Early rehabilitative treatment in patients with traumatic brain injuries: outcome at one-year follow-up.

Abstract

Aim: The aim of this study was to analyze the outcome at one-year follow-up of patients with traumatic brain injuries (TBI) after 4 years of application of our organizing model and compare our results with the international data in terms of disability (functional independence measure [FIM], disability rating scale [DRS] scores) and social integration (community integration questionnaire [CIQ], work reentry)

Methods: We started a routine based on the presence of the physiatrist in the Intensive Care Unit (ICU) and Neurosurgery 3 times per week to evaluate all patients with TBI, program and control physiotherapeutic treatments and transfers to rehabilitative centers. Data were collected considering 80 TBI patients sequentially discharged from our department, from August 1999 to December 2003. The sample was composed of patients with severe brain injury evaluated at rehabilitation admission, rehabilitation discharge and one-year follow-up. We compared our data with those of the Traumatic Brain Injury Model System Data Base (TBI MSDB) and Gruppo Italiano per lo Studio delle Cerebrolesioni Acquisite Riabilitazione (GISCAR).

Results: Disability at one-year follow-up was better than at discharge: increase in FIM value, in DRS value. Social reintegration and return to work were not optimal: CIQ value was 16 and only 38% of patients returned to work at follow-up. Disability and social integration mean scores in our sample were similar to those obtained in TBI MSDB and so were the values of onset-admission interval (OAI) and length of stay (LOS). Differences were found with the Italian GISCAR database where mean OAI and LOS were higher than in our sample (55 and 86 days vs 18 and 37 days).

Conclusions: Our data show that this kind of organizing model for the rehabilitative evolution of TBI patients can positively influence the cost-efficiency rate of rehabilitation process reducing care costs in terms of ICU and rehabilitation LOS without affecting outcome in terms of disability and reintegration.