Five years after traumatic brain injury: a study of individual outcomes and predictors of change in function

Abstract

Objective: Study functional changes between one and five years after traumatic brain injury (TBI).

Design: Prospective cohort.

Setting and participants: TBI Model Systems National Database subjects using cohort with complete one and five year data (n = 301).

Main outcome measures: Disability Rating Scale (DRS) Level of Functioning and Employability Items.

Results: On Level of Functioning, 53 (18%) individuals improved, 228 (76%) stayed the same, and 20 (7%) worsened by more than one point from Year 1 to Year 5. On Employability, 50 (17%) individuals improved, 237 (79%) stayed the same, and 14 (5%) worsened by greater than one point. Level of Functioning improvement was predicted by FIM-Motor, FIM-Cognitive, Rey Auditory Verbal Learning Test, Symbol Digit Modalities Test (written and oral), and Wechsler Adult Intelligence Scale-Revised Block Design, and worsening predicted by Symbol Digit Modalities Test (written and oral). Improvement in Employability was predicted by race, while Glasgow Coma Scale Eye Opening was predictive of worsening.

Conclusions: Although the majority did not demonstrate meaningful change on the DRS items from year 1 to 5, some individuals made dramatic gains and a minority declined. There are demographic and functional indicators present at one-year post-injury that may be predictive of subsequent change.