Functional outcome after rehabilitation for severe traumatic brain injury

Abstract

Objective: (1) Define functional status at rehabilitation discharge and follow-up for patients admitted with Functional Independence Measure (FIM) of 18 after traumatic brain injury; (2) describe patterns of function measured at discharge, rehabilitation lengths of stay and costs, and disposition.

Design: Retrospective, descriptive study using data from the Uniform Data System for Medical Rehabilitation (UDSMR) dataset.

Setting: Acute rehabilitation hospitals and, for follow-up data, variety of settings, from community to long-term care.

Patients: 328 patients with rehabilitation admission FIM of 18 (principal impairment group "Brain Dysfunction, Traumatic") drawn from 5,430 TBI patients entered into the data set during 1989-1991. Excluded were 22 persons readmitted to rehab, 5 deaths, 1 case without recorded disposition, and 49 cases without ICD-9 code consistent with brain trauma.

Main outcome measures: FIM scores at rehab discharge and follow-up; disposition; length of stay; cost.

Results: (1) Mean FIM score at discharge for the group overall (n = 328) was 53 (median = 42 with interquartile range of 18 to 87); (2) 7.6% had functional scores consistent with independence in motor areas measured by FIM; (3) 2.7% had functional scores consistent with independence in cognitive areas measured by FIM; (4) 26.1% showed no change in FIM score between admission and discharge; (5) 53% were discharged to community settings, 25% to long-term care, 11% to acute facilities, and 11% to other rehab facilities; (6) average length of stay in acute rehab was 110 days (SD = 70.9, median = 99 days, interquartile range = 57 to 153 days); (7) average rehabilitation charges (n = 322) were $110,891; (8) for those with follow-up data (n = 59), average FIM score was 79 (median, 90); 24% were in school and 5% worked in sheltered workshops.

Conclusions: (1) Even the most severely disabled persons admitted to acute rehabilitation after traumatic brain injury can show a large degree of measurable functional improvement; (2) while about 25% of patients showed no measured FIM change, some showed dramatic degrees of functional recovery; (3) most common discharge setting was home (and community).