CER, PBE, SCIRehab, NIDRR, and other important abbreviations

Traumatic Brain Injury Rehabilitation Comparative Effectiveness Research: Introduction to the Traumatic Brain Injury-Practice Based Evidence Archives Supplement

This supplement of the Archives of Physical Medicine and Rehabilitation is devoted to the Traumatic Brain Injury-Practice Based Evidence study, the first practice-based evidence study, to our knowledge, of traumatic brain injury rehabilitation. The purpose of this preface is to place this study in the broader context of comparative effectiveness research and introduce the articles in the supplement.

Occupational, Physical, and Speech Therapy Treatment Activities During Inpatient Rehabilitation for Traumatic Brain Injury

OBJECTIVE

To describe the use of occupational therapy (OT), physical therapy (PT), and speech therapy (ST) treatment activities throughout the acute rehabilitation stay of patients with traumatic brain injury.

DESIGN

Multisite prospective observational cohort study.

SETTING

Inpatient rehabilitation settings.

PARTICIPANTS

Patients (N=2130) admitted for initial acute rehabilitation after traumatic brain injury. Patients were categorized on the basis of admission FIM cognitive scores, resulting in 5 fairly homogeneous cognitive groups.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Percentage of patients engaged in specific activities and mean time patients engaged in these activities for each 10-hour block of time for OT, PT, and ST combined.

RESULTS

Therapy activities in OT, PT, and ST across all 5 cognitive groups had a primary focus on basic activities. Although advanced activities occurred in each discipline and within each cognitive group, these advanced activities occurred with fewer patients and usually only toward the end of the rehabilitation stay.

CONCLUSIONS

The pattern of activities engaged in was both similar to and different from patterns seen in previous practice-based evidence studies with different rehabilitation diagnostic groups.

Traumatic Brain Injury-Practice Based Evidence Study: Design and Patients, Centers, Treatments, and Outcomes

OBJECTIVES

To describe study design, patients, centers, treatments, and outcomes of a traumatic brain injury (TBI) practice-based evidence (PBE) study and to evaluate the generalizability of the findings to the U.S. TBI inpatient rehabilitation population.

DESIGN

Prospective, longitudinal, observational study.

SETTING

Ten inpatient rehabilitation centers.

PARTICIPANTS

Patients (N=2130) enrolled between October 2008 and September 2011 and admitted for inpatient rehabilitation after an index TBI injury.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Return to acute care during rehabilitation, rehabilitation length of stay, FIM at discharge, residence at discharge, and 9 months postdischarge rehospitalization, FIM, participation, and subjective well-being.

RESULTS

The level of admission FIM cognitive score was found to create relatively homogeneous subgroups for the subsequent analysis of best treatment combinations. There were significant differences in patient and injury characteristics, treatments, rehabilitation course, and outcomes by admission FIM cognitive subgroups. TBI-PBE study patients were overall similar to U.S. national TBI inpatient rehabilitation populations.

CONCLUSIONS

This TBI-PBE study succeeded in capturing naturally occurring variation in patients and treatments, offering opportunities to study best treatments for specific patient impairments. Subsequent articles in this issue report differences between patients and treatments and associations with outcomes in greater detail.

Trajectories of musculoskeletal shoulder pain after spinal cord injury: Identification and predictors

OBJECTIVE/BACKGROUND

Although shoulder pain is a problem in up to 86% of persons with a spinal cord injury (SCI), so far, no studies have empirically identified longitudinal patterns (trajectories) of musculoskeletal shoulder pain after SCI. The objective of this study was: (1) to identify distinct trajectories of musculoskeletal shoulder pain in persons with SCI, and (2) to determine possible predictors of these trajectories.

DESIGN/METHODS

Multicenter, prospective cohort study in 225 newly injured persons with SCI.

OUTCOME MEASURE

Shoulder pain was assessed on five occasions up to 5 years after discharge. Latent class growth mixture modeling was used to identify the distinct shoulder pain trajectories.

RESULTS

Three distinct shoulder pain trajectories were identified: (1) a "No or Low pain" trajectory (64%), (2) a "High pain" (30%) trajectory, and (3) a trajectory with a "Decrease of pain" (6%). Compared with the "No or Low pain" pain trajectory, the "High pain" trajectory consisted of more persons with tetraplegia, shoulder pain before injury, limited shoulder range of motion (ROM), lower manual muscle test scores, or more spasticity at t1. Multiple logistic regression analysis showed two significant predictors for the "High pain" trajectory (as compared with the "No or Low pain" trajectory): having a tetraplegia (odds ratio (OR) = 3.2; P = 0.002) and having limited shoulder ROM (OR = 2.8; P = 0.007).

CONCLUSION

Shoulder pain in people with SCI follows distinct trajectories. At risk for belonging to the "High pain" trajectory are persons with tetraplegia and those with a limited shoulder ROM at start of active rehabilitation.