TY  - JOUR
PY  - 2024//
TI  - Effectiveness of early rehabilitation interventions in patients with traumatic brain injury using a large database
JO  - PM & R : the journal of injury, function, and rehabilitation
A1  - Hayashi, Shota
A1  - Kamo, Tomohiko
A1  - Momosaki, Ryo
SP  - ePub
EP  - ePub
VL  - ePub
IS  - ePub
N2  - BACKGROUND: Rehabilitation 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. <br><br>OBJECTIVE: To examine the effectiveness and safety of early rehabilitation in patients with moderate-to-severe TBI using propensity score analysis and a large database. <br><br>DESIGN: Retrospective cohort study. SETTING: A large medical database (JMDC database) of tertiary care facilities was used to compare outcomes of early and delayed rehabilitation. PATIENTS: Patients 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. INTERVENTIONS: Patients 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. <br><br>RESULTS: After 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). <br><br>CONCLUSIONS: Early 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.<p />  <p>Language: en</p>
LA  - en
SN  - 1934-1482
UR  - http://dx.doi.org/10.1002/pmrj.13243
ID  - ref1
ER  -