Pre-injury Characteristics and Outcomes of Individuals who Do and Do Not Receive Rehabilitation

Past Studies 

Past Studies report that up to 2 million individuals sustain new traumatic brain injuries each year. It is suspected that only about 25% of those individuals are admitted to a hospital. Further, it is estimated that only 16% of those hospitalized, or 4% of all people who sustain a traumatic brain injury, receive inpatient rehabilitation. Historically, studies about individuals with traumatic brain injury have focused on those who received inpatient rehabilitation. Studies are lacking about the individuals with traumatic brain injury who do not seek or receive hospitalization and that do not receive rehabilitation after hospitalization.

This Study

This Study examined the medical records and surveyed 1059 individuals who were hospitalized with traumatic brain injuries in Colorado. Background information about the individuals and their injuries was obtained from the medical record review. The researchers conducted a structured telephone survey of the participants between 12 and 18 months after their brain injuries. The participants were surveyed about where they went after hospitalization, types of services received, their quality of life, and the abilities that they recovered following their traumatic brain injury.

The researchers found that nearly two-thirds of the participants did not receive any services after their hospitalization and were discharged to home. They received no inpatient rehabilitation, no outpatient services, and were not discharged to long-term care facilities. The individuals who received no services after hospitalization not only included 72% of those with mild traumatic brain injuries, but more than 50% of those with moderate traumatic brain injuries and almost 25% of those with the most severe initial injuries. These individuals were a little more likely to be minority males, to be employed at the time of their injuries, and to have non-government funded health insurance. Individuals that were discharged from the hospital to home with outpatient services were more likely to have milder brain injuries, to have non-government funded health insurance, and to be under the age of 65 and employed at the time of their injuries.

At one year from their injuries, individuals who were discharged to home with no services or with outpatient services had the highest rates of functional abilities, including physical mobility and higher cognitive (thinking) skills. Individuals who were discharged to home with no services reported a higher quality of life than individuals that were discharged to home with outpatient services. But keep in mind: better outcomes in this group are very likely explained by the fact that the majority of those discharged home without any services had mild injuries.

Individuals with severe brain injuries were 36 times more likely, while those with moderate brain injuries were three times more likely, to participate in inpatient rehabilitation. Individuals who received inpatient rehabilitation were more likely older, white, and female. At one year from their injuries, individuals who received inpatient rehabilitation had poor levels of functional abilities, except for physical mobility. Overall, individuals who received inpatient rehabilitation reported poor to good qualities of life. Is this because rehabilitation is not successful? Probably not. Please see the “Caveats” below.

Individuals who were discharged from the hospital or inpatient rehabilitation to a long-term care facility tended to be more severely injured older white individuals with government-funded healthcare. Individuals who were working prior to their brain injuries or were identified as belonging to a minority group were less likely to go to long-term care facilities. The individuals at the long-term care facilities had the poorest outcomes at one year from their injury dates. They had the lowest ratings for levels of physical mobility, social role fulfillment, health perception, and quality of life.

For all participants at one-year after the injury, discharge to a long-term care facility, having a severe brain injury, being female, being a minority, and having government-funded health insurance were factors associated with poor functional abilities. Working at the time of the injury was the factor associated with more favorable outcomes and more positive perceptions of health.

Who May Be Affected By These Findings

Individuals with traumatic brain injuries, healthcare providers, and researchers

Caveats

The researchers were not surprised that individuals who were discharged to long-term care facilities reported the poorest qualities of life. The researchers were surprised that individuals who received inpatient rehabilitation or were discharged to home reported poorer qualities of life—relatively few reported good or excellent quality of life. They suspect that their poorer outcomes and perceptions of quality of life at one year be because these individuals had more significant ongoing disabilities or deficits – regardless of how severe their injuries may have seemed initially. However this study did not specifically assess that. In any case, keep in mind that this study was not intended to directly assess the effectiveness of inpatient rehabilitation.

Bottom Line

Individuals who were discharged from the hospital to home without rehabilitation tended to have milder brain injuries, better outcomes, and reported the highest quality of life. Individuals who were discharged from the hospital or inpatient rehabilitation to long-term care facilities reported having the poorest functional abilities and the lowest qualities of life. For all participants at one-year after the injury, discharge to a long-term care facility, having a severe brain injury, being female, being a minority, and having government-funded health insurance were factors associated with poor functional abilities. Working at the time of the injury was the factor associated with more favorable outcomes and more positive perceptions of health.

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