title: Traumatic Brain Injury Patient, Injury, Therapy, and Ancillary Treatments Associated With Outcomes at Discharge and 9 Months Postdischarge.
abstract: OBJECTIVE
  To examine associations of patient and injury characteristics, inpatient rehabilitation therapy activities, and neurotropic medications with outcomes at discharge and 9 months postdischarge for patients with traumatic brain injury (TBI).
  
  
  METHODS
  Prospective, longitudinal observational study.
  
  
  METHODS
  Inpatient rehabilitation centers.
  
  
  METHODS
  Consecutive patients (N=2130) enrolled between 2008 and 2011, admitted for inpatient rehabilitation after an index TBI injury.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Rehabilitation length of stay, discharge to home, and FIM at discharge and 9 months postdischarge.
  
  
  RESULTS
  The admission FIM cognitive score was used to create 5 relatively homogeneous subgroups for subsequent analysis of treatment outcomes. Within each subgroup, significant associations were found between outcomes and patient and injury characteristics, time spent in therapy activities, and medications used. Patient and injury characteristics explained on average 35.7% of the variation in discharge outcomes and 22.3% in 9-month outcomes. Adding time spent and level of effort in therapy activities and percentage of stay using specific medications explained approximately 20% more variation for discharge outcomes and 12.9% for 9-month outcomes. After patient, injury, and treatment characteristics were used to predict outcomes, center differences added only approximately 1.9% additional variance explained.
  
  
  CONCLUSIONS
  At discharge, greater effort during therapy sessions, time spent in more complex therapy activities, and use of specific medications were associated with better outcomes for patients in all admission FIM cognitive subgroups. At 9 months postdischarge, similar but less pervasive associations were observed for therapy activities, but not classes of medications. Further research is warranted to examine more specific combinations of therapy activities and medications that are associated with better outcomes.
authors.affiliation: Institute for Clinical Outcomes Research, International Severity Information Systems, Salt Lake City, UT. Electronic address: susan.horn@hsc.utah.edu.
authors.forename: Susan D
authors.initials: SD
authors.lastname: Horn
authors.affiliation: Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, OH.
authors.forename: John D
authors.initials: JD
authors.lastname: Corrigan
authors.affiliation: Brooks Rehabilitation Hospital, Jacksonville, FL.
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Beaulieu
authors.affiliation: Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, OH.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bogner
authors.affiliation: Institute for Clinical Outcomes Research, International Severity Information Systems, Salt Lake City, UT.
authors.forename: Ryan S
authors.initials: RS
authors.lastname: Barrett
authors.affiliation: Rush University Medical Center, Chicago, IL.
authors.forename: Clare G
authors.initials: CG
authors.lastname: Giuffrida
authors.affiliation: Neuro Specialty Rehabilitation Unit, Intermountain Medical Center, Salt Lake City, UT.
authors.forename: David K
authors.initials: DK
authors.lastname: Ryser
authors.affiliation: Neuro Specialty Rehabilitation Unit, Intermountain Medical Center, Salt Lake City, UT.
authors.forename: Kelli
authors.initials: K
authors.lastname: Cooper
authors.affiliation: Neuro Specialty Rehabilitation Unit, Intermountain Medical Center, Salt Lake City, UT.
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Carroll
authors.affiliation: Maccabi Healthcare Services, Tel Aviv, Israel.
authors.forename: Daniel
authors.initials: D
authors.lastname: Deutscher
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000534:rehabilitation*; D002170:Canada; D055317:Evidence-Based Practice / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D026741:Physical Therapy Modalities / Q000706:statistics & numerical data; D011446:Prospective Studies; D020127:Recovery of Function; D012047:Rehabilitation Centers / Q000706:statistics & numerical data; D013070:Speech Therapy / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014481:United States
keywords: Brain injuries; Craniocerebral trauma; Outcome assessment (health care); Rehabilitation