Hart et al.

(2016)

Denmark

PCT

N=274

Population: TBI; US Group (n=145): Mean Age=37.5yr; Gender: Male=101, Female=44. Denmark Group (n=129): Mean Age=39.6yr; Gender: Male=103, Female=26.

Intervention: Patient outcomes from 2 TBI treatment centers were compared; a US center and a Denmark center where patients received significantly greater intensity and duration of rehabilitation.

Outcome Measure: Functional Independence Measure (FIM), Glasgow Outcome Scale (GOS), Disability Rating Scale, Participation Assessment with Recombined Tools, Perceived Quality of Life, Medical Outcome Study 12-Item Short-Form Health Survey, Brief Symptom inventory.

1.        Injury severity on admission was greater at the Denmark site compared to the US site. The DK center also provided significantly more rehabilitation services for both functional and emotional components (p<0.001).

2.        After adjusting for injury severity upon admission, there were no significant differences in functional or emotional outcomes between the Denmark and US site at 12 months post-TBI.

Zhu et al.

(2001)

Hong Kong

RCT

PEDro=8

N=36

Population: TBI; Conventional (n=21): Mean Age=33yr; Gender: Male=17, Female=4; Severity; Severe=13, Moderate=8. Intensive (n=15): Mean Age=30yr; Gender: Male=11, Female=4; Severity: Severe=10, Moderate=5.

Intervention: Patients were randomized into two groups: the intensive group received 4hr/day of therapy 5 days/wk while the conventional treatment group received 2 hr/day. Assessments were completed monthly for the first 6mo, then bi-monthly up to 1 yr.

Outcome Measure: Glasgow Outcome Scale (GOS) and Functional Independence Measure (FIM).

1.        A greater proportion of patients from the intensive group achieved “good” GOS outcome 2mo into treatment, compared with the conventional group (40% versus 10%; p=0.046). This difference, however, diminished from 3mo onwards.

2.        While there were no significant differences in mean FIM motor, cognitive and total scores, there appeared to be a trend in favour of the Intensive group.

Shiel et al.

(2001)

UK

RCT

PEDro=7

N=56

Population: ABI; Group 1 (n=12): Mean Age=34.2yr. Group 2 (n=13): Mean Age=36.2yr. Group 3 (n=12): Mean Age=37yr. Group 4 (n=14): Mean Age=39yr.

Intervention: Patients were randomly assigned to an intervention group with increased therapy intensity or a control group at two separate hospitals. Groups 1 and 2 were recruited from Southampton General Hospital and Groups 3 and 4 were recruited from Poole Hospital. Groups 1 and 3 received intensive therapy and Groups 2 and 4 received routine therapy.

Outcome Measure: Functional Independence Measure and Functional Assessment Measure, Length of Stay.

1.        Patients in Groups 3 and 4 were discharged significantly earlier (p=0.004) and received more routine therapy per week (p=0.0099) than patients in Groups 1 and 2.

2.        Length of stay was not significantly different between the overall intervention group (groups 1 and 3) and the control (groups 2 and 4).

3.        Patients in Groups 1 and 3 made significantly faster gains in self-care, psychosocial function (both p<0.001), continence (p=0.001), transfers (p=0.002), locomotion, cognition (both p=0.008) and communication (p=0.01) compared to patients in groups 2 and 4.

Webb & Glueckauf

(1994)

USA

RCT

PEDro=5

N=16

Population: TBI; Mean Age=27.4yr; Gender: Male=14, Female=2.

Intervention: Patients were assigned to either a high (n=8) or low (n=8) involvement neurorehabilitation goal-setting group. Assessments were completed 1wk pre-intervention, 1wk post-intervention and at 2mo follow-up.

Outcome Measure: Goal Attainment Scaling, Galveston Orientation and Amnesia Test.

1.        Both groups made significant improvements in obtaining their goals from pre- to post-intervention (p<0.01) but there were no significant differences between groups.

