PMID- 34018693 OWN - NLM STAT- MEDLINE DCOM- 20220408 LR - 20230402 IS - 1934-1563 (Electronic) IS - 1934-1482 (Print) IS - 1934-1482 (Linking) VI - 14 IP - 4 DP - 2022 Apr TI - Functional motor improvement during inpatient rehabilitation among older adults with traumatic brain injury. PG - 417-427 LID - 10.1002/pmrj.12644 [doi] AB - BACKGROUND: Older adults comprise an increasingly large proportion of patients with traumatic brain injury (TBI) receiving care in inpatient rehabilitation facilities (IRF). However, high rates of comorbidities and evidence of declining preinjury health among older adults who sustain TBI raise questions about their ability to benefit from IRF care. OBJECTIVES: To describe the proportion of older adults with TBI who exhibited minimal detectable change (MDC) and a minimally clinically important difference (MCID) in motor function from IRF admission to discharge; and to identify characteristics associated with clinically meaningful improvement in motor function and better discharge functional status. DESIGN: This retrospective cohort study used Medicare administrative data probabilistically linked to the National Trauma Data Bank to estimate the proportion of patients whose motor function improved during inpatient rehabilitation and identify factors associated with meaningful improvement in motor function and motor function at discharge. SETTING: Inpatient rehabilitation facilities in the United States. PATIENTS: Fee-for-service Medicare beneficiaries with TBI. MAIN OUTCOME MEASURES: Minimal Detectable Change (MDC) and Minimally Clinically Important Difference (MCID) in the Functional Independence Measure motor (FIM-M) score from admission to discharge, and FIM-M score at IRF discharge. RESULTS: From IRF admission to discharge 84% of patients achieved the MDC threshold, and 68% of patients achieved the MCID threshold for FIM-M scores. Factors associated with a higher probability of achieving the MCID for FIM-M scores included better admission motor and cognitive function, lower comorbidity burden, and a length of stay longer than 10 days but only among individuals with lower admission motor function. Older age was associated with a lower FIM-M discharge score, but not the probability of achieving the MCID in FIM-M score. CONCLUSION: Older adults with TBI have the potential to improve their motor function with IRF care. Baseline functional status and comorbidity burden, rather than acute injury severity, should be used to guide care planning. CI - (c) 2021 American Academy of Physical Medicine and Rehabilitation. FAU - Evans, Emily AU - Evans E AUID- ORCID: 0000-0002-1027-5441 AD - Department of Health Services, Policy and Practice, Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA. FAU - Krebill, Cicely AU - Krebill C AD - Warren Alpert School of Medicine of Brown University, Providence, Rhode Island, USA. FAU - Gutman, Roee AU - Gutman R AD - Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island, USA. FAU - Resnik, Linda AU - Resnik L AUID- ORCID: 0000-0002-0168-6759 AD - Department of Health Services, Policy and Practice, Center for Gerontology and Healthcare Research, Brown University School of Public Health and Providence VA Medical Center, Providence, Rhode Island, USA. FAU - Zonfrillo, Mark R AU - Zonfrillo MR AD - Departments of Emergency Medicine and Pediatrics, Warren Alpert School of Medicine of Brown University, Providence, Rhode Island, USA. FAU - Lueckel, Stephanie N AU - Lueckel SN AD - Division of Acute Care Surgery and Surgical Critical Care, Rhode Island Hospital, Warren Alpert School of Medicine of Brown University, Providence, Rhode Island, USA. FAU - Zhang, Wenhan AU - Zhang W AD - Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA. FAU - Kumar, Raj G AU - Kumar RG AD - Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, USA. FAU - Dams-O'Connor, Kristen AU - Dams-O'Connor K AD - Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, USA. AD - Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, USA. FAU - Thomas, Kali S AU - Thomas KS AD - Department of Health Services, Policy and Practice, Center for Gerontology and Healthcare Research, Brown University School of Public Health and Providence VA Medical Center, Providence, Rhode Island, USA. LA - eng GR - 90DPTB0009/ACL/ACL HHS/United States GR - IK2 HX001775/HX/HSRD VA/United States GR - R21 AG059120/AG/NIA NIH HHS/United States GR - T32 HS000011/HS/AHRQ HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, Non-P.H.S. PT - Research Support, U.S. Gov't, P.H.S. DEP - 20210628 PL - United States TA - PM R JT - PM & R : the journal of injury, function, and rehabilitation JID - 101491319 SB - IM MH - Aged MH - *Brain Injuries, Traumatic/diagnosis MH - Humans MH - *Inpatients MH - Length of Stay MH - Medicare MH - Recovery of Function MH - Rehabilitation Centers MH - Retrospective Studies MH - Treatment Outcome MH - United States PMC - PMC8606011 MID - NIHMS1708628 COIS- CONFLICT OF INTEREST RG has served as an expert witness for Johnson & Johnson. The authors have no other conflicts of interest to disclose. EDAT- 2021/05/22 06:00 MHDA- 2022/04/09 06:00 PMCR- 2023/04/01 CRDT- 2021/05/21 08:57 PHST- 2021/04/21 00:00 [revised] PHST- 2020/12/11 00:00 [received] PHST- 2021/05/07 00:00 [accepted] PHST- 2021/05/22 06:00 [pubmed] PHST- 2022/04/09 06:00 [medline] PHST- 2021/05/21 08:57 [entrez] PHST- 2023/04/01 00:00 [pmc-release] AID - 10.1002/pmrj.12644 [doi] PST - ppublish SO - PM R. 2022 Apr;14(4):417-427. doi: 10.1002/pmrj.12644. Epub 2021 Jun 28.