Panel answers questions about TBI, rehabilitation
How effective is rehab care for TBI patients?
The American Medical Rehabilitation Providers Association in Washington, DC, asked a panel of experts to review medical literature relating to traumatic brain injury (TBI) and to answer five questions about TBI rehabilitation treatment.
A full synopsis of the panel’s findings can be found on AMRPA’s Web site at http://amrpa. firminc.com. Here’s a thumbnail sketch of the panel’s conclusions:
1. Should interdisciplinary rehabilitation begin during acute hospitalization for traumatic brain injury?
One small study supported an association between the acute institution of multidisciplinary TBI rehabilitation and decreased length of stay (LOS). But no comparative studies presented evidence for or against early rehabilitation in patients with mild or moderate injury.
2. Does the intensity of inpatient interdisciplinary rehabilitation affect long-term outcomes?
The panel concluded that it does not, when intensity is measured as the hours of application of individual or grouped therapies. However, the studies had weak methodology and may have missed a significant relationship. The studies had insufficient information about severity of injury and baseline function.
The panel also found no scientific support for a hospital to mandate a minimum number of hours of applied therapy for all TBI patients. It recommended that future studies should compare acute, inpatient rehabilitation to common alternatives such as care in a skilled nursing facility or less-intense variations of acute rehabilitation.
3. Does the application of cognitive rehabilitation enhance outcomes for people who sustain TBI?
Two small studies showed evidence that personally adapted electronic devices, such as a notebook and an alarm wristwatch, reduce everyday memory failures for people with TBI. Another study showed that compensatory cognitive rehabilitation reduces anxiety and improves self-concept and relationships for people with TBI.
4. Does the application of supported employment or vocational rehabilitation services and training enhance outcomes for people with TBI?
Some studies indicated that supported employ ment can improve TBI survivors’ vocational outcomes. But those studies were limited and have not been replicated.
5. Does the provision of long-term care coordination enhance the general functional status of people with TBI?
The panel found few studies on the effectiveness of case management, and even those studies had mixed results, especially the study of the effects of case management on disability or functional status, living status, the family, and other aspects. The panel recommended that future research should focus on improving the outcomes measures used to examine the results of case management in TBI rehabilitation. Future research should include an indicator that looks at whether case management helped increase the use of community and rehabilitation services among families of TBI patients, the panel suggested.
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