Contextualized Treatment in Traumatic Brain Injury Inpatient Rehabilitation: Effects on Outcomes During the First Year after Discharge

Publication date: Available online 1 February 2019

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Jennifer Bogner, Marcel Dijkers, Erinn M. Hade, Cynthia Beaulieu, Erin Montgomery, Clare Giuffrida, Misti Timpson, Juan Peng, Kamie Gilchrist, Aubrey Lash, Flora M. Hammond, Susan Horn, John Corrigan

Abstract

Objective

To evaluate the effect of providing a greater percentage of therapy as contextualized treatment on acute traumatic brain injury (TBI) rehabilitation outcomes.

Design

Propensity score methods are applied to the TBI-Practice-Based Evidence (TBI-PBE) database, a database consisting of multi-site, prospective, longitudinal observational data.

Setting

Acute inpatient rehabilitation.

Participants

Patients enrolled in the TBI-PBE study (n=1843), aged 14 years or older, who sustained a severe, moderate, or complicated mild TBI, receiving their first IRF admission in the US, and consented to follow-up 3 and 9 months post discharge from inpatient rehabilitation.

Interventions

Not applicable.

Main Outcome Measures

Participation Assessment with Recombined Tools-Objective- -17, FIM^TM Motor and Cognitive scores, Satisfaction with Life Scale and Patient Health Questionnaire-9.

Results

Increasing the percentage of contextualized treatment during inpatient TBI rehabilitation leads to better outcomes, specifically in regard to community participation.

Conclusions

Increasing the proportion of treatment provided in the context of real-life activities appears to have a beneficial impact on outcome. Although the effect sizes are small, the results are consistent with other studies supporting functional-based interventions effecting better outcomes. Furthermore, any positive findings, regardless of size or strength, are endorsed as important by consumers (survivors of TBI). While the findings do not imply that decontextualized treatment should not be used, when the therapy goal can be addressed with either approach, the findings suggest that better outcomes may result if the contextualized approach is used.

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