title: Risk Factors for Institutionalization After Traumatic Brain Injury Inpatient Rehabilitation.
abstract: To create a profile of individuals with traumatic brain injury (TBI) who received inpatient rehabilitation and were discharged to an institutional setting using characteristics measured at rehabilitation discharge.
  
  
  
  The Traumatic Brain Injury Model Systems National Database is a prospective, multicenter, longitudinal database for people with moderate to severe TBI. We analyzed data for participants enrolled from January 2002 to June 2012 who had lived in a private residence before TBI. This cross-sectional study used logistic regression analyses to identify sociodemographic factors, lengths of stay, and cognitive and physical functioning levels that differentiated patients discharged to institutional versus private settings.
  
  
  
  Older age, living alone before TBI, and lower levels of function at rehabilitation discharge (independence in locomotion, bladder management, comprehension, and social interaction) were significantly associated with higher institutionalization rates and provided the best models identifying factors associated with institutionalization. Institutionalization was also associated with decreased independence in bed-chair-wheelchair transfers and increased duration of posttraumatic amnesia.
  
  
  
  Individuals institutionalized after inpatient rehabilitation for TBI were older, lived alone before injury, had longer posttraumatic amnesia durations, and were less independent in specific functional characteristics. Research evaluating the effect of increasing postdischarge support and improving treatment effectiveness in these functional areas is recommended.
authors.affiliation: West Haven Medical Group, a division of PACT, LLC, West Haven, Connecticut (Dr Eum); Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota (Dr Brown); Drucker Brain Injury Center, MossRehab, Albert Einstein Healthcare Network, and Temple University School of Medicine, Philadelphia, Pennsylvania (Dr Watanabe); Concussion Care Centre of Virginia, Ltd, Richmond, Tree of Life Services, Inc, Richmond, Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Department of Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, and International Brain Injury Association, Alexandria, Virginia (Dr Zasler); Department of Physical Medicine and Rehabilitation, Harvard Medical School, Brighton, Massachusetts (Dr Goldstein); Crawford Research Institute, Shepherd Center, Atlanta, Georgia (Dr Seel); Department of Physical Medicine and Rehabilitation, Northwestern Feinberg School of Medicine, and Patient Recovery Unit, Rehabilitation Institute of Chicago, Northwestern University, Chicago, Illinois (Dr Roth); Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Spaulding Rehabilitation Hospital, Charlestown, and Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Department of Physical Medicine and Rehabilitation, Boston, Massachusetts (Dr Zafonte); and Harvard Medical School, Spaulding Rehabilitation Hospital Boston, Charlestown, Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, and Department of Physical Medicine and Rehabilitation, Brigham and Women's Hospital, Boston, Massachusetts (Dr Glenn).
authors.forename: Regina S
authors.initials: RS
authors.lastname: Eum
authors.forename: Allen W
authors.initials: AW
authors.lastname: Brown
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Watanabe
authors.forename: Nathan D
authors.initials: ND
authors.lastname: Zasler
authors.forename: Richard
authors.initials: R
authors.lastname: Goldstein
authors.forename: Ronald T
authors.initials: RT
authors.lastname: Seel
authors.forename: Elliot J
authors.initials: EJ
authors.lastname: Roth
authors.forename: Ross D
authors.initials: RD
authors.lastname: Zafonte
authors.forename: Mel B
authors.initials: MB
authors.lastname: Glenn
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D000070642:Brain Injuries, Traumatic / Q000175:diagnosis / Q000534:rehabilitation*; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015994:Incidence; D007297:Inpatients / Q000706:statistics & numerical data*; D007326:Institutionalization / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D000066530:Neurological Rehabilitation / Q000379:methods*; D016017:Odds Ratio; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011379:Prognosis; D020127:Recovery of Function; D012008:Recurrence; D012047:Rehabilitation Centers; D019233:Retreatment / Q000379:methods; D012307:Risk Factors; D012737:Sex Factors; D055815:Young Adult