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Publications

Journal Article Epublish

PubMed: 42539357 DOI: 10.1177/2689288X261452589

Rehabilitation and Outcomes in Patients after Traumatic Brain Injury Admitted to the Intensive Care Unit: Results from the CENTER-TBI Study.

Neurotrauma Rep 7:2689288X261452589

Authors: Nada Andelic, Diego Rivera, Laiene Olabarrieta-Landa, Mari S Rasmussen, Emilie I Howe, Louis Jacob, Philippe Azouvi, Marina Zeldovich, Eirik Helseth, Cathrine Tverdal, John Castro, Torgeir Hellstrøm, Marit V D Forslund, Ida Borgen, Ingerid Kleffelgaard, Helene L Søberg, Unni Sveen, Marianne Løvstad, Solveig L Hauger, Juan Lu, Simon Beaulieu-Bonneau, Olli Tenovuo, Nicole von Steinbuechel, Cecilie Røe

Affiliations

  • Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.
  • Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway.
  • Departamento de Ciencias de la Salud, Universidad Pública de Navarra, Pamplona, Spain.
  • Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain.
  • Faculty of Health Sciences, Oslo Metropolitan University, OsloMet, Oslo, Norway.
  • Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Physical Medicine and Rehabilitation, Lariboisière-Fernand Widal Hospital, Université Paris Cité, Paris, France.
  • Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases (EpiAgeing), Université Paris Cité, Paris, France.
  • Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Barcelona, Spain.
  • AP-HP, Department of Physical Medicine and Rehabilitation, Raymond Poincaré Hospital, Université Versailles Saint-Quentin, Garches, France.
  • Research unit INSERM MOODS, CESP, UMR 1018, Université Paris-Saclay, Université de Versailles Saint-Quentin-en-Yvelines, Gif-sur-Yvette, France.
  • Faculty of Psychotherapy Science, Sigmund Freud University Vienna, Vienna, Austria.
  • Department of Neurosurgery, Oslo University Hospital, Oslo, Norway.
  • Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
  • Center for Research and Education, Sunnaas Rehabilitation Hospital Trust, Nesoddtangen, Norway.
  • Department of Psychology, University of Oslo, Oslo, Norway.
  • Department of Epidemiology, School of Public Health, Virginia Commonwealth University, Richmond, Virginia, USA.
  • École de Psychologie, Université Laval, Québec, QC, Canada.
  • Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada.
  • Division of Clinical Neurosciences, University of Turku, Turku, Finland.
  • Institute of Psychology, University of Innsbruck, Innsbruck, Austria.

Abstract

Despite clinical guidelines for the management of traumatic brain injury (TBI), evidence-based rehabilitation programmes and large-scale studies evaluating rehabilitation provision and outcomes remain limited. This study aimed to (1) describe rehabilitation services delivered to patients admitted to the intensive care unit (ICU) after TBI, (2) examine associations between rehabilitation support and functional outcome, emotional distress, and TBI-specific health-related quality of life (HRQoL) at 12 months post-injury, and (3) assess the stability of outcomes at 3, 6, and 12 months post-injury. Data were obtained from the CENTER-TBI study. Participants were adults (≥18 years) admitted to the ICU who reported rehabilitation use and completed follow-up assessments. Functional outcome was assessed using the Glasgow Outcome Scale-Extended (GOSE), emotional distress using the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder scale (GAD-7), and HRQoL using the Quality of Life after Brain Injury-Overall Scale (QOLIBRI-OS). The study included 661 patients (72.3% male; mean age 46.7 years). At 12-month post-injury, 87% achieved favorable recovery (GOSE 5-8), with mild depressive symptoms, minimal anxiety, and a mean QOLIBRI-OS score of 65.7. Rehabilitation provision increased from 30.6% at 3 months to 51.3% at 12 months. Early rehabilitation was most common among patients with mild TBI, while rehabilitation provision for those with moderate and severe TBI increased over time. Nevertheless, approximately half of patients with moderate-to-severe TBI did not receive rehabilitation within the first-year post-injury. Delayed initiation of rehabilitation, older age, lower education, unemployment, greater injury severity, and road traffic-related injuries were associated with poorer functional outcomes and lower HRQoL. Pre-injury psychiatric disorders predicted higher emotional distress. Functional recovery and HRQoL improved over time, whereas emotional distress remained relatively stable. Despite increasing rehabilitation provision, substantial gaps in access persist, particularly for patients with moderate and severe TBI. Early and well-coordinated rehabilitation remains essential to optimize recovery and long-term quality of life after TBI.

MeSH

Patient Health Questionnaire, Quality Of Life, Brain Injuries, Brain, Rehabilitation, Recycling, Brain Injuries, Traumatic, Intensive Care Units, Psychological Distress, Generalized Anxiety Disorder