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The Association of Rehospitalization With Participation 5 Years After Traumatic Brain Injury

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

The Journal of Head Trauma Rehabilitation: November/December 2018 - Volume 33 - Issue 6 - p E77–E84
doi: 10.1097/HTR.0000000000000386
Focus on Clinical Research and Practice

Objective: To determine whether rehospitalization during the first 2 years after moderate to severe traumatic brain injury (TBI) is associated with poor participation at 5 years post-TBI, after controlling for demographic and severity factors.

Setting: TBI Model Systems Program.

Participants: Community-dwelling individuals with TBI, 16 years or older (n = 1940).

Design: Retrospective data analysis of a multicenter prospective study.

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

Results: After controlling for demographic and severity factors, a general linear model indicated that rehospitalization status (ie, never rehospitalized during years 1 and 2, rehospitalized either during year 1 or 2, or rehospitalized during both years 1 and 2) predicted less participation at 5 years post-TBI (P = .0353). The PART-O scores were in the hypothesized direction, with the lowest covariate-adjusted mean participation score found for the group with rehospitalizations during both years and the highest covariate-adjusted mean participation score found in the group with no rehospitalizations. Examining total number of rehospitalizations during years 1 and 2, rather than rehospitalization status, yielded analogous results (P = .0148).

Conclusions: This study suggests that rehospitalization in the first 2 years after TBI is negatively associated with participation at 5 years after injury. Since participation is considered a key indicator of successful TBI rehabilitation, minimizing the need for rehospitalizations and promoting health in the community setting should be a priority of postacute care for individuals with TBI.

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

Corresponding Author: Kimberly S. Erler, PhD, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA 02129 (kerler@partners.org).

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

The authors declare no conflicts of interest.

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