A first-of-its-kind study on the rehabilitation process for traumatic brain injury (TBI) patients has found that not all rehabilitation programs are created equal. These differences show up as differences in outcomes (patient recovery). When the study began, researchers at Baylor had certain expectations on what they would find, however they discovered their expectations were incorrect.
The study looked at outcomes at post-discharge and one-year points in 21 Traumatic Brain Injury Model System (TBIMS) centers. The Baylor Institute of Rehabilitation (BIR) was involved in the study.
According to Marie Dahdah, PhD, investigator at the Baylor Institute for Rehabilitation, “We expected that, after accounting for differences in patient characteristics and severity of injury, patient outcomes would be similar across centers. They were not. There were significant variations, with a 25 percent to 45 percent difference between the best performing site and the site with the lowest outcomes at discharge.”
Differences in rehabilitation outcomes have long been reported in specific trauma centers. This study was the first piece of research to demonstrate that differences exist in the rehabilitation context. The team notes that variances could be attributed to institutions structures, resources and clinical practices. However, more research is required to determine which factors are linked to optimal outcomes.
To address these issues, the researchers are trying to determine the combination of variables across centers that identify different patient, injury and process-level factors linked with functional outcomes. As Dahdah notes, once these factors are known, they can be targeted to improve outcomes.
Other aspects of the study are reviewing the quantity and frequency of various types of rehabilitation used in the TBI setting. The researchers will also look at evidenced-based best practices for speech, occupational, physical and recreational therapy interventions. They will also look at neurocognitive and psychosocial interventions. Information from these studies may help to identify gaps in current therapies and evidence-based best practices. This information can be used to inform rehabilitation programs across the country and ensure that all centers have the same opportunities for quality outcomes.
Dahdah comments, “I think I speak for my entire research team when I say that our involvement in this type of research comes out of our collective desire to improve quality of rehabilitation care, thereby enhancing outcomes following TBI. My hope is that by synthesizing and disseminating what is known about effective evidence-based rehabilitation interventions, BIR as part of the North Texas TBIMS will be able to encourage changes necessary to help institutions, clinicians and therapists to provide the best quality TBI rehabilitation care to their patients.”
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A common question posed to Dahdah is, how well did BIR compare with the 20 other centers? Dahdah comments, “To ensure the integrity of our study, even our research team is blind to the identity of the centers”. He points out that no matter how well even the strongest rehab centers perform comparatively speaking, there is always room for improvement particularly where best-practice regimens are concerned.
Dahdah goes on further to say, “Our research has already started discussions within the TBI Model Systems research community. We believe more research needs to be done to identify the key determinants of patient outcomes so that benchmarks for quality rehabilitation care can be derived for patients and their families.”
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