Cognitive and Motor Recovery and Predictors of Long-Term Outcome in Patients With Traumatic Brain Injury
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OBJECTIVES: To explore the patterns of cognitive and motor recovery at 4 time points from admission to 9 months after discharge from inpatient rehabilitation (IR) and to investigate the association of therapeutic factors and conditions before and after discharge with long-term outcomes. DESIGN: Secondary analysis of traumatic brain injury (TBI) and practice-based evidence dataset. SETTING: IR in Ontario, Canada. PARTICIPANTS: Patients with TBI consecutively admitted for IR between 2008 and 2011 who had data available from admission to 9 months after discharge (N=85). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: FIM-Rasch cognitive and motor scores at admission, discharge, 3 months after discharge, and 9 months after discharge. RESULTS: Cognitive and motor recovery showed similar patterns of improvement with recovery up to 3 months but no significant change from 3 to 9 months. Having fewer postdischarge health conditions was associated with better long-term cognitive scores (95% confidence interval, -13.06 to -1.2) and added 9.9% to the explanatory power of the model. More therapy time in complex occupational therapy activities (95% confidence interval, .02 to .09) and fewer postdischarge health conditions (95% confidence interval, -19.5 to -3.8) were significant predictors of better long-term motor function and added 14.3% and 7.2% to the explanatory power of the model, respectively. CONCLUSION: Results of this study inform health care providers about the influence of the timing of IR on cognitive and motor recovery. In addition, it underlines the importance of making patients and families aware of residual health conditions following discharge from IR.
