| Résumé : |
Objective
To use causal inference methods to determine if receipt of a greater proportion of inpatient rehabilitation treatment focused on higher level functions, for example, executive functions, ambulating over uneven surfaces (advanced therapy [AdvTx]), results in better rehabilitation outcomes.
Design
A cohort study using propensity score methods applied to the traumatic brain injury practice-based evidence (TBI-PBE) database, a database consisting of multisite, prospective, longitudinal observational data.
Setting
Acute inpatient rehabilitation facilities.
Participants
Patients enrolled in the TBI-PBE study (N=1843), aged 14 years or older, who sustained a severe, moderate, or complicated mild TBI, receiving their first inpatient rehabilitation facility admission to 1 of 9 sites in the United States, and consented to follow-up 3 and 9 months postdischarge from inpatient rehabilitation.
Interventions
Not applicable.
Main Outcome Measures
Participation Assessment with Recombined Tools-Objective-17, FIM motor and cognitive scores, Satisfaction with Life Scale, and Patient Health Questionnaire-9.
Results
Controlling for measured potential confounders, increasing the percentage of AdvTx during inpatient TBI rehabilitation was found to be associated with better community participation, functional independence, life satisfaction, and decreased likelihood of depression during the year after discharge from inpatient rehabilitation. Participants who began rehabilitation with greater disability experienced larger gains on some outcomes than those who began rehabilitation with more intact abilities.
Conclusions
Increasing the proportion of treatment targeting higher level functions appears to have no detrimental and a small, beneficial effect on outcome. Caution should be exercised when inferring causality given that a large number of potential confounders could not be completely controlled with propensity score methods. Further, the extent to which unmeasured confounders influenced the findings is not known and could be of particular concern due to the potential for the patient’s recovery trajectory to influence therapists’ decisions to provide a greater amount of AdvTx. |
Visionner les documents numériques
Faire une suggestion Affiner la rechercheAdapting Strategy Training for Adults With Acquired Brain Injury: A Feasibility Study in a Chinese Population in American journal of occupational therapy, Vol. 74, n° 3 (May/June 2020)
Als je kind het zelf niet kan: praktische handleiding voor de dagelijkse activiteiten van een kind met een motorische handicap ten gevolge van een hersenbeschadiging (1997)
Aphasie : données anatomiques
