Physicians' preferences and expectations in traumatic brain injury rehabilitation--results of a case-based questionnaire survey.
OBJECTIVE
Analysis of medical decisions in the differential allocation of traumatic brain injury (TBI) rehabilitation programmes.


METHODS
Medical specialists routinely involved in the treatment and rehabilitation of TBI patients from acute hospitals, rehabilitation centres, and the Medical Services of the Workers' Pension Insurance of Sachsen-Anhalt and Mecklenburg-Vorpommern were included in a systematic survey, in which they had to give their opinions on the individually optimal rehabilitation setting and therapies and probable outcome on the basis of case vignettes. These specialists are crucial for decision-making in rehabilitation resource allocation.


RESULTS
Both allocation and prognosis depended mainly on patient characteristics. In a mixed logistic regression model, which takes into account that: (a) patient and physician characteristics may influence each other; and (b) that expert assessments might be correlated, setting preferences were related to chronicity and degree of motor and cognitive impairment, but also to the institutional background of the reviewer. Neuropsychological therapy dominated intervention recommendations, followed by physio- and occupational therapy. A comparatively great demand of psychotherapy and medicosocial assessment was recognized. Preferred rehabilitation setting did not influence the physicians' subjective prognosis. Older, chronic and motorically impaired patients were considered to profit less from rehabilitation. Physician characteristics and recommendations of either rehabilitation setting or therapies did not influence prognostic expectations.


CONCLUSIONS
Physician characteristics influenced setting preferences. Preferences for type of treatment and ADL-prognosis depended on patients' variables only. Expected effects of rehabilitation were independent on rehabilitation setting and kinds of treatment.
Hasenbein
U
U
Institute of Neurological and Neurosurgical Rehabilitation Research, Magdeburg, Germany. neuro.wallesch@medizin.uni-magdeburg.de
Kuss
O
O
Bäumer
M
M
Schert
C
C
Schneider
H
H
Wallesch
C W
CW
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D001930:Brain Injuries / Q000175:diagnosis / Q000534:rehabilitation*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D010349:Patient Compliance; D026741:Physical Therapy Modalities / Q000379:methods*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011379:Prognosis; D012047:Rehabilitation Centers; D018570:Risk Assessment; D012307:Risk Factors; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D016896:Treatment Outcome