Cognitive Rehabilitation for Traumatic Brain Injury: A Randomized Trial

• 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
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.283.23.3075

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.