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Predicting the Trajectory of Participation After Traumatic Brain Injury: A Longitudinal Analysis

Erler, Kimberly S., PhD; Whiteneck, Gale G., PhD; Juengst, Shannon B., PhD; Locascio, Joseph J., PhD; Bogner, Jennifer A., PhD; Kaminski, Jamie, BS; Giacino, Joseph T., PhD

Section Editor(s): Bushnik, Tamara PhD

The Journal of Head Trauma Rehabilitation: July/August 2018 - Volume 33 - Issue 4 - p 257–265
doi: 10.1097/HTR.0000000000000383
Original Articles
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Objective: To identify factors that predict trajectories of participation over the first 5 years after moderate to severe traumatic brain injury (TBI).

Setting: TBI Model System Programs.

Participants: Community-dwelling individuals with TBI, 16 years of age or older (n = 1947).

Design: Secondary analysis of a prospective, nonrandomly sampled, longitudinal data registry.

Main Measures: Participation Assessment with Recombined Tools—Objective (PART-O).

Results: Age at injury and FIM Motor score predicted trajectory of participation over the first 5 years after moderate to severe TBI. Older age predicted generally worse participation overall as well as progressively worsening participation over time. Higher FIM Motor raised the predicted participation values, although it reduced the rate of improvement in participation scores over time. FIM Cognitive scores, race, depression, years of education, and living setting did not predict trajectory but did significantly influence participation consistently at all time points.

Conclusion: The trajectories of participation over the first 5 years after TBI can be predicted by age at injury and FIM Motor scores. These findings may enhance the ability of rehabilitation professionals to identify individuals at risk for poor participation after TBI and develop targeted interventions for optimizing involvement in life activities.

Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts (Drs Erler and Giacino and Ms Kaminski); Research Department, Craig Hospital, Englewood, Colorado (Dr Whiteneck); Departments of Physical Medicine & Rehabilitation and Rehabilitation Counseling, University of Texas Southwestern Medical Center, Dallas (Dr Juengst); Department of Neurology, Harvard Medical School, Boston, Massachusetts (Dr Locascio); and Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus (Dr Bogner).

Corresponding Author: Kimberly S. Erler, PhD, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, 300 1st Ave, Charlestown, MA (kerler@partners.org).

This work was conducted with support from Harvard Catalyst. The Harvard Clinical and Translational Science Center (National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health Award UL1 TR001102) and financial contributions from Harvard University and its affiliated academic healthcare centers. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University and its affiliated academic healthcare centers, or the National Institutes of Health.

This work was conducted with support from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR; grant numbers 90DP0034, 90DP0039, 90DP0040, 90DP0041). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health & Human Services (HHS). The contents of this manuscript do not necessarily represent the policy of NIDILRR, ACL, HHS, and endorsement by the Federal Government should not be assumed.

The authors declare no conflicts of interest.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.