Journal CME, March 2023: Predictors of cognitive gains during inpatient rehabilitation for older adults with traumatic brain injury-Journal CME, March 2023: Predictors of cognitive gains during inpatient rehabilitation for older adults with traumatic brain injury

Journal CME, March 2023: Predictors of cognitive gains during inpatient rehabilitation for older adults with traumatic brain injury

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This study by Byom et al. examines the factors influencing cognitive recovery during inpatient rehabilitation for older adults with traumatic brain injury (TBI). With a growing incidence of TBI in adults aged 65 and older, understanding these factors is crucial for effective rehabilitation planning. Conducted as a secondary data analysis of 137,583 patients from Uniform Data System for Medical Rehabilitation-participating IRFs in the U.S. (2002-2018), the study investigates patient-, clinical-, and facility-level characteristics that impact cognitive outcomes.<br /><br />Key findings indicate that patients had better odds of favorable cognitive recovery if they were female, had higher motor functioning at IRF admission, experienced a longer length of stay, or received care at freestanding IRFs as opposed to hospital-based rehab units. Conversely, factors such as older age, Black or Hispanic/Latino race, higher cognitive function at IRF admission, high-cost comorbid conditions, and presence of certain medical complications were associated with lower odds of cognitive improvement.<br /><br />The study also discusses critical clinical factors, where higher initial motor function and extended rehabilitation duration were positively associated with cognitive gains. However, a high number of comorbidities and complications, particularly mental disorders, adversely affected cognitive recovery. Facility characteristics revealed that patients at freestanding IRFs had better cognitive outcomes compared to those in hospital units. Interestingly, non-accredited facilities were linked to more favorable outcomes, potentially suggesting that patients with more severe conditions were more likely to be treated at accredited facilities.<br /><br />Ultimately, the study reinforces the need for tailored rehabilitation strategies that consider individual demographics, clinical conditions, and the type and accreditation status of the rehabilitation facility to enhance cognitive recovery outcomes for older adults with TBI. The research is significant for developing targeted, evidence-based rehabilitation protocols and addressing disparities in health outcomes.

Keywords

cognitive recovery

inpatient rehabilitation

older adults

traumatic brain injury

TBI

rehabilitation planning

clinical factors

facility characteristics

comorbid conditions

health disparities