Background: Traumatic brain injury (TBI) is increasingly recognized as a significant public health issue, but the most effective rehabilitation methods have not been identified. Reviews of the literature recommend using databases drawn from actual patient-care documentation to examine the effectiveness of current practices. This study will use a practice-based evidence database as recommended.
Objectives: The first objective of this study is to compare the effectiveness of different rehabilitation approaches. We believe that patients who receive therapy targeting more advanced functions will have better outcomes than patients who do not. We also believe treatment is more effective when it includes activities that are meaningful to patients. Our second objective is to compare the effectiveness of differences in the delivery of therapies. We think that the overall time spent in therapy has less of an effect on outcome than the patient’s ability to devote full effort to treatment. We also believe that patients have better outcomes when families attend therapy.
Methods: We will use an existing database that includes detailed information for 2,130 patients on rehabilitation therapies, course of recovery, characteristics of the patient and injury, and outcomes during and after rehabilitation. Advanced analytic methods will be used to compare the effects of different rehabilitation interventions on outcomes at discharge and during the first nine months following rehabilitation.
Patient Outcomes: This study focuses on outcomes important to patients: independent living, community participation, and subjective well-being. Community participation, as reported by patients, will be the primary outcome variable.
Patient and Stakeholder Engagement: The project will include co-investigators with TBI, family members, and clinicians. They have been involved in preparing this research proposal and will be actively involved in project implementation. In addition, the Advisory Council of the Ohio Valley Center for Brain Injury Prevention and Rehabilitation will play an advisory and evaluative role on the project. A Provider Advisory Group will also provide perspectives of clinicians, administrators, and clinical investigators.
Anticipated Impact: This study will identify rehabilitation interventions associated with optimal outcomes for persons with TBI. By reaching consumers, state advocacy agencies, the rehabilitation facility accrediting organization, as well as the multiple organizations that generate rehabilitation practice guidelines, we hope to see successful implementation of our findings, thus improving rehabilitation practice and optimizing outcomes for persons with TBI.