Unmet Needs for Community-Based Rehabilitation the First 12 Months Postinjury in a Traumatic Brain Injury Population with Moderate-to-Severe Trauma—a Longitudinal Cohort Study

Abstract

Objective

To describe and explore factors related to unmet needs and differences in urban vs rural centrality of community-based rehabilitation in patients with moderate-to-severe traumatic injuries with TBI at 12 months postinjury.

Design

A 12-month follow-up study of rehabilitation needs in a longitudinal multicenter cohort study Rehabilitation Needs, Service Provision, and Costs in the First Year after Traumatic Injuries.

Setting

Two reginal trauma centers and the patients’ municipality of residence.

Participants

Patients with moderate-to-severe trauma with a traumatic brain injury with age≥18 years, a New Injury Severity Score>9, an Abbreviated Injury – Head score≥2, admission to the trauma centers within 72 hours, and a hospital stay of at least 2 days. N=235 community dwelling patients (mean age 51.9y; 77.4% men) were included.

Interventions

Not applicable.

Main Outcome Measures

Unmet rehabilitation needs at 12 months on the Needs and Provision Complexity Scale. We hypothesized that injury severity and urban vs rural centrality of residence would predict unmet rehabilitation needs at 12 months postinjury.

Results

42.1% reported unmet rehabilitation needs on the Needs and Provision Complexity Scale Rehabilitation subscale at 12 months postinjury. Median unmet rehabilitation needs was 2.0 (interquartile range 1-3). Mean Glasgow Outcome Scale Extended (GOSE) was 6.2 (SD, 1.5).

A logistic regression model that included demographic and injury-related variables, urban vs rural centrality of residence and global functioning on the GOSE found that significant predictors of unmet rehabilitation needs were living in less central municipalities (odds ratio [OR], 2.18), AIS-Head≥3 (OR, 3.35), and lower GOSE scores at 6 months (OR, 1.60).

Conclusions

Unmet rehabilitation needs are common after moderate-to-severe trauma with TBI at 12 months postinjury. Particular attention is required for individuals with more severe TBI and those in less central municipalities, because they face higher risk of unmet rehabilitation needs.