Outcome of a comprehensive neurorehabilitation program for patients with traumatic brain injury.
OBJECTIVE
To evaluate the outcome of a comprehensive neurorehabilitation program compared with that of conventional clinical care and rehabilitation for patients with traumatic brain injury (TBI).


METHODS
Nonrandomized, controlled trial with a 2-year follow-up.


METHODS
Nationwide rehabilitation center and level I trauma center, both in Finland.


METHODS
We studied 19 consecutive adults with a significant TBI who underwent a comprehensive neurorehabilitation program and 20 control patients who received conventional rehabilitation referred by physicians in the general health care system. The outcome of the control patients was not known before the selection. The groups were similar in age, sex, education, injury severity (assessed on the Glasgow Coma Scale, radiologic and neuropsychologic findings, neurosurgical interventions), time from the injury, and preinjury employment status.


METHODS
A postacute, intensive, interdisciplinary, 6-week rehabilitation program for TBI patients who are considered to have adequate potential to achieve productivity by this means; focus on neuropsychologic rehabilitation and psychotherapy with vocational interventions and follow-up support.


METHODS
Status of productivity, judged as productive (defined as working, studying, or participating in volunteer activities) or nonproductive, evaluated on questionnaires filled in by patients and their significant others at the time of follow-up evaluation.


RESULTS
At follow-up, 89% of the treated patients were productive compared with 55% of the controls. The rehabilitation program was significantly predictive of the productive status at follow-up (odds ratio=6.96; 95% confidence interval, 1.26-38.44; P=.017). Other factors did not explain the better productivity of the treatment group. Two neuropsychologist-evaluators, who were blind to the rehabilitation history of patients and to each other's evaluations, were perfectly consistent in their classification of patients' productivity statuses.


CONCLUSIONS
The findings support the proposition that comprehensive neuropsychologically oriented rehabilitation programs can improve psychosocial functioning in terms of productivity in postacute patients with moderate to severe TBI. Additional larger controlled studies are needed to establish the efficacy of TBI rehabilitation interventions.
Sarajuuri
Jaana M
JM
Department of Clinical Neuropsychology, Käpylä Rehabilitation Centre, Finnish Association of People with Mobility Disabilities, Helsinki, Finland. jaana.sarajuuri@invalidiliitto.fi
Kaipio
Marja-Liisa
ML
Koskinen
Sanna K
SK
Niemelä
Mika R
MR
Servo
Antti R
AR
Vilkki
Juhani S
JS
D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000534:rehabilitation*; D004651:Employment; D005260:Female; D005387:Finland; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team; D012046:Rehabilitation / Q000379:methods / Q000458:organization & administration; D012047:Rehabilitation Centers; D012050:Rehabilitation, Vocational; D014193:Trauma Centers