Long-term follow-up of use of therapy services for patients with moderate-to-severe traumatic brain injury
Nada Andelic, Marit V. Forslund, Paul B. Perrin, Solrun Sigurdardottir, Juan Lu, Emilie I. Howe, Unni Sveen, Mari S. Rasmussen, Helene L. Søberg, Cecilie Røe
Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
Objectives: To examine the probabilities and baseline predictors of the use of physical therapy, occupational therapy and speech therapy over a period of 10 years after traumatic brain injury.
Design: Longitudinal prospective follow-up at 1, 2, 5 and 10 years after traumatic brain injury.
Participants: A total of 97 patients with moderate-to-severe traumatic brain injury recruited from Oslo University Hospital, Norway, during acute hospital admission in 2005–2007.
Methods: Socio-demographics and injury characteristics were recorded at baseline. Use of physical therapy, occupational therapy and speech therapy were recorded at follow-ups. Hierarchical linear modelling was applied to examine service use probabilities across the 4 time-points.
Results: Service use decreased substantially over time, with physical therapy being the main service utilized at the 10-year follow-up (physical therapy 16%, occupational therapy 1%, speech therapy 3%). Use of services was related to severity of injury (CT head severity scores and post-traumatic amnesia), female sex, and pre-injury employment. In addition, in this sample, time since injury was associated with use of occupational therapy and speech therapy.
Conclusion: This study presents a novel model for the long-term probability of use of physical therapy, occupational therapy and speech therapy following traumatic brain injury. The use of services was much lower than the expected problem profile of severe traumatic brain injuries, suggesting an insufficient long-term provision of traditional traumatic brain injury rehabilitation services.
Long-term disabilities are common after traumatic brain injury. Consequently, many patients need healthcare services following injury. This study followed 97 individuals with traumatic brain injury until 10 years after injury, and found that the use of physical therapy, occupational therapy and speech therapy decreased substantially over time. Approximately 1 in 6 individuals used physical therapy at 10 years, whereas the use of occupational and speech therapy was much lower. Higher use of services was associated with more severe injury, female sex, and being employed before injury. The low level of service use at 10 years after injury might indicate unmet needs in this patient population.
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