TY - JOUR
T1 - Cognitive rehabilitation for traumatic brain injury
T2 - A randomized trial
AU - Salazar, Andres M.
AU - Warden, Deborah L.
AU - Schwab, Karen
AU - Spector, Jack
AU - Braverman, Steven
AU - Walter, Joan
AU - Cole, Reginald
AU - Rosner, Mary M.
AU - Martin, Elisabeth M.
AU - Ecklund, James
AU - Ellenbogen, Richard G.
PY - 2000/6/21
Y1 - 2000/6/21
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=0034697892&partnerID=8YFLogxK
U2 - 10.1001/jama.283.23.3075
DO - 10.1001/jama.283.23.3075
M3 - Article
C2 - 10865301
AN - SCOPUS:0034697892
SN - 0098-7484
VL - 283
SP - 3075
EP - 3081
JO - JAMA - Journal of the American Medical Association
JF - JAMA - Journal of the American Medical Association
IS - 23
ER -