Functional outcome after rehabilitation for severe traumatic brain injury.

OBJECTIVE

(1) Define functional status at rehabilitation discharge and follow-up for patients admitted with Functional Independence Measure (FIM) of 18 after traumatic brain injury; (2) describe patterns of function measured at discharge, rehabilitation lengths of stay and costs, and disposition.

DESIGN

Retrospective, descriptive study using data from the Uniform Data System for Medical Rehabilitation (UDSMR) dataset.

SETTING

Acute rehabilitation hospitals and, for follow-up data, variety of settings, from community to long-term care.

PATIENTS

328 patients with rehabilitation admission FIM of 18 (principal impairment group "Brain Dysfunction, Traumatic") drawn from 5,430 TBI patients entered into the data set during 1989-1991. Excluded were 22 persons readmitted to rehab, 5 deaths, 1 case without recorded disposition, and 49 cases without ICD-9 code consistent with brain trauma.

MAIN OUTCOME MEASURES

FIM scores at rehab discharge and follow-up; disposition; length of stay; cost.

RESULTS

(1) Mean FIM score at discharge for the group overall (n = 328) was 53 (median = 42 with interquartile range of 18 to 87); (2) 7.6% had functional scores consistent with independence in motor areas measured by FIM; (3) 2.7% had functional scores consistent with independence in cognitive areas measured by FIM; (4) 26.1% showed no change in FIM score between admission and discharge; (5) 53% were discharged to community settings, 25% to long-term care, 11% to acute facilities, and 11% to other rehab facilities; (6) average length of stay in acute rehab was 110 days (SD = 70.9, median = 99 days, interquartile range = 57 to 153 days); (7) average rehabilitation charges (n = 322) were $110,891; (8) for those with follow-up data (n = 59), average FIM score was 79 (median, 90); 24% were in school and 5% worked in sheltered workshops.

CONCLUSIONS

(1) Even the most severely disabled persons admitted to acute rehabilitation after traumatic brain injury can show a large degree of measurable functional improvement; (2) while about 25% of patients showed no measured FIM change, some showed dramatic degrees of functional recovery; (3) most common discharge setting was home (and community).