Affiliation:
1. Department of Physical Therapy, Faculty of Rehabilitation Gunma Paz University Takasaki Japan
2. Department of Health Science Gunma Paz University Graduate School of Health Sciences Takasaki Japan
3. Department of Rehabilitation Medicine Mie University Graduate School of Medicine Tsu Japan
Abstract
AbstractBackgroundRehabilitation is important for patients with moderate‐to‐severe traumatic brain injury (TBI). However, the timing of early rehabilitation initiation is ambiguous, and its safety and effectiveness are unknown.ObjectiveTo examine the effectiveness and safety of early rehabilitation in patients with moderate‐to‐severe TBI using propensity score analysis and a large database.DesignRetrospective cohort study.SettingA large medical database (JMDC database) of tertiary care facilities was used to compare outcomes of early and delayed rehabilitation.PatientsPatients aged between 20 and 90 years who were diagnosed with TBI were admitted to acute care hospitals. Inclusion criteria were patients undergoing rehabilitation within 7 days of admission with a Glasgow Coma Scale score of 3 to 12 on admission. This study included 3074 patients with moderate‐to‐severe TBI.InterventionsPatients were classified into an early rehabilitation group (within 2 days of admission) or a delayed rehabilitation group (3 to 7 days postadmission), depending on when rehabilitation started after TBI. Rehabilitation was defined as any type or intensity of intervention provided by a physical, occupational, and/or speech/language therapist. Interventions were not controlled.Main Outcome Measure(s)The primary outcome was Barthel Index (BI) efficiency (BI gain/length of stay). Secondary outcomes included BI gain (discharge BI − admission BI), incidence of aspiration pneumonia complications during hospitalization, discharge to home, mortality, and length of stay.ResultsAfter applying inverse probability weighting with propensity scores, the total was 6152 patients. 3074 (50.0%) patients received early rehabilitation. The early rehabilitation group showed no difference in inpatient mortality (p = .438), improved BI efficiency (β = 0.86, p < .001), and shorter length of stay (β = −5.00, p = .018).ConclusionsEarly rehabilitation in patients with moderate‐to‐severe TBI is associated with more efficient functional improvement and reduced hospital stays without an increase in inpatient mortality.