ABSTRACT

Severe acquired brain injury has long-term physical and cognitive effects. Identifying patient variables predictive of recovery in different brain injury populations would generate improved prognostic information and help rehabilitation teams set appropriate therapeutic goals. This cohort study of 447 NHS neurorehabilitation inpatients aimed to identify functional and cognitive predictors of recovery following severe acquired brain injury caused by trauma, stroke and anoxia. Motor and cognitive impairment ratings were collected at admission and discharge using the Functional Independence Measure and Functional Assessment Measure (FIM+FAM), and injury-related and demographic data were collated from medical records. Predictors of physical, cognitive and overall recovery were identified via hierarchical regression analyses. Several key findings emerged. Firstly, on-admission motor skills predicted functional and overall outcomes across groups. Secondly, on-admission social interaction skills predicted cognitive discharge outcomes in stroke and trauma, and overall outcomes for stroke, but did not predict anoxia outcomes. Thirdly, age predicted all forms of recovery for stroke only. Further group-specific factors were also identified as predicting motor and cognitive recovery, indicating that factors key to the rehabilitation trajectory may differ between populations. These variables should be considered in rehabilitation goal planning, although further research is required to explore their contributions to recovery.

摘要

严重的获得性脑损伤具有长期的身体和认知影响。识别可预测不同脑损伤人群康复的患者变量将产生更好的预后信息，并帮助康复团队设定适当的治疗目标。这项针对 447 名 NHS 神经康复住院患者的队列研究旨在确定由创伤、中风和缺氧引起的严重获得性脑损伤后恢复的功能和认知预测因素。使用功能独立测量和功能评估测量 (FIM+FAM) 在入院和出院时收集运动和认知障碍评分，并从医疗记录中整理与损伤相关的人口统计数据。通过分层回归分析确定了身体、认知和整体恢复的预测因素。出现了几个关键发现。首先，入院时的运动技能可以预测各组的功能和整体结果。其次，入院时的社交互动技能可预测中风和创伤的认知放电结果，以及中风的总体结果，但不能预测缺氧结果。第三，年龄只能预测中风的所有形式的恢复。进一步的群体特定因素也被确定为预测运动和认知恢复，表明康复轨迹的关键因素可能因人群而异。在康复目标规划中应考虑这些变量，尽管需要进一步研究来探索它们对康复的贡献。入院时的社交互动技能可预测中风和创伤的认知放电结果，以及中风的总体结果，但不能预测缺氧结果。第三，年龄只能预测中风的所有形式的恢复。进一步的群体特定因素也被确定为预测运动和认知恢复，表明康复轨迹的关键因素可能因人群而异。在康复目标规划中应考虑这些变量，尽管需要进一步研究来探索它们对康复的贡献。入院时的社交互动技能可预测中风和创伤的认知放电结果，以及中风的总体结果，但不能预测缺氧结果。第三，年龄只能预测中风的所有形式的恢复。进一步的群体特定因素也被确定为预测运动和认知恢复，表明康复轨迹的关键因素可能因人群而异。在康复目标规划中应考虑这些变量，尽管需要进一步研究来探索它们对康复的贡献。表明康复轨迹的关键因素可能因人群而异。在康复目标规划中应考虑这些变量，尽管需要进一步研究来探索它们对康复的贡献。表明康复轨迹的关键因素可能因人群而异。在康复目标规划中应考虑这些变量，尽管需要进一步研究来探索它们对康复的贡献。