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Titre : | Economic Evaluation of Activities of Daily Living Retraining During Posttraumatic Amnesia for Inpatient Rehabilitation Following Severe Traumatic Brain Injury (2019) |
Auteurs : | Duncan Mortimer ; Jessica Trevena-Peters ; Adam McKay |
Type de document : | Article |
Dans : | Archives of Physical Medicine and Rehabilitation (Vol. 100, n° 4, 2019) |
Article en page(s) : | p. 648-655 |
Langues: | Anglais |
Descripteurs : |
HE Vinci Activités de la vie quotidienne ; Coûts et analyse des coûts ; Lésions traumatiques de l'encéphale ; Rééducation et réadaptation |
Résumé : |
Objective
To evaluate the cost-effectiveness of structured activities of daily living (ADL) retraining during posttraumatic amnesia (PTA) plus treatment as usual (TAU) vs TAU alone for inpatient rehabilitation following severe traumatic brain injury (TBI). Design Trial-based economic evaluation from a health-system perspective. Setting Inpatient rehabilitation center. Participants Participants (N=104) admitted to rehabilitation and in PTA for >7 days following severe TBI. Interventions Structured ADL retraining during PTA plus TAU vs TAU alone. Structured ADL retraining was manualized to minimize the risk of agitation and maximize functional improvement, following principles of errorless and procedural learning and targeting individualized therapy goals. TAU included physiotherapy and/or speech therapy during PTA plus ADL retraining after PTA emergence. Main Outcome Measures FIM total scores at baseline, PTA emergence, hospital discharge, or final follow-up (2mo postdischarge) where FIM total scores were calculated as the sum of 5 FIM motor self-care items and a FIM meal-preparation item. Results Structured ADL retraining during PTA significantly increased functional independence at PTA emergence (mean difference: 4.90, SE: 1.4, 95% confidence interval [CI]: 1.5, 8.3) and hospital discharge (mean difference: 5.22, SE: 1.4, 95% CI: 1.8, 8.7). Even in our most pessimistic scenario, structured ADL retraining was cost-saving as compared to TAU (mean: -$7762; 95% CI: -$8105, -$7419). Together, these results imply that structured ADL retraining dominates (less costly but no less effective) TAU when effectiveness is evaluated at PTA emergence and hospital discharge. Conclusions Structured ADL retraining during PTA yields net cost-savings to the health system and offers a cost-effective means of increasing functional independence at PTA emergence and hospital discharge. |
Disponible en ligne : | Oui |
En ligne : | https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/science/article/pii/S0003999318313637 |