title: Rehabilitation pathways and functional independence one year after severe traumatic brain injury.
abstract: BACKGROUND
  After severe traumatic brain injury (TBI) it is recommended that patients in need of rehabilitation be transferred directly from acute care to specialized rehabilitation. However, recent European cohort studies found a variety of care pathways and delays in admission to rehabilitation after severe TBI.
  
  
  OBJECTIVE
  To study the pathways within rehabilitation services in a Norwegian national cohort with severe TBI and the association to functional independence 12 months post-injury.
  
  
  METHODS
  Observational prospective multicenter study.
  
  
  METHODS
  Regional trauma centers.
  
  
  METHODS
  A total of 163 adults, age 16-85 years, with severe TBI.
  
  
  METHODS
  The main variables were transfer between acute care and rehabilitation, type of rehabilitation services and functional independence.
  
  
  RESULTS
  75% of the patients had specialized TBI rehabilitation, 11% non-specialized and 14% no in-patient rehabilitation. In total, 48% were transferred directly to specialized rehabilitation from acute units in regional trauma centers. There were no differences in injury severity between patients transferred directly and non-directly, but the direct-transfer patients were younger. At 12 months post-injury, 71% were functionally independent and 90% lived in their home. Younger age, fewer days of ventilation and shorter post-traumatic amnesia were associated with independence. Among patients treated with specialized rehabilitation, direct transfer to rehabilitation was associated with functional independence (OR=4.3, P<0.01).
  
  
  CONCLUSIONS
  A direct clinical pathway including specialized rehabilitation in dedicated units was associated with functional independence.
  
  
  CONCLUSIONS
  Direct pathways from acute care to sub-acute specialized rehabilitation might prove beneficial to functional status.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway - unni.sveen@hioa.no.
authors.forename: Unni
authors.initials: U
authors.lastname: Sveen
authors.forename: Cecilie
authors.initials: C
authors.lastname: Røe
authors.forename: Solrun
authors.initials: S
authors.lastname: Sigurdardottir
authors.forename: Toril
authors.initials: T
authors.lastname: Skandsen
authors.forename: Nada
authors.initials: N
authors.lastname: Andelic
authors.forename: Unn
authors.initials: U
authors.lastname: Manskow
authors.forename: Svein A
authors.initials: SA
authors.lastname: Berntsen
authors.forename: Helene L
authors.initials: HL
authors.lastname: Soberg
authors.forename: Audny
authors.initials: A
authors.lastname: Anke
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000070642:Brain Injuries, Traumatic / Q000175:diagnosis* / Q000534:rehabilitation*; D015331:Cohort Studies; D019091:Critical Pathways; D004185:Disability Evaluation; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009664:Norway; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D020127:Recovery of Function; D012047:Rehabilitation Centers; D018570:Risk Assessment; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult