Rehabilitation and outcomes after complicated vs uncomplicated mild TBI: results from the CENTER-TBI study

Emilie Isager Howe*, Marina Zeldovich, the CENTER-TBI Participants and Investigators, Nada Andelic, Nicole von Steinbuechel, Silje C.R. Fure, Ida M.H. Borgen, Marit V. Forslund, Torgeir Hellstrøm, Helene L. Søberg, Unni Sveen, Mari Rasmussen, Ingerid Kleffelgaard, Cathrine Tverdal, Eirik Helseth, Marianne Løvstad, Juan Lu, Juan Carlos Arango-Lasprilla, Olli Tenovuo, Philippe AzouviHelen Dawes, Cecilie Roe, Cecilia Åkerlund, Krisztina Amrein, Lasse Andreassen, Audny Anke, Anna Antoni, Kelly Foks, Benjamin Gravesteijn, Juanita A. Haagsma, Iain Haitsma, Jilske Huijben, Erwin Kompanje, Hester Lingsma, Ana Mikolic, Daan Nieboer, Dana Pisica, Suzanne Polinder, Isabel Retel Helmrich, Charlie Sewalt, Ranjit D. Singh, Ewout W. Steyerberg, Dick Tibboel, Marjolein Timmers, Mathieu van der Jagt, Thomas A. van Essen, Ernest van Veen, Kimberley Velt, Victor Volovici, Daphne Voormolen, Eveline Wiegers

*Corresponding author for this work

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Abstract

Background: Despite existing guidelines for managing mild traumatic brain injury (mTBI), evidence-based treatments are still scarce and large-scale studies on the provision and impact of specific rehabilitation services are needed. This study aimed to describe the provision of rehabilitation to patients after complicated and uncomplicated mTBI and investigate factors associated with functional outcome, symptom burden, and TBI-specific health-related quality of life (HRQOL) up to six months after injury. Methods: Patients (n = 1379) with mTBI from the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study who reported whether they received rehabilitation services during the first six months post-injury and who participated in outcome assessments were included. Functional outcome was measured with the Glasgow Outcome Scale – Extended (GOSE), symptom burden with the Rivermead Post Concussion Symptoms Questionnaire (RPQ), and HRQOL with the Quality of Life after Brain Injury – Overall Scale (QOLIBRI-OS). We examined whether transition of care (TOC) pathways, receiving rehabilitation services, sociodemographic (incl. geographic), premorbid, and injury-related factors were associated with outcomes using regression models. For easy comparison, we estimated ordinal regression models for all outcomes where the scores were classified based on quantiles. Results: Overall, 43% of patients with complicated and 20% with uncomplicated mTBI reported receiving rehabilitation services, primarily in physical and cognitive domains. Patients with complicated mTBI had lower functional level, higher symptom burden, and lower HRQOL compared to uncomplicated mTBI. Rehabilitation services at three or six months and a higher number of TOC were associated with unfavorable outcomes in all models, in addition to pre-morbid psychiatric problems. Being male and having more than 13 years of education was associated with more favorable outcomes. Sustaining major trauma was associated with unfavorable GOSE outcome, whereas living in Southern and Eastern European regions was associated with lower HRQOL. Conclusions: Patients with complicated mTBI reported more unfavorable outcomes and received rehabilitation services more frequently. Receiving rehabilitation services and higher number of care transitions were indicators of injury severity and associated with unfavorable outcomes. The findings should be interpreted carefully and validated in future studies as we applied a novel analytic approach. Trial registration: ClinicalTrials.gov NCT02210221.

Original languageEnglish
Article number1536
JournalBmc Health Services Research
Volume22
Issue number1
DOIs
Publication statusPublished - 16 Dec 2022

Bibliographical note

Funding Information:
CENTER-TBI was supported by the European Union 7th Framework programme (EC grant 602150). Additional funding was obtained from the Hannelore Kohl Stiftung (Germany), from OneMind (USA), and from Integra LifeSciences Corporation (USA). The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.

Publisher Copyright: © 2022, The Author(s).

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