title: Predicting levels of independence with expressing needs and ideas 1 year after severe brain injury.
abstract: OBJECTIVE
  Severe brain injury (BI) is a catastrophic event often evolving into a complex chronic and severely disabling condition making activity participation possible only with sustained caregiving. One aspect of building sustainable caregiving is early provision of information about expected outcomes germane to patients and their caregivers. An analysis was conducted to determine whether 2 levels of independence with expressing needs and ideas 1-year after severe BI could be predicted using variables available early after injury.
  
  
  METHODS
  The authors examined a subsample (n = 79) of participants of an outcome study who received repeated neurobehavioral evaluations with the Disorders of Consciousness Scale (DOCS) and who were assessed 1 year after injury with the Functional Independence Measures (FIM). Explanatory variables included DOCS measures, patient characteristics, coexisting conditions, and interventions. The outcome is measured with the FIM Expression item. Optimal data analysis was used to construct multivariate classification tree models.
  
  
  RESULTS
  The 2nd (p = .004) DOCS visual measure and seizure (p = .004) entered the final model providing 79% accuracy in classifying more or less independence with expressing needs and ideas at 1 year. The model will correctly identify 78% of future severe BI survivors who will have more independence and 82% of persons who will have less independence.
  
  
  CONCLUSIONS
  For persons incurring severe BI, it is possible to predict, early after injury, more and less independence with expressing needs and ideas 1-year after injury. This evidence is 1 contribution to a larger body of evidence needed to enable early caregiver education about recovery expectations in terms of patient functioning relative to caregiving needs, which in turn will help build sustainable caregiving for this population.
authors: The Department of Veterans Affairs (VA), Research Service and the Center for Management of Complex Chronic Care Center of Excellence, Edward Hines Jr. VA Hospital.
authors: Theresa Louise-Bender
authors: TL
authors: Pape
authors: Ann
authors: A
authors: Guernon
authors: Sandra
authors: S
authors: Lundgren
authors: Vijaya
authors: V
authors: Patil
authors: Amy A
authors: AA
authors: Herrold
authors: Bridget
authors: B
authors: Smith
authors: Melanie
authors: M
authors: Blahnik
authors: Linda M
authors: LM
authors: Picon
authors: Brett
authors: B
authors: Harton
authors: Michelle
authors: M
authors: Peterson
authors: Trudy
authors: T
authors: Mallinson
authors: Michael
authors: M
authors: Hoffmann
mesh_terms: D000203:Activities of Daily Living / Q000145:classification* / Q000523:psychology*; D000293:Adolescent; D000328:Adult; D020208:Brain Injury, Chronic / Q000175:diagnosis / Q000523:psychology* / Q000534:rehabilitation*; D003142:Communication; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D009483:Neuropsychological Tests; D018458:Persistent Vegetative State / Q000523:psychology / Q000534:rehabilitation; D011379:Prognosis; D012047:Rehabilitation Centers; D055815:Young Adult