Original articleRehabilitation of Traumatic Brain Injury in Active Duty Military Personnel and Veterans: Defense and Veterans Brain Injury Center Randomized Controlled Trial of Two Rehabilitation Approaches
Section snippets
Participants
All patients admitted to the CARF-accredited acute inpatient rehabilitation brain injury programs at 4 participating VAMCs (Minneapolis, Palo Alto, Richmond, and Tampa) during the study enrollment period were screened for eligibility. Inclusion criteria were (1) moderate-to-severe nonpenetrating TBI within the preceding 6 months, manifested by a postresuscitation Glasgow Coma Scale score of 12 or less, or coma of 12 hours or more, or PTA of 24 hours or more, and/or focal cerebral contusion or
Recruitment
During enrollment (July 19, 1996–May 16, 2003), 476 patients out of the 897 total rehabilitation admissions fit eligibility criteria and were invited to participate. Of these, 366 subjects consented and were randomized (fig 1). Five subjects rescinded consent before study procedures began, and 1 withdrew consent later, leaving 360 subjects, 180 in each treatment arm, for the intent-to-treat sample. These were distributed among the 4 study sites as follows: Minneapolis (n=65), Palo Alto (n=91),
Discussion
This study is the first randomized clinical head-to-head comparison of 2 acute inpatient interdisciplinary rehabilitation approaches to treating moderate to severe TBI. The competing treatment approaches, cognitive versus functional, were concurrently implemented in a large military and veteran sample using independent teams to maintain treatment purity. The primary outcomes were 1-year global functional measures rather than short-term impairment-based measures and did not differ between
Conclusions
The results from this trial, with the largest sample ever treated in a randomized controlled rehabilitation trial of TBI, indicated no difference between cognitive-didactic and functional-experiential approaches to brain injury rehabilitation on the primary 1-year global outcome measures of the study. However, patients in the cognitive treatment arm had better posttreatment cognitive performance than patients in the functional treatment arm. In addition, subgroup analyses found that younger
Acknowledgments
We thank the Defense and Veterans Brain Injury Center Study Group. Minneapolis VAMC: Barbara Sigford, MD, PhD, Rose Collins, PhD, Richard A. Lanham Jr, PhD, Jeanne Lojovich, PT, NCS, Donald MacLennan, MA, CCC/SLP, Michelle Peterson, DPT, NCS, Deborah Voydetich, OTR. Palo Alto VAMC: Elaine S. Date, MD, Rex A. Bierley, PhD, John H. Poole, PhD, Jill Storms, OTR/L, Sarah Eggen Thornhill, OTR/L, Rose Marie Salerno, RN. Richmond VAMC: William Walker, MD, Tripti Jena, MD, Micaela Cornis-Pop, PhD,
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Cited by (0)
Supported by the Defense and Veterans Brain Injury Center, Uniformed Services University of the Health Sciences, Bethesda, MD, the Department of Veterans Affairs, Veterans Health Administration, and a Department of Defense award administered through the Henry Jackson Foundation (grant no. MDA 905-03-2-0003).
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.