title: Functional recovery after severe traumatic brain injury: an individual growth curve approach.
abstract: OBJECTIVE
  To examine person, injury, and treatment characteristics associated with recovery trajectories of people with severe traumatic brain injury (TBI) during inpatient rehabilitation.
  
  
  METHODS
  Observational prospective longitudinal study.
  
  
  METHODS
  TBI rehabilitation units.
  
  
  METHODS
  Adults (N=206) with severe nonpenetrating TBI admitted directly to inpatient rehabilitation from acute care. Participants were excluded for prior disability and intentional etiology of injury.
  
  
  METHODS
  Naturally occurring treatments delivered within comprehensive multidisciplinary teams were recorded daily in 15-minute units provided to patients and family members, separately.
  
  
  METHODS
  Motor and cognitive FIM were measured on admission, discharge, and every 2 weeks in between and were analyzed with individual growth curve methodology.
  
  
  RESULTS
  Inpatient recovery was best modeled with linear, cubic, and quadratic components: relatively steep recovery was followed by deceleration of improvement, which attenuated prior to discharge. Slower recovery was associated with older age, longer coma, and interruptions to rehabilitation. Patients admitted at lower functional levels received more treatment, and more treatment was associated with slower recovery, presumably because treatment was allocated according to need. Therefore, effects of treatment on outcome could not be disentangled from effects of case mix factors.
  
  
  CONCLUSIONS
  FIM gain during inpatient recovery from severe TBI is not a linear process. In observational studies, the specific effects of treatment on rehabilitation outcomes are difficult to separate from case mix factors that are associated with both outcome and allocation of treatment.
authors.affiliation: Moss Rehabilitation Research Institute, Elkins Park, PA. Electronic address: thart@einstein.edu.
authors.forename: Tessa
authors.initials: T
authors.lastname: Hart
authors.affiliation: Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Kozlowski
authors.affiliation: Moss Rehabilitation Research Institute, Elkins Park, PA.
authors.forename: John
authors.initials: J
authors.lastname: Whyte
authors.affiliation: Department of Neurorehabilitation, Traumatic Brain Injury Unit, Research Unit on Brain Injury Rehabilitation, Glostrup Hospital, Copenhagen University, Copenhagen, Denmark.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Poulsen
authors.affiliation: Department of Neurorehabilitation, Traumatic Brain Injury Unit, Research Unit on Brain Injury Rehabilitation, Glostrup Hospital, Copenhagen University, Copenhagen, Denmark.
authors.forename: Karin
authors.initials: K
authors.lastname: Kristensen
authors.affiliation: Department of Neurorehabilitation, Traumatic Brain Injury Unit, Research Unit on Brain Injury Rehabilitation, Glostrup Hospital, Copenhagen University, Copenhagen, Denmark.
authors.forename: Annette
authors.initials: A
authors.lastname: Nordenbo
authors.affiliation: Rehabilitation Institute of Chicago, Chicago, IL; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors.forename: Allen W
authors.initials: AW
authors.lastname: Heinemann
mesh_terms: D000328:Adult; D000367:Age Factors; D001930:Brain Injuries / Q000534:rehabilitation*; D003071:Cognition; D003718:Denmark; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D063868:Patient Outcome Assessment; D011446:Prospective Studies; D011597:Psychomotor Performance; D020127:Recovery of Function; D014481:United States; D014949:Wounds, Nonpenetrating / Q000534:rehabilitation*; D055815:Young Adult
keywords: Brain injuries; Rehabilitation