Cognitive rehabilitation for traumatic brain injury: A randomized trial. Defense and Veterans Head Injury Program (DVHIP) Study Group.
BACKGROUND
Traumatic brain injury (TBI) is a principal cause of death and disability in young adults. Rehabilitation for TBI has not received the same level of scientific scrutiny for efficacy and cost-efficiency that is expected in other medical fields.


OBJECTIVE
To evaluate the efficacy of inpatient cognitive rehabilitation for patients with TBI.


METHODS
Single-center, parallel-group, randomized trial conducted from January 1992 through February 1997 at a US military medical referral center.


METHODS
One hundred twenty active-duty military personnel who had sustained a moderate-to-severe closed head injury, manifested by a Glasgow Coma Scale score of 13 or less, or posttraumatic amnesia lasting at least 24 hours, or focal cerebral contusion or hemorrhage on computed tomography or magnetic resonance imaging.


METHODS
Patients were randomly assigned to an intensive, standardized, 8-week, in-hospital cognitive rehabilitation program (n=67) or a limited home rehabilitation program with weekly telephone support from a psychiatric nurse (n=53).


METHODS
Return to gainful employment and fitness for military duty at 1-year follow-up, compared by intervention group.


RESULTS
At 1-year follow-up, there was no significant difference between patients who had received the intensive in-hospital cognitive rehabilitation program vs the limited home rehabilitation program in return to employment (90% vs 94%, respectively; P=.51; difference, 4% [95% confidence interval ¿CI¿, -5% to 14%]) or fitness for duty (73% vs 66%, respectively; P=. 43; difference, 7% [95% CI, -10% to 24%]). There also were no significant differences in cognitive, behavioral, or quality-of-life measures. In a post-hoc subset analysis of patients who were unconscious for more than 1 hour (n = 75) following TBI, the in-hospital group had a greater return-to-duty rate (80% vs 58%; P=. 05).


CONCLUSIONS
In this study, the overall benefit of in-hospital cognitive rehabilitation for patients with moderate-to-severe TBI was similar to that of home rehabilitation. These findings emphasize the importance of conducting randomized trials to evaluate TBI rehabilitation interventions. JAMA. 2000;283:3075-3081
Salazar
A M
AM
Defense and Veterans Head Injury Program, Bldg 1, Room B210, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA. asalazar@dvhip.org
Warden
D L
DL
Schwab
K
K
Spector
J
J
Braverman
S
S
Walter
J
J
Cole
R
R
Rosner
M M
MM
Martin
E M
EM
Ecklund
J
J
Ellenbogen
R G
RG
D000041:Absenteeism; D000328:Adult; D001930:Brain Injuries / Q000534:rehabilitation*; D003362:Cost-Benefit Analysis; D005260:Female; D006699:Home Care Services / Q000191:economics; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D008889:Military Personnel; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012046:Rehabilitation / Q000191:economics; D014481:United States