Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia; Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia.
Research Department, Craig Hospital, Englewood, Colorado.
Arch Phys Med Rehabil. 2021 Mar;102(3):371-377. doi: 10.1016/j.apmr.2020.09.387. Epub 2020 Oct 22.
This study compared traumatic brain injury (TBI) outcomes from 2 cohorts: the National Institute on Disability, Independent Living, and Rehabilitation Research Traumatic Brain Injury Model Systems (TBIMS) in the United States and Longitudinal Head Injury Outcome Study conducted in Victoria, Australia, by the Monash Epworth Rehabilitation Research Centre (MERRC).
Cohort study with 1- and 2-year follow-up.
Acute trauma care and inpatient rehabilitation with follow-up.
Patients (N=1056) with moderate-severe TBI admitted in 2000-2012 to inpatient rehabilitation after motor vehicle-related collisions, who completed follow-up, were matched using 1:2 matching algorithm based on age at injury, days of posttraumatic amnesia, and years education, resulting in groups of 352 (MERRC) and 704 patients (TBIMS).
The cohorts had received acute trauma care and inpatient rehabilitation for a median 38 (MERRC) or 33 days (TBIMS). The MERRC group also had routine access to community-based support and rehabilitation for return to work or school, attendant care, and home help as justified, funded by an accident compensation system, whereas the TBIMS cohort had variable access to these services.
Outcomes were assessed 1 and 2 years post injury in terms of employment, living situation, marital status, and Glasgow Outcome Scale-Extended (GOS-E) scores.
At 2 years post injury, MERRC participants were more likely to be competitively employed. At both 1 and 2 years post injury, MERRC participants were more likely to be married and living independently. On GOS-E, the TBIMS group had higher percentages of patients in Lower Severe Disability/Vegetative State and Upper Good Recovery than MERRC participants, whereas the MERRC cohort had higher percentages of Lower Moderate Disability than TBIMS.
Findings may suggest that routine provision of community-based supports could confer benefits for long-term TBI outcomes. Further studies documenting rehabilitation services are needed to explore this.
本研究比较了两个队列的创伤性脑损伤（TBI）结局：美国国家残疾、独立生活和康复研究创伤性脑损伤模型系统（TBIMS）和莫纳什伊普斯维奇康复研究中心（MERRC）在澳大利亚维多利亚州进行的纵向头部损伤结局研究。
具有 1 年和 2 年随访的队列研究。
急性创伤护理和住院康复，随访。
2000 年至 2012 年期间因机动车相关事故入住住院康复的中重度 TBI 患者，完成随访，采用基于损伤时年龄、创伤后遗忘天数和受教育年限的 1:2 匹配算法进行匹配，结果为 352 例（MERRC）和 704 例（TBIMS）患者。
两组患者均接受急性创伤护理和住院康复治疗，中位数为 38 天（MERRC）或 33 天（TBIMS）。MERRC 组还常规获得社区支持和康复服务，以重返工作或学校、随行护理和家庭帮助，如合理需要，由事故赔偿系统资助，而 TBIMS 组则可获得这些服务。
以就业、生活状况、婚姻状况和格拉斯哥结局量表-扩展（GOS-E）评分评估损伤后 1 年和 2 年的结局。
在损伤后 2 年，MERRC 参与者更有可能从事竞争性就业。在损伤后 1 年和 2 年，MERRC 参与者更有可能已婚且独立生活。在 GOS-E 评分上，TBIMS 组有更多的患者处于下重度残疾/植物状态和上良好恢复状态，而 MERRC 组有更多的患者处于下中度残疾状态。
研究结果可能表明，常规提供社区支持可能对长期 TBI 结局有益。需要进一步的研究来记录康复服务，以探讨这一点。
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