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JAMA. 2000 Jun 21;283(23):3075-81.

Cognitive rehabilitation for traumatic brain injury: A randomized trial. Defense and Veterans Head Injury Program (DVHIP) Study Group.

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  • 1Defense and Veterans Head Injury Program, Bldg 1, Room B210, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA. asalazar@dvhip.org

Abstract

CONTEXT:

Traumatic 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.

OBJECTIVE:

To evaluate the efficacy of inpatient cognitive rehabilitation for patients with TBI.

DESIGN AND SETTING:

Single-center, parallel-group, randomized trial conducted from January 1992 through February 1997 at a US military medical referral center.

PATIENTS:

One 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.

INTERVENTIONS:

Patients 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 MEASURES:

Return to gainful employment and fitness for military duty at 1-year follow-up, compared by intervention group.

RESULTS:

At 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).

CONCLUSIONS:

In 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. JAMA. 2000;283:3075-3081

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PMID:
10865301
[PubMed - indexed for MEDLINE]
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