Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria; Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Richmond, Victoria.
Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria; Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Richmond, Victoria.
Arch Phys Med Rehabil. 2021 Mar;102(3):378-385. doi: 10.1016/j.apmr.2020.06.024. Epub 2020 Jul 31.
To examine the effect of agitation, cognitive impairment, fatigue, and pain on physical therapy participation and outcomes during posttraumatic amnesia (PTA) after traumatic brain injury (TBI).
Prospective longitudinal study.
Inpatient rehabilitation hospital.
Participants (N=77) with moderate-to-severe TBI who were deemed to be experiencing PTA using the Westmead Post-Traumatic Amnesia Scale.
Not applicable.
The Pittsburgh Rehabilitation Participation Scale and time in therapy (min) were recorded twice daily after routine physical therapy sessions during PTA. The FIM-motor (select items related to physical therapy) score rated on admission and after emergence from PTA was used to calculate FIM-motor change.
Agitation was associated with lower participation in therapy. The presence of agitation and pain both predicted lower FIM-motor change at emergence from PTA. Higher levels of cognitive impairment and fatigue were also associated with lower participation and less time in therapy.
The presence of agitation, fatigue, pain, and cognitive impairment impede rehabilitation success during PTA. This study strengthens the case for implementing environmental and behavioral recommendations, such as conducting therapy earlier in the day within a familiar space (ie, on the ward) and tailoring session duration to patient needs. This is with the aim of minimizing fatigue, agitation, and pain, while promoting cognitive recovery and arousal during PTA to maximize physical gains. Further research is warranted to examine the factors associated with rehabilitation success across other therapeutic disciplines.
探讨在创伤性脑损伤（TBI）后创伤后遗忘期（PTA）期间，患者的躁动、认知障碍、疲劳和疼痛对物理治疗参与度和结局的影响。
前瞻性纵向研究。
住院康复医院。
使用 Westmead 创伤后遗忘量表被认为处于 PTA 状态的中重度 TBI 患者（N=77）。
无。
在 PTA 期间，每日常规物理治疗后两次记录匹兹堡康复参与量表和治疗时间（min）。入院时和 PTA 后进行的 FIM-运动（与物理治疗相关的选择项目）评分用于计算 FIM-运动变化。
躁动与治疗参与度降低相关。躁动和疼痛的存在均预测 PTA 后 FIM-运动变化降低。认知障碍和疲劳程度较高也与参与度降低和治疗时间减少相关。
躁动、疲劳、疼痛和认知障碍的存在会阻碍 PTA 期间的康复成功。本研究为实施环境和行为建议提供了依据，例如在熟悉的环境（如病房）中更早地进行治疗，根据患者需求调整治疗时间，以最大程度地减少疲劳、躁动和疼痛，同时促进 PTA 期间的认知恢复和觉醒，从而最大限度地提高身体康复效果。需要进一步研究以探讨其他治疗学科中与康复成功相关的因素。
