Year: 2019
Type: dissertation
Study design: Observational Study
Abstract: The goals of this thesis were to a) compare the content and process of inpatient rehabilitation (IR) between patients with Traumatic Brain Injury (TBI) who were treated in one Canadian and nine US facilities, b) investigate the association of therapeutic factors with short-term functional outcomes, and c) describe the functional recovery from admission to nine months post-discharge at 4 time points as well as explore the predictive value of therapeutic and post-discharge determinants to explain the variation in long-term outcomes in patients with TBI who were admitted to a Canadian facility. This thesis was based on three studies. The results of the first study showed that there are significant differences between components of IR for patients with TBI who were treated in Canadian versus US facilities. These findings provide informative data for practitioners and researchers about variations in service provision for patients with similar profiles. The findings of the second study revealed that level of effort was associated with higher discharge cognitive scores. Additionally, more intensity of time spent in complex occupational and physical therapy activities were significant predictors of better discharge motor scores. These findings provide evidence to consider patient level of effort and intensity of specific activities in the process of goal setting. The results of the third study demonstrated that after three months post-discharge, patients did not show significant variations in functional outcomes. Also, the number of post-discharge health issues was negatively associated with both cognitive and motor scores at nine months post-discharge, and a greater intensity of time spent in complex occupational therapy activities was a predictor of better motor scores at nine months follow-up. These findings inform health care providers about the temporal influence of IR and the necessity of investigating the association of continuous treatments with long-term outcomes after IR discharge. In summary, this thesis provides valuable information for stakeholders to consider the effect of variations of pattern and content of care on short and long-term outcomes following IR and to direct the resources for providing adequate and appropriate level of care.
Source: TSpace (University of Toronto)
Author: Sareh Zarshenas
Language: English
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W3099252067