Characterizing the Outcomes for Patients With Brain Injury in Acute Care Rehabilitation

SIGNIFICANCE: The purpose of this study was to understand the factors affecting recovery of patients with brain injury (BI) by examining the etiology and demographic variables within the inpatient rehabilitation setting. This analysis is important because BI is a disorder of major public health concern due to its high incidence, prevalence, and economic consequences. BI can severely compromise the independence, productivity, and well-being of patients for the remainder of their lives. BI affects people of all ages and is the leading cause of long-term disability in young adults that often compromise their well-being.

INNOVATION: In this study, we analyzed data from a large number of patients (N = 1,620) in which a large number of clinical variables could be associated with outcomes. An innovative component of the study was to analyze the influence of marital status and living situation on BI patients’ cognitive and motor recovery.

APPROACH AND RESULTS: We hypothesized that factors such as older age, presence of nontraumatic BI, male gender, and lower premorbid functional status would correlate with longer rehabilitation course, discharge to another facility with assistance, and less change in Functional Independence Measure (FIM) scores. In this descriptive study, we used retrospective data that are routinely collected and stored in patients’ medical records. Data were gathered for 1,620 male and female patients who (1) were aged 18 yr or older at the time of admission, (2) were diagnosed with an acquired BI and treated in the Brain Injury Program at Spaulding Rehabilitation Hospital (SRH) Boston, (3) were admitted to SRH Boston from January 2007 through June 2011, (4) had data available in the medical record database. The independent variables include age, gender, marital status/support, prior living environment, work history, comorbidities at admission, and BI diagnosis. The dependent variables consisted of change in cognitive and motor FIM scores, discharge disposition, and length of rehabilitation course.

Regression analyses were performed to determine which independent variables were predictive factors of outcomes. Each of the four dependent measures—discharge disposition, length of rehabilitation course, change in cognitive FIM, and change in motor FIM—were analyzed within separate regression models.

We found that patients with traumatic BI have better motor and cognitive outcomes, but longer rehabilitation stay, compared to patients with nontraumatic BI. Those working prior to injury had better cognitive and motor gains with a greater likelihood of ultimate home discharge. Younger patients had greater gains in motor function and were more likely to be discharged home, but they had a longer rehabilitation course. Gender was not a predictor of outcomes. Living with another person was a strong predictor for home discharge and a shorter length of stay. Patients with a spouse had greater improvements in cognitive function, but marital support was not a predictive factor in home discharge, shorter length of stay, or gains in motor function.

CONCLUSION: The results support the study hypothesis and elucidate other important factors in BI recovery and outcomes, including marital status and living with another person. Clinicians should consider these factors to optimally guide treatment interventions and discharge planning to promote recovery and independence in their patients.