Rehabilitation pathways and functional independence one year after severe traumatic brain injury

Abstract

bacKGround: after severe traumatic brain injury (tbi) it is recommended that patients in need of rehabilitation be transferred directly from acute care to specialized rehabilitation. however, recent European cohort studies found a variety of care pathways and delays in admission to rehabilitation after severe tbi. aiM: to study the pathways within rehabilitation services in a norwegian national cohort with severe tbi and the association to functional independence 12 months post-injury. dEsiGn: observational prospective multicenter study. sEttinG: regional trauma centers. population: a total of 163 adults, age 16-85 years, with severe tbi. MEthods: the main variables were transfer between acute care and rehabilitation, type of rehabilitation services and functional independence. results: 75% of the patients had specialized tbi rehabilitation, 11% non-specialized and 14% no in-patient rehabilitation. in total, 48% were trans - ferred directly to specialized rehabilitation from acute units in regional trauma centers. there were no differences in injury severity between patients transferred directly and non-directly, but the direct-transfer patients were younger. at 12 months post-injury, 71% were functionally independent and 90% lived in their home. younger age, fewer days of ventilation and shorter post-traumatic amnesia were associated with independence. among patients treated with specialized rehabilitation, direct transfer to rehabilitation was associated with functional independence (or=4.3, p<0.01). conclusions: a direct clinical pathway including specialized rehabilitation in dedicated units was associated with functional independence. CLINICAL REHABILITATION IMPACT: Direct pathways from acute care to sub-acute specialized rehabilitation might prove beneficial to functional status