Next up John Corrigan spoke on Asking Rehabilitation Outcomes Questions with Observational Designs: The TBI Experience.
John’s presentation focused on 1 large database of data– the TBI Model Systems– and what the 700+ peer-reviewed articles generated from the data therein have discovered about TBI in the US.
First, let’s meet the TBI Model Systems. It is a longitudinal dataset funded by the National Institute on Disability, Independent Living and Rehabilitation Research (NIDILRR) since 1983. There are 16 acute rehabilitation centers that enroll people with TBI in the data collection study and 4 follow-up locations. Those 4 locations collect follow-up data at 1 year, 2 years, 5 years and then every 5 years post-TBI. The earliest enrollees are now 25 years post-TBI! As of 3/31/16, 14,663 individuals with TBI amounting to 49, 468 follow-ups were represented in the data. The purpose of all this is to provide data from observational studies of rehab outcomes, both acute and longer-term.
So what have we learned from all of that?
— 5 years post-TBI 21.7% are dead (That was a lovely beginning stat wasn’t it?)
— 32.3% need some level of physical assistance in at least 1 area of physical functioning 5 years post-TBI (determined with FIM motor)
— 29.1% are more dissatisfied than satisfied with life at 5 years post-TBI
— 55.3% of those employed pre-TBI are not working 5 years post-TBI
— 54.5% are not able to drive 5 years post-TBI
— 57.8% have moderate-severe disability (defined as not able to be left alone overnight) 5 years post-TBI
— 38.8% exhibit at decline at 5 years post-TBI as compared to their own follow-up data at 1 or 2 years post-TBI
So what does all this tell us? The effect of a TBI is not limited to the single traumatic event; it is a life-long condition that needs to be managed appropriately, not only in the therapy world, but medically and within the mental health realms as well.
John then moved to another large dataset: the TBI Practice Based Evidence (PBE) Study. In contrast to the Model Systems, the PBE was a 1 time study funded by NIH and NIDILRR encompassing 10 centers in the US and Canada, 2, 130 people with TBI. Follow-up data on these folks were collected at 3 months and 9 months post discharge from acute rehab. They were looking at functional independence, discharge disposition, length of stay, participation in the community and subjective well-being. All important items of interest.
From this dataset we learned:
— the lower the FIM cognitive score upon admission to rehab, the higher the length of stay
— the lower the FIM cognitive score, the more likely the patient is to die from both things related to the BI OR other things
I found this slide very interesting. It’s the type of treatment provided by PT depending on the FIM cognitive score upon admission and how that progresses during acute rehabilitation.
In case you’re having a hard time reading the words in the boxes like I am, the darkest blue=assessment, light blue = advanced gait community mobility, green= transitional movements, purple =therex, red=gait, orange=pre-gait and standing, pink=positioning.
Beyond what the data found, the TBI Model System and TBI-PBE each use innovative stats techniques in observational analysis. The Model System uses individualized growth curve analysis, while the PBE uses propensity score analysis. And that’s all I’m going to say about that.