Variations in Inpatient Rehabilitation Functional Outcomes Across Centers in the Traumatic Brain Injury Model Systems Study and the Influence of Demographics and Injury Severity on Patient Outcomes

Marie N. Dahdah, Sunni Barnes, Amy Buros, Rosemary Dubiel, Cynthia Dunklin, Librada Callender, Caryn Harper, Amy Wilson, Ramon Diaz-Arrastia, Thomas Bergquist, Mark Sherer, Gale Whiteneck, Christopher Pretz, Rodney D. Vanderploeg, Shahid Shafi

Research output: Contribution to journalArticle

11 Scopus citations

Abstract

Objective To compare patient functional outcomes across Traumatic Brain Injury Model Systems (TBIMS) rehabilitation centers using an enhanced statistical model and to determine factors that influence those outcomes. Design Multicenter observational cohort study. Setting TBIMS centers. Participants Patients with traumatic brain injury (TBI) admitted to 19 TBIMS rehabilitation centers from 2003–2012 (N=5505). Interventions Not applicable. Main Outcome Measures Functional outcomes of patients with TBI. Results Individuals with lower functional status at the time of admission, longer duration of posttraumatic amnesia, and higher burden of medical comorbidities continued to have worse functional outcomes at discharge from inpatient rehabilitation and at the 1-year follow-up, whereas those who were employed at the time of injury had better outcomes at both time periods. Risk-adjusted patient functional outcomes for patients in most TBIMS centers were consistent with previous research. However, there were wide performance differences for a few centers even after using more recently collected data, improving on the regression models by adding predictors known to influence functional outcomes, and using bootstrapping to eliminate confounds. Conclusions Specific patient, injury, and clinical factors are associated with differences in functional outcomes within and across TBIMS rehabilitation centers. However, these factors did not explain all the variance in patient outcomes, suggesting a role of some other predictors that remain unknown.

Original languageEnglish (US)
Pages (from-to)1821-1831
Number of pages11
JournalArchives of Physical Medicine and Rehabilitation
Volume97
Issue number11
DOIs
StatePublished - Nov 1 2016

Keywords

  • Brain injuries
  • Inpatients
  • Rehabilitation
  • Treatment outcome

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation

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    Dahdah, M. N., Barnes, S., Buros, A., Dubiel, R., Dunklin, C., Callender, L., Harper, C., Wilson, A., Diaz-Arrastia, R., Bergquist, T., Sherer, M., Whiteneck, G., Pretz, C., Vanderploeg, R. D., & Shafi, S. (2016). Variations in Inpatient Rehabilitation Functional Outcomes Across Centers in the Traumatic Brain Injury Model Systems Study and the Influence of Demographics and Injury Severity on Patient Outcomes. Archives of Physical Medicine and Rehabilitation, 97(11), 1821-1831. https://doi.org/10.1016/j.apmr.2016.05.005