Rehabilitation characteristics and outcomes of adults with traumatic brain injury: A retrospective study in UMMC, a tertiary centre in Klang Valley

INTRODUCTION: Traumatic brain injury (TBI) is a major cause of disabilities among young adults worldwide. Although rehabilitation interventions were shown to reduce the extent of disabilities, there is limited data on the rehabilitation details of TBI patients in Malaysia. This current research is aimed at describing the rehabilitation characteristics of adults with TBI in UMMC, which include the characteristics of patients referred, the rehabilitation setting, intensity of therapy and duration of rehabilitation interventions. Secondly, it is aimed at examining the patients' outcomes at discharge and 1 year.

MATERIALS AND METHODS: This research is a retrospective review on 201 electronic medical records of TBI patients referred for the multidisciplinary acute rehabilitation. Data on socio-demographic, TBI-related characteristics, rehabilitation details and functional outcomes at admission, discharge and 1-year post-TBI were analysed.

RESULTS: From the study population, males and Malay ethnicity were predominant and the Mean (SD) age was 42 ± 19 years. About two-thirds had severe TBI (63%), with concomitant fractures (70%), and 43% were first referred for rehabilitation during post-traumatic amnesia (PTA) state. 63% of them were directly transferred to the inpatient rehabilitation ward with an average length of stay of 18.8 ± 18.3 days. Only 25% of the patients received the full multidisciplinary team input and interventions during the acute inpatient rehabilitation program. The average hours of therapy received during the acute rehabilitation was 7 hours in a 5 day-week, translating to about 1.5 hours per day. In the first-year post-injury, most patients only received outpatient therapy less than once a month after the rehabilitation discharges. Significant improvements were noted in the Modified Barthel Index, Montreal Cognitive Assessment, 6- Minute Walk Test and Westmead PTA scales from rehabilitation admission to discharge and at 1-year post-TBI (p<0.05).

CONCLUSION: More than two-thirds of the TBI patients were transferred to the rehabilitation ward within the first three weeks of injury. Significant improvement in general function, cognition, physical mobility and endurance were reported at the rehabilitation discharge and 1 year. These improvements highlight the positive gains of acute rehabilitation interventions after TBI.