Inpatient rehabilitation for traumatic brain injury (TBI) has been studied largely as an undifferentiated black box. Research has not addressed which specific therapy interventions or medical procedures are effective for specific types of patients and impairments. This project proposes to open the black box of acute rehabilitation for individuals with TBI and create sophisticated, outcomes-based tools for clinical decision- making. This 5-year study will use Clinical Practice Improvement (CPI) methodology to characterize rehabilitation therapy services for 1,815 individuals with moderate to severe TBI and evaluate effects of these therapies on TBI rehabilitation outcomes, controlling for differences in patient characteristics and severity of injury and illness. CPI isolates specific components of rehabilitation treatments to determine how, and to what degree, each component is associated with outcomes. Three primary outcomes addressed are: (1) extent of functional improvement; (2) discharge to a private residence (versus nursing home, hospital, other institutional setting); and (3) resources reflected in length of stay. This is a collaborative research partnership among nine geographically and demographically diverse hospital-based TBI rehabilitation facilities and the ISIS Institute for Clinical Outcomes Research. Detailed, daily documentation of interventions performed in each therapy session, medical procedures delivered including medications and surgeries, nursing interventions, and psychosocial services will be recorded for a patient's entire acute rehabilitation stay. Standardized documentation that reflects current practice and existing research will be developed by clinicians and researchers from the participating centers.
Specific aims of the proposal and relevance to.public health are:
Aim 1 : Identify individual patient characteristics, including demographics, severity of brain injury, and severity of illness (complications and comobordities), associated with significant variation in outcomes.
Aim 2 : Identify medical procedures and therapy interventions, or combinations of procedures and interventions, that are associated with better outcomes, controlling for patient characteristics.
Aim 3 : Determine whether specific impairment by treatment interactions are associated with better outcomes. ? ? ?
|Majercik, Sarah; Bledsoe, Joseph; Ryser, David et al. (2017) Volumetric analysis of day of injury computed tomography is associated with rehabilitation outcomes after traumatic brain injury. J Trauma Acute Care Surg 82:80-92|
|Horn, Susan D; Corrigan, John D; Beaulieu, Cynthia L et al. (2015) Traumatic Brain Injury Patient, Injury, Therapy, and Ancillary Treatments Associated With Outcomes at Discharge and 9 Months Postdischarge. Arch Phys Med Rehabil 96:S304-29|
|Corrigan, John D; Horn, Susan D; Barrett, Ryan S et al. (2015) Effects of Patient Preinjury and Injury Characteristics on Acute Rehabilitation Outcomes for Traumatic Brain Injury. Arch Phys Med Rehabil 96:S209-21.e6|
|Seel, Ronald T; Barrett, Ryan S; Beaulieu, Cynthia L et al. (2015) Institutional Variation in Traumatic Brain Injury Acute Rehabilitation Practice. Arch Phys Med Rehabil 96:S197-208|
|Hammond, Flora M; Barrett, Ryan; Dijkers, Marcel P et al. (2015) Group Therapy Use and Its Impact on the Outcomes of Inpatient Rehabilitation After Traumatic Brain Injury: Data From Traumatic Brain Injury-Practice Based Evidence Project. Arch Phys Med Rehabil 96:S282-92.e5|
|Horn, Susan D; Corrigan, John D; Bogner, Jennifer et al. (2015) Traumatic Brain Injury-Practice Based Evidence Study: Design and Patients, Centers, Treatments, and Outcomes. Arch Phys Med Rehabil 96:S178-96.e15|
|Hammond, Flora M; Horn, Susan D; Smout, Randall J et al. (2015) Rehospitalization During 9 Months After Inpatient Rehabilitation for Traumatic Brain Injury. Arch Phys Med Rehabil 96:S330-9.e4|
|Bogner, Jennifer; Barrett, Ryan S; Hammond, Flora M et al. (2015) Predictors of Agitated Behavior During Inpatient Rehabilitation for Traumatic Brain Injury. Arch Phys Med Rehabil 96:S274-81.e4|
|Seel, Ronald T; Corrigan, John D; Dijkers, Marcel P et al. (2015) Patient Effort in Traumatic Brain Injury Inpatient Rehabilitation: Course and Associations With Age, Brain Injury Severity, and Time Postinjury. Arch Phys Med Rehabil 96:S235-44|
|Horn, Susan D; Corrigan, John D; Dijkers, Marcel P (2015) Traumatic Brain Injury Rehabilitation Comparative Effectiveness Research: Introduction to the Traumatic Brain Injury-Practice Based Evidence Archives Supplement. Arch Phys Med Rehabil 96:S173-7|
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