Trajectories of Functional Change After Inpatient Rehabilitation for Traumatic Brain Injury

Abstract

Objective: To examine trajectories of functional recovery after rehabilitation for traumatic brain injury (TBI).

Design: Prospective study.

Setting: Inpatient rehabilitation hospitals in the Uniform Data System for Medical Rehabilitation.

Participants: A subset of individuals receiving inpatient rehabilitation services for TBI from 2002 to 2010 who also had postdischarge measurement of functional independence (N=16,583).

Interventions: Inpatient rehabilitation.

Main outcomes measures: Admission, discharge, and follow-up data were obtained from the Uniform Data System for Medical Rehabilitation. We used latent class mixture models to examine recovery trajectories for both cognitive and motor functioning as measured by the FIM instrument.

Results: Latent class models identified 3 trajectories (low, medium, high) for both cognitive and motor FIM subscales. Factors associated with membership in the low cognition trajectory group included younger age, male sex, racial/ethnic minority, Medicare or Medicaid (vs commercial or other insurance), comorbid conditions, and greater duration from injury date to rehabilitation admission date. Factors associated with membership in the low motor trajectory group included older age, racial/ethnic minority, Medicare or Medicaid coverage, comorbid conditions, open head injury, and greater duration to admission.

Conclusions: Standard approaches to assessing recovery patterns after TBI obscure differences between subgroups with trajectories that differ from the overall mean. Select demographic and clinical characteristics can help classify patients with TBI into distinct functional recovery trajectories, which can enhance both patient-centered care and quality improvement efforts.

Keywords: Recovery of function; Rehabilitation; Traumatic brain injury.

Figure 1

Plots of cognitive FIM rating (top panel) and motor FIM rating (bottom panel) predicted from linear models (double line) and predicted and observed (icons) values for three trajectory groups: low FIM rating (dotted line), moderate FIM rating (dashed line), and high FIM rating (solid line).