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Rehabilitation needs and participation restriction in patients with cognitive disorder in the chronic phase of traumatic brain injury

Sashika, Hironobu MD; Takada, Kaoruko BM; Kikuchi, Naohisa MD

Section Editor(s): Tusconi., Massimo

doi: 10.1097/MD.0000000000005968
Research Article: Observational Study

The purpose of this study was to clarify psychosocial factors/problems, social participation, quality of life (QOL), and rehabilitation needs in chronic-phase traumatic brain injury (TBI) patients with cognitive disorder discharged from the level-1 trauma center (L1-TC), and to inspect the effects of rehabilitation intervention to these subjects.

A mixed-method research (cross-sectional and qualitative study) was conducted at an outpatient rehabilitation department.

Inclusion criteria of subjects were transfer to the L1-TC due to TBI; acute-stage rehabilitation treatment received in the L1-TC from November 2006 to October 2011; age of ≥18 and <70 years at the time of injury; a score of 0–3 on the Modified Rankin Scale at discharge and that of 4–5 due to physical or severe aggressive behavioral comorbid disorders. Study details were sent, via mail, to 84 suitable candidates, of whom 36 replied. Thirty-one subjects (median age: 33.4 years; male: 17; and average time since injury: 48.1 months), who had consented to study participation, were participated. Cognitive function, social participation, QOL, psychosocial factors/problems, rehabilitation needs, and chronic-phase rehabilitation outcomes were evaluated using the Wechsler Adult Intelligence Scale, Third Edition, the Wechsler Memory Scale-Revised, the Zung Self-Rating Depression Scale, the Sydney Psychosocial Reintegration Scale, Version 2, and the Short Form 36, Version 2, qualitative analysis of semistructured interviews, etc.

Participants were classified into achieved-social-participation (n = 11; employed: 8), difficult-social-participation (n = 12; unemployed: 8), and no-cognitive-dysfunction groups (n = 8; no social participation restriction). Relative to the achieved-social-participation group, the difficult-social-participation group showed greater injury and cognitive dysfunction and lower Sydney Psychosocial Reintegration Scale and Short Form 36 role/social component summary scores (64.9/49.1 vs 44.3/30.4, respectively, P < 0.05). Linear regression analysis showed that the social participation status was greatly affected by the later cognitive disorders and psychosocial factors/problems not by the severity of TBI. No changes were observed in these scores following chronic-phase rehabilitation intervention.

Chronic-phase TBI with cognitive disorder led to rehabilitation needs, and improvement of subjects’ psychosocial problems and QOL was difficult.

aDepartment of Rehabilitation Medicine, Graduate School of Medicine, Association of Medical Science

bGraduate School of Medicine, Yokohama City University, Kanazawa Ward

cDepartment of Rehabilitation Medicine, Yokohama City University Medical Center, Association of Medical Science, Yokohama City University, Minami Ward, Yokohama City, Japan.

Correspondence: Hironobu Sashika, Department of Rehabilitation Medicine, Graduate School of Medicine, Association of Medical Science, Yokohama City University, Kanagawa Prefecture, Yokohama City, Japan (e-mail:

Abbreviations: BADS = Behavioral Assessment of the Dysexecutive Syndrome, GCS = Glasgow coma scale, L1-TC = level-1 trauma center, m-RS = Modified Rankin Scale, QOL = quality of life, RBMT = Rivermead Behavioral Memory Test, SDS = Zung Self-Rating Depression Scale, SF-36v2 = The Japanese edition of the 2nd version of the 36-Item Short-Form Health Survey, SPRS-2 = Sydney Psychosocial Reintegration Score, Version 2, TBI = traumatic brain injury, WAIS-III = Wechsler Adult Intelligence Scale, Third Edition, WMS-R = Wechsler Memory Scale-Revised.

This research was presented at the 52nd Annual Meeting of the Japanese Association of Rehabilitation Medicine in Niigata (Japan), in May 2015, and at the 10th World Congress on Brain Injury in San Francisco (USA), in March, 2014.

Funding/support: This work was supported by a Grant-in-Aid for Scientific Research (C) from the Japanese Ministry of Education, Culture, Sports, Science, and Technology: “A qualitative study of rehabilitation needs and participation restriction of chronic-phase subjects with cognitive disorder due to traumatic brain injury” (2012–2014), Project Number: 24500599.

The authors have no conflicts of interest to disclose.

This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received November 4, 2015

Received in revised form November 23, 2016

Accepted December 31, 2016

Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.