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

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

N_Initial=167, N_Final=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.

Tuel et al.

(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.