Early predictors of long-term participation in patients with severe acquired traumatic injury discharged from Intensive Rehabilitation Unit.

Abstract

Background: Participation represents the most relevant indicator of successful functioning after a severe traumatic brain injury (sTBI), since it correlates with a higher perceived quality of life by patients, their families, and healthcare professionals. Nevertheless, studies on Italian population are lacking.

Aim: The aim of this study was to evaluate the long-term participation and its early predictors in patients after a sTBI.

Design: This paper is an observational retrospective single-site study with long-term follow-up.

Setting: The Intensive Rehabilitation Units (IRU) of the IRCCS Don Gnocchi Foundation, Florence, Italy.

Population: The population included adults who were admitted to the IRU after a sTBI from August 2012 to May 2020 and who underwent a longitudinal follow-up between September 2021 and April 2022.

Methods: Patients were contacted by a phone interview including participation assessment using the Community Integration Questionnaire (CIQ). When the patients were unable to respond, the caregiver was interviewed. Early predictors of long-term participation at admission and discharge from the IRU were assessed by a univariate and a multivariate analysis.

Results: Among one hundred and forty-nine eligible patients, 3 died during their IRU stay, 35 patients were lost at the follow-up, 5 refused to participate in the interview and 46 died between discharge and follow-up. Sixty patients (men: 48 [80%]; age: 53.8 [IQR: 34.1] years; time postonset [TPO]: 36.5 [IQR: 22] days; education level: 8 [IQR: 5] years; mean time event-follow-up: 5.8 [IQR: 3.5] years) were included. The total CIQ Score was 11 (0-28): Home integration score 4 (0-10), Social integration 6 (0-12) and Productive activity 0 (0-6). Among 33 patients who worked or studied before the event, 19 (57.6%) returned to their previous activities. Only a younger age was associated with a better long-term participation both at admission (B=-0.210, P<0.001, R²=0.307) and at discharge (B=-0.173, P<0.001, R²=0.398).

Conclusions: This study reveals that under the same umbrella label of sTBI there are patients whose trajectories of long-term participation recovery are extremely heterogeneous. Further studies on larger samples are needed to identify patients with better participation recovery profiles, to customize their rehabilitation pathway.

Clinical rehabilitation impact: The present study provides relevant information to help clinicians in giving accurate information to caregivers and drawing adequate rehabilitation pathways.