Assessment of long-term activity limitations and participation restrictions of persons with traumatic brain injury using the disability rating scale

Abstract

The rehabilitation of patients with traumatic brain injury (TBI), or intracranial injury, is the most complex segment of rehabilitation. The majority of patients with TBI are young, and the consequences are temporary or permanent limitation of activities and participation. Rehabilitation is primarily carried out in special hospitals for medical rehabilitation, and occasionally continues with rehabilitation on an outpatient basis or in the patient's home. The question of when treatment and rehabilitation is complete is often posed. An investigation of 40 patients with TBI was conducted at the completion of hospital rehabilitation and again three to five years after the completion of hospital treatment to assess the disability rating scale (DRS). The average age of patients was 33 years at the time of occurrence of the TBI, and the great majority were male (90%). The follow-up survey was conducted at the patient's home, and only in a few cases in the Osijek University Hospital or the Krapinske Toplice Special Hospital for Medical Rehabilitation. The DRS is an assessment of the level of activity and participation through four components: arousability, awareness, responsivity; cognitive ability for self-care activities; dependence on others; psychosocial adaptability and total DRS. Statistical testing was conducted at a significance level of 95%, and data analysis was carried out on the licensed programme STATISTICA 6.1 (StatSoft inc. 1983-2003, license no. AGA304B211928E61). The Wilcoxon test was used to determine statistical differences. After three to five years, there were no cases of statistically significant worsening or improvement of arousability, awareness and responsivity (0.067890, p > 0.05) or cognitive ability for self-care activities (0.108810, p > 0.05). However, there was a statistically significant improvement in dependence on others (0.000012, p < 0.05) and psychosocial adaptation (0.011719, p < 0.05). The TBI patients in the study had statistically significant improvement of their activities and progression three to five years after the completion of hospital rehabilitation monitored using the DRS (0.000004, p < 0.05). These results refer only to those patients who continued to live in a family environment. It is necessary to conduct further study to determine an improvement or worsening of activities and participation of patients with TBI who continued living outside a family (senior rest home, social care institute, private home for seniors and the disabled). The present study established that there is improvement in patients with TBI living in a family environment even three to five years after the completion of inpatient medical rehabilitation, particularly in the segments of dependence on others in activities of everyday life, education and employment.