Table 3.5 Timing of Inpatient Rehabilitation Post ABI
Author Year Country Research Design PEDro Sample Size |
Methods |
Outcomes |
Formisano et al. (2016) Italy Case Control N=651 |
Population: TBI; Mean Age=43.67yr; Gender: Male=516, Female=135; Severity: Severe. Treatment: Participants were recruited from an inpatient rehabilitation centre and categorized by time from injury to rehabilitation (latency). Outcome Measures: Length of stay (LOS), Disability Rating Scale (DRS). |
1. There was a significant positive correlation between latency and LOS (p<0.01). 2. There was a significant positive correlation between latency and mean admission DRS (p<0.01). 3. There was a significant positive correlation between latency and mean discharge DRS (p<0.01). 4. There was a positive correlation between latency and the number of participants retransferred to acute care (p>0.05). |
Bender et al. (2014) Germany Case Series N=125 |
Population: TBI=38, Intracerebral Hemorrhage=23, Stroke=23, Anoxic Encephalopathy=20, Unknown=1; Mean Age=50.4yr; Gender: Male=73 Female=53. Intervention: Retrospective analysis of a group of patients with severe ABI who participated in an early rehabilitation program (ERP), followed by an inpatient interval rehabilitation program (IRP) a mean of 1.5 years later. Outcome Measure: Goal Attainment Scale, Barthel Index (BI), Functional Independence Measure (FIM), and Coma Remission Scale. |
1. Thirty-seven percent of IRP inpatients were successful overall in achieving their goals; success rates varied based on primary goals: 86.7% for decannulation, 34.6% for improvements in Activities of Daily Living (ADL), 30% for improvement in dysphagia, 17% for other individual goals (p<0.001). 2. Improvement in FIM scores was found during ERP, community care and also IRP (p<0.001). 3. BI scores improved significantly during ERP (p<0.001) and continued to improve during IRP (p<0.001). |
High et al. (2006) USA PCT NInitial=167, NFinal=141 |
Population: TBI; Group 1 (n=115): Mean Age=31.5yr; Gender: Male=86, Female=29. Group 2 (n=23): Mean Age=32.8yr; Gender: Male=14, Female=9. Group 3 (n=29): Mean Age=27.2yr; Gender: Male=18, Female=11. Treatment: Patients were enrolled in a comprehensive, integrated post-acute brain injury rehabilitation program. Patients were grouped depending on length of time between injury and admission: <6mo (Group 1), 6-12mo (Group 2), and >12mo (Group 3). Patients participated in an interview at admission, discharge and at approximately 1.5yr follow-up. Outcome Measure: Disability Rating Scale (DRS), Supervision Rating Scale (SRS), and Community Integration Questionnaire (CIQ). |
1. For those in Group 1, DRS scores from admission to discharge improved significantly (p<0.001). Such improvements were not seen in Groups 2 or 3. 2. SRS scores decreased from admission to follow-up for Group 1 at all time-points (all p<0.001). 3. Groups 2 and 3 reported significant decrease in supervision between admission and discharge (p=0.001 and p=0.002 respectively) but no significant change was observed between discharge and follow-up. 4. All groups demonstrated improvements in CIQ between admission and discharge (p<0.001) and between discharge and follow-up (p=0.003). 5. Social integration improved significantly between admission and follow-up (p=0.014) for all groups. |
Wagner et al. (2003) USA Case Control N=1,866 |
Population: TBI; Group 1 (n=520): Mean Age=48.5yr; Gender: Male=339, Female=181; Severity: Severe=178, Mild/Moderate=326. Group 2 (n=1,346): Mean Age=39.4yr; Gender: Male=939, Female=407; Severity: Severe=90, Mild/Moderate=1163. Treatment: A comparison was conducted between Group 1, patients who received physical medicine and rehabilitation consultation and those who did not (Group 2). Data was extracted from hospital records. Outcome Measure: Modified Functional Independence Measure (mFIM). |
1. Patients in Group 1, compared to Group 2, were more likely to have worse mFIM scores at acute discharge (p=0.05), have at least one premorbid condition (p=0.002) and have significantly longer length of stay (11.85 days versus 2.47 days, p<0.001). 2. For group 1, when the consultations occurred earlier (<48hr after hospital admission) patients experienced significantly better mFIM scores for transfers and locomotion (both p=0.05) and had significantly shorter acute length of stay (p=0.001). |
Edwards et al. (2003) USA Cohort N=290 |
Population: ABI: TBI=110, Intracerebral Hemorrhage/Subarachnoid Hemorrhage/Cerebral Infarction=122, Other=58; Mean Age=38yr; Gender: Male=193, Female=97. Treatment: Data was extracted from a hospital database. Patient assessments were conducted within 4wk of admission, every 6-8wk and at discharge. Patients were retrospectively split into two group, those admitted <200 days post-injury (n=264) and those admitted >200 days post-injury (n=26). Outcome Measure: Length of Stay, Barthel Index (BI), and Functional Independence Measure (FIM). |
1. Rehabilitation length of stay was similar for the two groups. 2. Lower BI and FIM scores at admission were significant predictors for increased length of stay for all patients (both p<0.001). 3. Discharge BI and FIM scores were lower in the admitted >200 days post-injury group than the <200 days post-injury group (BI, 11 versus 14; FIM, 77 versus 92 respectively), but the differences were not significant. |
(1992) USA Case Series N=49 |
Population: ABI; Mean Age=23.6yr; Gender: Male=38, Female=11; Mean Time Post Injury=2.9yr. Intervention: Data was obtained from records of patients readmitted to inpatient rehabilitation more than 12mo after injury. Outcome Measure: Barthel Index (BI). |
1. Fifty-three percent (n=26) showed improvement (mean BI gain of 11.2 points). 2. Statistically significant improvements of BI scores were shown from re-admission to discharge (p=0.0001). 3. Length of readmission was significantly correlated with improvements in BI (p=0.0016). |
Cope and Hall (1982) USA Case Control N=36 |
Population: ABI; Early Group (n=16): Mean Age=29yr; Gender: Male=9, Female=7; Mean Time Post Injury=20.88 days; Mean GCS=5.54. Late Group (n=20): Mean Age=29.15yr; Gender: Male=15, Female=5; Mean Time Post Injury=61.35 days; Mean GCS=5.11. Treatment: Patients were retrospectively assigned to one of two groups: an Early Rehabilitation Group which consisted of patients admitted to a rehabilitation facility at <35d post-injury or a Late Rehabilitation Group with patients admitted to a rehabilitation facility at >35d post-injury. Outcome Measure: Disability Rating Scale, Glasgow Outcome Scale, Social Status Outcome (SSO). |
1. Both groups reached equivalent levels of functional recovery at discharge and SSO ratings at 2yr post-injury. 2. Those in the Late Group spent significantly more time in acute care (p=0.001) and inpatient rehabilitation (p=0.01) than the Early Group. 3. At 2mo post-injury, patients in the Early Group experienced significantly less psychological impairment (p=0.02), and fewer problems with bowel and bladder function (p=0.05) than the Late Group. |