Few studies have assessed the long-term functional outcomes of traumatic brain injury (TBI) in large, well-characterized samples. Using the Traumatic Brain Injury Model Systems cohort, this study assessed the maintenance of independence between years 5 and 15 post-injury and risk factors for decline. The study sample included 1381 persons with TBI who received inpatient rehabilitation, survived to 15 years post-injury, and were available for data collection at 5 or 10 years and 15 years post-injury. The Functional Independence Measure (FIM) and Disability Rating Scale (DRS) were used to measure functional outcomes. The majority of participants had no changes during the 10-year time frame. For FIM, only 4.4% showed decline in Self-Care, 4.9% declined in Mobility, and 5.9% declined in Cognition. Overall, 10.4% showed decline in one or more FIM subscales. Decline was detected by DRS Level of Function (24% with >1-point change) and Employability (6% with >1-point change). Predictors of decline factors across all measures were age >25 years and, across most measures, having less than or equal to a high school education. Additional predictors of FIM decline included male sex (FIM Mobility and Self-Care) and longer rehabilitation length of stay (FIM Mobility and Cognition). In contrast to studies reporting change in the first 5 years post-TBI inpatient rehabilitation, a majority of those who survive to 15 years do not experience functional decline. Aging and cognitive reserve appear to be more important drivers of loss of function than original severity of the injury. Interventions to identify those at risk for decline may be needed to maintain or enhance functional status as persons age with a TBI.

中文翻译：

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创伤性脑损伤后 5 到 15 年的功能变化

很少有研究在大型、特征明确的样本中评估创伤性脑损伤 (TBI) 的长期功能结果。使用创伤性脑损伤模型系统队列，本研究评估了损伤后 5 年和 15 年之间独立性的维持以及下降的风险因素。研究样本包括 1381 名 TBI 患者，他们接受了住院康复治疗，在受伤后存活至 15 年，并可在受伤后 5 年或 10 年和 15 年进行数据收集。功能独立测量 (FIM) 和残疾评定量表 (DRS) 用于测量功能结果。大多数参与者在 10 年的时间范围内没有变化。对于 FIM，只有 4.4% 的自我保健下降，4.9% 的流动性下降，5.9% 的认知下降。总的来说，10。4% 显示一项或多项 FIM 分量表下降。DRS 功能水平（24% 变化 > 1 点）和就业能力（6% 变化 > 1 点）检测到下降。所有测量中下降因素的预测因素是年龄 > 25 岁，并且在大多数测量中，教育程度低于或等于高中教育。FIM 下降的其他预测因素包括男性（FIM 流动性和自我护理）和更长的康复住院时间（FIM 流动性和认知）。与报告 TBI 住院康复后前 5 年的变化的研究相比，大多数存活到 15 年的人没有经历功能衰退。衰老和认知储备似乎是导致功能丧失的更重要的驱动因素，而不是最初的损伤严重程度。