Summary

  1. There is Level 2 evidence that patients cared for in a Level I trauma center experience fewer complications, have a lower likelihood of progression of the neurological insult, and reduced mortality rates compared to patients cared for in a Level II center.
     
  2. There is Level 2 evidence suggesting that reduction in the time spent in acute care and in rehabilitation does not have a negative impact on overall patient outcomes. 
     
  3. There is Level 2 evidence indicating the overall cost of care is directly related to injury severity.
     
  4. There is Level 2 evidence that guideline adherence in acute care results in improved functional outcomes.
     
  5. There is Level 2 evidence that standardized trauma protocols result in decreased mortality rates and improved outcomes for patients with TBI.
     
  6. There is Level 4 evidence that traditional rehabilitation and functionally based rehabilitation programs result in similar total Functional Independence Measures (FIM) gains; however, patients in a neuro-physical rehabilitation program have higher FIM motor efficiency than patients in traditional rehabilitation.
     
  7. There is Level 2 evidence that traditional rehabilitation and functionally based rehabilitation programs result in similar total Functional Independence Measures (FIM) gains; however, patients in a neuro-physical rehabilitation program have higher FIM motor efficiency that patients in traditional rehabilitation.
     
  8. There is Level 3 evidence that patients discharged from rehabilitation make greater Functional Independence Measure gains than individuals discharged against medical advice.
     
  9. There is Level 3 evidence that patients with ABI are able to make continued improvements in an inpatient interval rehabilitation program.
     
  10. There is Level 2 evidence that individualized interdisciplinary rehabilitation results in functional improvements over the course of treatment.
     
  11. There is Level 3 evidence that inpatient rehabilitation significantly improved functional outcome, as measured by the Functional Independence Measure.
     
  12. There is Level 1b evidence that intensive rehabilitation improves functional outcome, as measured by Functional Independence Measure and Glasgow Outcome Scale scores, at two and three months post-injury, but not necessarily at six months and beyond. 
     
  13. There is Level 2 evidence that multidisciplinary inpatient rehabilitation is more effective than a single discipline approach.
     
  14. There is Level 4 evidence that increasing rehabilitation intensity reduces length of stay.
     
  15. There is Level 2 evidence that therapy intensity predicts motor functioning at discharge, but not cognitive gain.
     
  16. There is Level 4 evidence that patients with a long length of stay who receive high-intensity rehabilitation fair better on the Rancho Los Amigos Scale at discharge than those who receive low-intensity rehabilitation.
     
  17. Based on the findings from several studies, there is Level 2 evidence that early rehabilitation is associated with better outcomes such as shorter comas and lengths of stay, higher cognitive levels at discharge, better Functional Independence Measure scores, and a greater likelihood of discharge to home.
     
  18. There is Level 2 evidence that a transitional living setting during the last weeks of inpatient rehabilitation results in greater functional independence in activities of daily living than inpatient rehabilitation alone.
     
  19. There is Level 3 evidence that inpatient brain injury rehabilitation results in significantly greater gains in total Functional Independence Measure change, self-care, and social cognition for patients with TBI than patients with brain tumours. However, there are no statistically significant differences between the two groups regarding Functional Independence Measure efficiency and length of stay.  
     
  20. There is Level 3 evidence that inpatient rehabilitation results in a higher rate of change on functional measures in patients aged 18-54 than patients aged 55 years or olders.
     
  21. Based on the findings from one case series, there is Level 4 evidence that inpatient rehabilitation results in successful return to work and return to duty for many military service members.
     
  22. There is Level 4 evidence suggesting that being older, female, and having a longer length of stay in inpatient care results in a lesser likelihood of being discharged home.
     
  23. There is Level 2 evidence that behavioural and cognitive skills post ABI can be improved by participating in neurorehabilitation or neurobehavioural programs.
     
  24. There is Level 2 evidence that multidisciplinary outpatient rehabilitation can improve functional outcomes up to one year post discharge.
     
  25. There is Level 1b evidence that a supervised fitness center-based program is equally as effective as an unsupervised home-based program for improving cardio-respiratory fitness.    
     
  26. There is Level 1b evidence that structured multidisciplinary community-based rehabilitation is more effective in improving functional ability, as well as activity, participation, and psychological aspects of functioning in the community compared to educational booklets. 
     
  27. There is Level 2 evidence that a high-level of involvement in neurorehabilitation goal setting results in a greater number of attained goals being maintained at follow-up (two months), whereas patients with low-involvement show a decline in the number of goals attained.  
     
  28. There is Level 4 evidence that a transitional community rehabilitation program improves functional abilities, emotional adjustment and participation post ABI.
     
  29. There is Level 4 evidence that patients with a dual-diagnosis of TBI and substance abuse often do not benefit from community-based treatment programs to become chemical-free due to lack of compliance on the part of the patient.
     
  30. There is Level 4 evidence that participation in a comprehensive day treatment program reduces impaired self-awareness and distress, as well as improves societal participation at one-year follow-up.
     
  31. There is Level 4 evidence that individualized work re-entry programs are effective.
     
  32. There is Level 4 evidence that after vocational rehabilitation the majority of subjects have fair or good adjusted outcome, while over one-third become gainfully employed or full-time students. 
     
  33. There is Level 4 evidence that individuals with the most significant cognitive impairments benefit the most from vocational rehabilitation services.
     
  34. There is Level 2 evidence that cognitive symptom management and rehabilitation with standard supported employment results in greater employment rates, improved memory and a reduction in psychiatric and post-concussive symptoms.
     
  35. There is Level 3 evidence that supported employment improves competitive employment outcomes particularly for ABI survivors who are older, have more education, have no prior work experience or who have suffered more severe injuries. 
     
  36. There is Level 4 evidence that support groups generate positive results such as improving feelings of hopelessness, coping with depression, reducing aggression, and improving psychosocial functioning.
     
  37. There is Level 2 evidence that individuals living in both rural and urban settings benefited from an integrated network of inpatient, outpatient and community services.
     
  38. Although continuity of care has been shown to be beneficial in optimizing recovery, there is insufficient evidence to draw any conclusions regarding the ideal structure of a complete model of ABI care.