2.        Patients who had high involvement in their neurorehabilitation goal-setting maintained their improvements at 2mo follow-up (p<0.001) whereas patients who received low involvement demonstrated a decline in the number of goals attained.

Cicerone et al.

(2004)

USA

PCT

N=56

Population: TBI; Group 1 (n=27): Mean Age=37.8yr; Gender: Male=17, Female=10; Mean Time Post Injury=33.9 mo. Group 2 (n=29): Mean Age=37.1yr; Gender: Male=23, Female=6; Mean Time Post Injury=4.8 mo.

Intervention: Patients participated in one of two groups: Group 1 took part in an intensive cognitive rehabilitation program and group 2 was given a standard neurorehabilitation program for 4 mo.

Outcome Measure: Community Integration Questionnaire (CIQ), Trail-Making Test Parts A and B, California Verbal Learning Test, Controlled Oral Word Association Test, Rey Complex Figure, and Category Test.

1.        Both groups showed significant improvements on total CIQ scores following treatment (p<0.001). There was also a between-group difference, with participants in Group 1 showing greater improvement than those in Group 2 (p=0.021).

2.        Patients in Group 1 demonstrated significant improvements in neuropsychological function from pre- to post-treatment (p<0.001). Neuropsychological function was not evaluated for Group 2.

3.        There was a significant difference in patients’ satisfaction with community functioning; patients in Group 2 indicated greater levels of satisfaction than patients in Group 1 (p=0.03).

Cifu et al.

(2003)

USA

PCT

N=491

Population: TBI; Mean Age=34.3yr; Gender: Male=354, Female=137; Mean GCS=7.98.

Intervention:  Inpatient rehabilitation data from three medical centers was collected from the Traumatic Brain Injury Model Systems database. Patients received a combination of rehabilitation therapies, including speech, psychological, occupational and physical therapy.

Outcome Measure: Functional Independence Measure, Length of Stay (LOS), and hours of therapy.

1.        Rehabilitation intensity predicted motor functioning at discharge (p<0.001), but did not predict cognitive gain.

2.        Cognition and motor abilities at admission significantly predicted LOS (p<0.01).

Spivack et al.

(1992)

USA

Case Series

N=95

Population: TBI; Mean Age=38.6yr; Gender: Male=61, Female=34; Mean Time Post Injury=62.4 days; Mean GCS=8.8.

Intervention: Data was obtained from monthly medical records at a comprehensive inpatient rehabilitation program. Time spent and intensity of rehabilitation therapies were also observed including physical therapy, cognitive remediation, neuropsychology and therapeutic recreation.

Outcome Measure: Physical Performance*, Higher-level Cognitive Skills*, Cognitively Mediated Physical Skills*, Rancho Los Amigos Levels of Cognitive Functioning Scale (RLAS);*Denotes seven-point functional status scales developed by the clinicians within each rehabilitation discipline.

1.        For physical performance, higher-level cognitive skills and cognitively mediated physical skills, all subjects showed improvements from admission to discharge. The short LOS group was significantly better than the long LOS group at admission (p<0.05); however, at discharge all outcome measures were comparable between the 2 groups.

2.        The effect of training intensity in the first month on physical performance and cognitively mediated physical skills was not significant and approached significance for higher level cognitive skills (p=0.06).

3.        A significant interaction between training intensity for the first month and RLAS was obtained, with those in the high intensity group showing greater improvements (p<0.05).

Blackerby,

(1990)

USA

Case Control

N=86

Population: TBI=83, Other=3.

Intervention: Retrospective analysis of 2 hospitals that increased their rehabilitation intensity from 5hr/day to 8hr/day, 7 days/wk. Patients who underwent rehabilitation before the intensity increase were compared to those who underwent rehabilitation after.

Outcome Measure: Length of Stay (LOS).

1.        Increased rehabilitation therapy resulted in a 31% decrease in LOS for both coma and acute groups at both hospitals in the study (p<0.05).

2.        Patients in the coma group experienced an average LOS reduction of 48.43 days and the acute group averaged 52.87 days in reduced LOS.