Cognitive Rehabilitation for Traumatic Brain InjuryA Randomized Trial

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Abstract
Research from JAMA — Cognitive Rehabilitation for Traumatic Brain Injury — A Randomized Trial — ContextTraumatic brain injury (TBI) is a principal cause of death and disability in young adults. Rehabilitation for TBI has not received the same level of scientific scrutiny for efficacy and cost-efficiency that is expected in other medical fields.ObjectiveTo evaluate the efficacy of inpatient cognitive rehabilitation for patients with TBI.Design and SettingSingle-center, parallel-group, randomized trial conducted from January 1992 through February 1997 at a US military medical referral center.PatientsOne hundred twenty active-duty military personnel who had sustained a moderate-to-severe closed head injury, manifested by a Glasgow Coma Scale score of 13 or less, or posttraumatic amnesia lasting at least 24 hours, or focal cerebral contusion or hemorrhage on computed tomography or magnetic resonance imaging.InterventionsPatients were randomly assigned to an intensive, standardized, 8-week, in-hospital cognitive rehabilitation program (n=67) or a limited home rehabilitation program with weekly telephone support from a psychiatric nurse (n=53).Main Outcome MeasuresReturn to gainful employment and fitness for military duty at 1-year follow-up, compared by intervention group.ResultsAt 1-year follow-up, there was no significant difference between patients who had received the intensive in-hospital cognitive rehabilitation program vs the limited home rehabilitation program in return to employment (90% vs 94%, respectively; P=.51; difference, 4% [95% confidence interval {CI}, −5% to 14%]) or fitness for duty (73% vs 66%, respectively; P=.43; difference, 7% [95% CI, −10% to 24%]). There also were no significant differences in cognitive, behavioral, or quality-of-life measures. In a post-hoc subset analysis of patients who were unconscious for more than 1 hour (n = 75) following TBI, the in-hospital group had a greater return-to-duty rate (80% vs 58%; P=.05).ConclusionsIn this study, the overall benefit of in-hospital cognitive rehabilitation for patients with moderate-to-severe TBI was similar to that of home rehabilitation. These findings emphasize the importance of conducting randomized trials to evaluate TBI rehabilitation interventions.