Department of Neurology, Alfred Health, Melbourne, Australia.
Department of Neuroscience, Central Clinical School, Faculty of Medicine Nursing and Health Science, Monash University, The Alfred Centre, Melbourne, Australia.
Arch Phys Med Rehabil. 2023 Jul;104(7):1115-1123. doi: 10.1016/j.apmr.2023.03.015. Epub 2023 Apr 5.
This study characterized substance use (alcohol, illicit drugs, amphetamines) in patients with traumatic brain injury (TBI) receiving rehabilitation to determine potential benefit of rehabilitation and whether substance use influenced outcomes in moderate-severe TBI.
Prospective, longitudinal study of adults with moderate or severe TBI receiving inpatient rehabilitation.
Specialist-staffed acquired brain injury rehabilitation center in Melbourne, Australia.
A total of 153 consecutive inpatients with TBI admitted between January 2016 and December 2017 (24 months).
All inpatients with TBI (n=153) received specialist-provided brain injury rehabilitation in accordance with evidence-based guideline care at one 42-bed rehabilitation center.
Data were collected at time of TBI, upon rehabilitation admission, and discharge and 12 months' post-TBI. Recovery was measured by posttraumatic amnesia posttraumatic amnesia length-days and change in Glasgow Coma Scale (admission-discharge). Functional independence was measured on the FIM, Functional Assessment Measure, and Mayo Portland Adaptability Index. Quality of life (QOL) was measured on the EuroQOL-5D-5L and Quality of Life After Brain Injury (QOLIBRI) instruments.
Inpatients with history of illicit drug use (n=54) reported lower QOL and adjustment at 12 months' post-TBI compared with those with no history (QOLIBRI social relationships: ratio of means=0.808, P=.028; Mayo Portland Adaptability Index adjustment: incidence rate ratio, 1.273; P=.032). Amphetamine use at time of injury (n=10) was associated with quicker recovery (posttraumatic amnesia length-days: incidence rate ratio, 0.173; P<.01); however, lower QOL at 12 months post-TBI was noted in those with a history of amphetamine use (n=34) compared with those without (QOLIBRI bothered feelings: ratio of means, 0.489, P=.036).
All participants made improvements with rehabilitation post-TBI; however, a history of substance use was associated with lower reported 12-month QOL. These findings add insight to the associations between substance use and acute recovery, potentially suggestive of a short-term recovery-promoting effect of amphetamines but highlighting the importance of rehabilitation to address long-term sequalae.
本研究旨在描述接受康复治疗的创伤性脑损伤（TBI）患者的物质使用情况（酒精、非法药物、苯丙胺），以确定康复的潜在益处，以及物质使用是否会影响中重度 TBI 的结果。
对 2016 年 1 月至 2017 年 12 月（24 个月）期间在墨尔本澳大利亚一家专门从事脑损伤康复的综合性医院接受住院康复治疗的中重度 TBI 成年患者进行前瞻性、纵向研究。
墨尔本澳大利亚专门从事脑损伤康复的综合性医院。
共有 153 名连续接受 TBI 治疗的住院患者（24 个月）。
所有 TBI 住院患者（n=153）均在一家 42 张床位的康复中心接受了专家提供的脑损伤康复治疗，遵循基于证据的指南护理。
数据在 TBI 时、康复入院时和出院时以及 TBI 后 12 个月收集。康复程度通过创伤后遗忘长度天数和格拉斯哥昏迷量表（入院-出院）的变化来衡量。功能独立性通过功能独立性评定量表、功能评估量表和梅奥波特兰适应能力指数来衡量。生活质量（QOL）通过欧洲五维健康量表-5 维度-5 水平（EQ-5D-5L）和脑损伤后生活质量量表（QOLIBRI）来衡量。
与无既往史的患者相比，有既往非法药物使用史（n=54）的患者在 TBI 后 12 个月报告的生活质量和调整情况较低（QOLIBRI 社会关系：均数比，0.808，P=.028；梅奥波特兰适应能力指数调整：发病率比，1.273；P=.032）。受伤时使用苯丙胺（n=10）与更快的康复（创伤后遗忘长度天数：发病率比，0.173；P<.01）相关；然而，与没有使用苯丙胺的患者相比，有苯丙胺使用史（n=34）的患者在 TBI 后 12 个月时报告的生活质量较低（QOLIBRI 感到困扰的感觉：均数比，0.489，P=.036）。
所有参与者在 TBI 后接受康复治疗都有所改善；然而，物质使用史与较低的 12 个月报告生活质量相关。这些发现增加了对物质使用与急性恢复之间关系的了解，可能提示苯丙胺具有短期促进恢复的作用，但强调了康复在解决长期后遗症方面的重要性。
