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European Journal of Physical and Rehabilitation Medicine 2016 October;52(5):650-61

Copyright © 2016 EDIZIONI MINERVA MEDICA

language: English

Rehabilitation pathways and functional independence one year after severe traumatic brain injury

Unni SVEEN 1, 2, Cecilie RØE 1, 3, Solrun SIGURDARDOTTIR 4, 5, Toril SKANDSEN 6, 7, Nada ANDELIC 1, Unn MANSKOW 8, 11, Svein A. BERNTSEN 9, Helene L. SOBERG 1, 2, Audny ANKE 8, 10

1 Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; 2 Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway; 3 Faculty of Medicine, University of Oslo, Oslo, Norway; 4 Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway; 5 Faculty of Medicine, Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), University of Oslo, Oslo, Norway; 6 Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; 7 Department of Physical Medicine and Rehabilitation, St. Olav’s Hospital, Trondheim University Hospital, Trondheim, Norway; 8 Department of Rehabilitation, University Hospital of North Norway, Tromso, Norway; 9 Department of Physical Medicine and Rehabilitation, Sorlandet Hospital, Kristiansand, Norway; 10 Faculty of Health Sciences, Department of Clinical Medicine, University of Tromso, Tromso, Norway; 11 Faculty of Health Sciences, Department of Health and Care Sciences, University of Tromso, Tromso, Norway


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BACKGROUND: After severe traumatic brain injury (TBI) it is recommended that patients in need of rehabilitation be transferred directly from acute care to specialized rehabilitation. However, recent European cohort studies found a variety of care pathways and delays in admission to rehabilitation after severe TBI.
AIM: To study the pathways within rehabilitation services in a Norwegian national cohort with severe TBI and the association to functional independence 12 months post-injury.
DESIGN: Observational prospective multicenter study.
SETTING: Regional trauma centers.
POPULATION: A total of 163 adults, age 16-85 years, with severe TBI.
METHODS: The main variables were transfer between acute care and rehabilitation, type of rehabilitation services and functional independence. Results: 75% of the patients had specialized TBI rehabilitation, 11% non-specialized and 14% no in-patient rehabilitation. In total, 48% were transferred directly to specialized rehabilitation from acute units in regional trauma centers. There were no differences in injury severity between patients transferred directly and non-directly, but the direct-transfer patients were younger. At 12 months post-injury, 71% were functionally independent and 90% lived in their home. Younger age, fewer days of ventilation and shorter post-traumatic amnesia were associated with independence. Among patients treated with specialized rehabilitation, direct transfer to rehabilitation was associated with functional independence (OR=4.3, P<0.01).
CONCLUSIONS: A direct clinical pathway including specialized rehabilitation in dedicated units was associated with functional independence.
CLINICAL REHABILITATION IMPACT: Direct pathways from acute care to sub-acute specialized rehabilitation might prove beneficial to functional status.

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