Effects of inpatient rehabilitation on long-term motor, neuropsychological, and functional outcomes in children with severe traumatic brain injury

Despite growing clinician and family recognition of the need for rehabilitation in children surviving severe traumatic brain injury (TBI), there is a paucity of evidence to inform comprehensive rehabilitation guidelines. To advance understanding of rehabilitation care after acute medical management in children with severe TBI, we characterized the use of inpatient rehabilitation services and evaluated its associations with long-term motor, neuropsychological, behavioral, functional, and quality-of-life outcomes in a multisite, multinational cohort, the Approaches and Decisions in Acute Pediatric TBI (ADAPT) trial. First, we observed that children receiving inpatient rehabilitation, regardless of the need for additional non-inpatient rehabilitation services, had a shorter length of acute hospitalization compared to those receiving only non-inpatient rehabilitation. Children from the US were more likely to receive inpatient rehabilitation compared with children from the UK. Among the US cohort, whites were more likely to receive inpatient rehabilitation compared with African Americans. Next, using inverse probability weighting to adjust for confounding and selection biases, we found no differences between children receiving inpatient rehabilitation and children receiving only non-inpatient rehabilitation in tests of motor skills, intellectual functioning, verbal learning, memory, processing speed, cognitive flexibility and parent/guardian-rated executive function and behaviors at 12 months after injury. Then, using a similar analytical approach, we found that children receiving inpatient rehabilitation had more favorable global function at 12 months after injury among those with a Glasgow Coma Scale (GCS) < 13 at hospital discharge, though such association was not observed in children with a higher GCS. No differences between rehabilitation groups in parent/guardian-reported or child self-reported health related quality of life were found. These results likely reflect the benefits of inpatient rehabilitation for children with more severely impaired consciousness when medically stable. Overall, these findings provided the much-needed evidence on the characteristics associated with the use of inpatient rehabilitation and the effects of different patterns of rehabilitation care on long-term outcomes in children with severe TBI. These results are of public health relevance by providing a strong foundation for the development and implementation of policies or clinical practice to optimize rehabilitation care for children with severe TBI.