Cognitive Rehabilitation for Traumatic Brain Injury: A Randomized Trial

Cognitive Rehabilitation for Traumatic Brain Injury: A Randomized Trial

CONTEXT Traumatic brain injury (TBI) is a principal cause of death and disability in young adults. Rehabilitation for TBI has not received the same level of scientific scrutiny for efficacy and cost-efficiency that is expected in other medical fields. OBJECTIVE To evaluate the efficacy of inpatient...

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Published in:JAMA : the journal of the American Medical Association Vol. 283; no. 23; pp. 3075 - 3081
Main Authors: Salazar, Andres M, Warden, Deborah L, Schwab, Karen, Spector, Jack, Braverman, Steven, Walter, Joan, Cole, Reginald, Rosner, Mary M, Martin, Elisabeth M, Ecklund, James, Ellenbogen, Richard G, for the Defense and Veterans Head Injury Program (DVHIP) Study Group
Format: Journal Article
Language:English
Published: Chicago, IL American Medical Association 21-06-2000
Subjects:
Biological and medical sciences
Brain
Cognition & reasoning
Diseases of the nervous system
Head injuries
Medical sciences
Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)
Rehabilitation
Human
Evaluation
Nervous system diseases
Craniocerebral
Diseases of the osteoarticular system
Trauma
Cerebral disorder
Result
Randomization
Reeducation
Health economy
Central nervous system disease
Skull disease
Rehabilitation(human)
Clinical trial
Public health
Cognitive control
Cost efficiency analysis
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Summary:CONTEXT Traumatic brain injury (TBI) is a principal cause of death and disability in young adults. Rehabilitation for TBI has not received the same level of scientific scrutiny for efficacy and cost-efficiency that is expected in other medical fields. OBJECTIVE To evaluate the efficacy of inpatient cognitive rehabilitation for patients with TBI. DESIGN AND SETTING Single-center, parallel-group, randomized trial conducted from January 1992 through February 1997 at a US military medical referral center. PATIENTS One hundred twenty active-duty military personnel who had sustained a moderate-to-severe closed head injury, manifested by a Glasgow Coma Scale score of 13 or less, or posttraumatic amnesia lasting at least 24 hours, or focal cerebral contusion or hemorrhage on computed tomography or magnetic resonance imaging. INTERVENTIONS Patients were randomly assigned to an intensive, standardized, 8-week, in-hospital cognitive rehabilitation program (n=67) or a limited home rehabilitation program with weekly telephone support from a psychiatric nurse (n=53). MAIN OUTCOME MEASURES Return to gainful employment and fitness for military duty at 1-year follow-up, compared by intervention group. RESULTS At 1-year follow-up, there was no significant difference between patients who had received the intensive in-hospital cognitive rehabilitation program vs the limited home rehabilitation program in return to employment (90% vs 94%, respectively; P=.51; difference, 4% [95% confidence interval {CI}, −5% to 14%]) or fitness for duty (73% vs 66%, respectively; P=.43; difference, 7% [95% CI, −10% to 24%]). There also were no significant differences in cognitive, behavioral, or quality-of-life measures. In a post-hoc subset analysis of patients who were unconscious for more than 1 hour (n = 75) following TBI, the in-hospital group had a greater return-to-duty rate (80% vs 58%; P=.05). CONCLUSIONS In this study, the overall benefit of in-hospital cognitive rehabilitation for patients with moderate-to-severe TBI was similar to that of home rehabilitation. These findings emphasize the importance of conducting randomized trials to evaluate TBI rehabilitation interventions.
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ISSN:0098-7484
1538-3598
DOI:10.1001/jama.283.23.3075