Results Summary

What was the research about?

Traumatic brain injury, or TBI, is a change in brain function due to damage caused by a jolt to the head, shaking, or other external forces. TBI can happen from car crashes, sports, falls, violence, or other events. Patients with severe TBI often have a hard time focusing or remembering things. They can also have trouble with walking, dressing, and other daily tasks. Rehabilitation, or rehab, therapy can help patients recover from a TBI.

In this study, the research team looked at two types of rehab therapy:

  • Advanced therapy. In advanced therapy, people work on difficult tasks, such as problem solving. The team compared patients who spent more versus less of their therapy time in advanced therapy.
  • Therapy with real-life tasks. In this type of therapy, people practice doing tasks of daily life, such as remembering a phone number or calling someone on the phone. The team compared patients who spent more versus less of their therapy time working on real-life tasks.

What were the results?

Advanced therapy. Compared with patients who spent less of their therapy time in advanced therapy, patients who spent more of their therapy time in this type of therapy

  • Spent more time in their communities
  • Could do more daily tasks without help
  • Reported improved well-being

Among those who spent a greater portion of time in advanced therapy, patients with more severe disability improved more on doing daily tasks compared with patients with less severe disability.

Therapy with real-life tasks. Compared with patients who spent less of their therapy time working with real-life tasks, patients who spent more of their therapy time this way

  • Spent more time in their communities.

However, the two groups did not differ in their well-being or ability to do daily tasks without help.

Among those who received a greater portion of time in this therapy, patients with more severe disability improved more on doing daily tasks compared with patients with less severe disability.

Who was in the study?

The research team looked at health and research records for 1,843 patients who received rehab therapy while staying in one of nine hospitals across the United States after a TBI. The typical length of patients’ hospital stay was 25 days, with about 15 hours of therapy delivered each week. Of the patients, 82 percent were white, 15 percent were black, and 3 percent were of another race. The average age was 44, and 72 percent were men.

What did the research team do?

The research team reviewed patient records to see

  • How much of their therapy was advanced therapy
  • How much of their therapy used real-life tasks
  • Results from patient surveys about spending time in the community and well-being

The research team used these records to divide people into groups that received a lesser portion of each type of therapy and groups that received a greater portion of each type of therapy. Then they compared the different groups.

Patients with TBI and rehab professionals helped design and conduct the study.

What were the limits of the study?

Although the results suggested that patients with TBI could benefit from spending more time in both types of therapy, the research team can’t be sure it was the amount of time in the two types of therapy that caused the benefits.

Future research could use other study designs and look at the longer term effects of these two types of therapy.

How can people use the results?

Doctors and patients with TBI can use these results when considering what type of therapy patients should get.

Final Research Report

View this project's final research report.

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented, and the researchers made changes or provided responses. The comments and responses included the following:

  • The reviewers asked that the report include more interpretation of the findings and what they mean practically. In addition, they commented that results need to be written so that they are clear to a general medical research readership. The researchers revised the results section to include more interpretation and to make it more readable to those not accustomed to the types of analyses used in this study.
  • Reviewers said it was not clear whether researchers made adjustments in statistical significance for multiple comparisons to reduce the potential for false-positive conclusions. The researchers said they did not adjust for multiple comparisons because they chose the primary outcome and time point of interest before starting the study, and because they were more interested in estimating treatment effects rather than measuring the statistical significance of the effects. By providing all the analyses they conducted and the estimated effect sizes for all comparisons, the researchers said they were providing transparency to allow readers to assess whether the results seem meaningful and whether the conclusions seem valid. 
  • Reviewers suggested that the two methods for classifying treatments—as advanced or contextualized—are not clearly delineated, and the overlap in these concepts would make analyses difficult to interpret. The researchers argued that the two methods of classification have a minimal relationship with each other. They agreed that a follow-up study could evaluate the effects of therapies with different combinations of contextual and advanced characteristics, but the current study indicates that the most beneficial approach seems to be to provide treatments that target advanced functions in the context of meaningful activities.

Conflict of Interest Disclosures

Project Information

Jennifer A. Bogner, PhD
Ohio State University College of Medicine
Comparative Effectiveness of Rehabilitation Interventions for Traumatic Brain Injury

Key Dates

September 2014
June 2019

Study Registration Information


Has Results
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Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
Populations Populations PCORI is interested in research that seeks to better understand how different clinical and health system options work for different people. These populations are frequently studied in our portfolio or identified as being of interest by our stakeholders. View Glossary
Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
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Last updated: April 19, 2024