title: Late Functional Changes Post-Severe Traumatic Brain Injury Are Related to Community Reentry Support: Results From the PariS-TBI Cohort.
abstract: To explore late functional changes after a traumatic brain injury and their relation to patients' characteristics and reentry support.
  
  
  
  Prospective follow-up of an inception cohort of adults with severe traumatic brain injury recruited in 2005-2007 in the Parisian area, France. One and 4-year assessments were performed by trained neuropsychologists. One-to-4-year change in the Glasgow Outcome Scale-Extended defined 3 groups: "improvement," "stability," and "worsening." Relationships between these groups and patients' characteristics were analyzed.
  
  
  
  Among 504 recruited patients and 245 four-year survivors, 93 participated in both evaluations. Overall Glasgow Outcome Scale-Extended improved by 0.4. Forty percent of the sample improved, 44% were stable, and 16% worsened. Being in a more unfavorable group was related to preinjury alcohol abuse and to higher anxiety and depression at 4 years. Attendance to a specialized community reentry unit was related to higher chances of being in the "improvement" group in univariate analyses and after adjustment for age, time to follow command, preinjury alcohol and occupation, and mood disorders (adjusted odds ratio [OR] = 4.6 [1.1-20]).
  
  
  
  Late functional changes were related to psychosocial variables and to reentry support. The effect of reentry support on late recovery needs to be confirmed by further investigations.
authors.affiliation: Service de Médecine Physique et de Réadaptation, APHP, Hôpital Raymond Poincaré, Garches, France (Drs Jourdan, Vallat-Azouvi, and Azouvi); HANDIReSP EA 4047, Université de Versailles Saint-Quentin, Montigny-Le-Bretonneux, France (Drs Jourdan, Vallat-Azouvi, and Azouvi); Université Pierre et Marie Curie, Paris, France (Drs Bayen and Pradat-Diehl); APHP-Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Service de Médecine Physique et de Réadaptation, Paris, France (Drs Bayen and Pradat-Diehl); EA 2027, Université Paris VIII, Saint-Denis, France (Dr Vallat-Azouvi); Antenne UEROS-SAMSAH92-UGECAM IDF, Hôpital Raymond Poincaré, Garches, France (Dr Vallat-Azouvi); APHP-Hôpital Ambroise Paré, Unité de Recherche Clinique (URC), Boulogne, France (Messrs Ghout, Darnoux, and Azerad and Dr Aegerter); Centre Ressources Francilien du Traumatisme Crânien (CRFTC), Paris, France (Dr Charanton); and UMR-S 1168, Université de Versailles Saint-Quentin, UFR des Sciences de la Santé-Simone Veil, Montigny-le-Bretonneux, France (Dr Aegerter).
authors.forename: Claire
authors.initials: C
authors.lastname: Jourdan
authors.forename: E
authors.initials: E
authors.lastname: Bayen
authors.forename: C
authors.initials: C
authors.lastname: Vallat-Azouvi
authors.forename: I
authors.initials: I
authors.lastname: Ghout
authors.forename: E
authors.initials: E
authors.lastname: Darnoux
authors.forename: S
authors.initials: S
authors.lastname: Azerad
authors.forename: J
authors.initials: J
authors.lastname: Charanton
authors.forename: P
authors.initials: P
authors.lastname: Aegerter
authors.forename: P
authors.initials: P
authors.lastname: Pradat-Diehl
authors.forename: A
authors.initials: A
authors.lastname: Ruet
authors.forename: P
authors.initials: P
authors.lastname: Azouvi
mesh_terms: D000328:Adult; D000367:Age Factors; D000070642:Brain Injuries, Traumatic / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D015331:Cohort Studies; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000534:rehabilitation; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005602:France; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D062707:Return to Work / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012737:Sex Factors; D017741:Survivors; D013997:Time Factors; D014505:Urban Population; D055815:Young Adult