EMBASE, CINHAL, PsychINFO, and CENTRAL, including multidisciplinary rehabilitation interventions with RCT designs and service relevance targeting moderate and severe TBI in the post-acute phase. Results: 23 studies with 4,644 TBI patients were included. More than two-thirds of the studies were conducted in a hospital-based rehabilitation setting. The contrast in Context between the intervention arms often co-varied with Resources. The funding of the services was explicitly described in only one study. Aspects of the Delivery dimension were described in all of the studies, and the Mode of Production, Intensity, Aspects of Time and Peer Support were contrasted in the intervention arms in several of the studies. A wide variety of outcome measures were applied often covering Body function, as well as the Activities and Participation domains of the International Classification of Functioning, Disability, and Health (ICF). Conclusion: Aspects of service organization and resources as well as delivery may clearly influence outcome of rehabilitation. Presently, lack of uniformity of data and collection methods, the heterogeneity of structures and processes of rehabilitation services, and a lack of common outcome measurements make comparisons between the studies difficult. Standardized descriptions of services by ICSO-R, offer the possibility to improve comparability in the future and thus enhance the relevance of rehabilitation studies.

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Variations in Inpatient Rehabilitation Functional Outcomes Across Centers in the Traumatic Brain Injury Model Systems Study and the Influence of Demographics and Injury Severity on Patient Outcomes

Cited by 31 publications

References 50 publications

Trajectories of Functional Change After Inpatient Rehabilitation for Traumatic Brain Injury

Trajectories of Functional Change After Inpatient Rehabilitation for Traumatic Brain Injury

Assessment of R18, COG1410, and APP96-110 in excitotoxicity and traumatic brain injury

Randomized Controlled Trials of Rehabilitation Services in the Post-acute Phase of Moderate and Severe Traumatic Brain Injury – A Systematic Review

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