Factors associated with patients' participation in rehabilitation services: a comparative injury analysis 12 months post-discharge.

PURPOSE: To determine key characteristics or factors associated with rehabilitation participation during the first year following discharge for persons with either traumatic brain injury (TBI), spinal cord injury (SCI), intra-articular fracture (IAF), or burn injury (BURNS). METHOD: Medical records and longitudinal survey [telephone questionnaire] data were collected for persons in the four injury groups and analyzed using hierarchical logistic regression procedures for each domain of factors. RESULTS: The only significant predictors with odds ratios greater than one were those for vocational rehabilitation participation. TBI patients lacking private insurance were 2.6 times more likely to participate in vocational rehabilitation; older SCI and TBI patients are about twice as likely to participate in vocational rehabilitation; and finally those with IAF or BURNS who are married at 12 months post discharge are 11.5 and 4.4 times respectively more likely to participate in vocational rehabilitation. CONCLUSION: Those lacking valuable socio-economic resources, such as private insurance (for TBI) and social support systems provided by marriage (for BURNS and IAF patients) are much more likely to be referred to vocational rehabilitation. This is true for older SCI and TBI patients as well. Lacking such resources, patients may be viewed by referral agents as less likely to benefit from in or outpatient rehabilitation.

Determinants of self-efficacy among persons with spinal cord injuries.

The purpose of this study was to determine the factors affecting self-efficacy among persons with spinal cord injury (SCI). The study population consisted of 105 persons with SCI who were discharged from one of eight hospitals in north central Alabama between October 1989 and September 1992. Data were derived from a retrospective acute-care medical record review and 12-month annual follow-up telephone interviews. The findings indicate that high self-efficacy is significantly associated with less severe neurological impairment, being white, employed at injury, having a high-school education or beyond, and having an unintentional injury. In terms of marital status our data indicate the odds of divorced persons having high self-efficacy are 8.2 (CL = 0.919, 74.1) times those of married persons. In addition, 64% of those who were divorced during the 12 months after injury had high self-efficacy compared to 50% of those who were divorced prior to injury.

Factors associated with awareness of vocational rehabilitation services after traumatic brain injury.

OBJECTIVES: To determine the characteristics of persons with traumatic brain injury (TBI) who were aware of vocational rehabilitation (VR) services 1 year after hospital discharge. DESIGN: Medical record and longitudinal survey data on persons with TBI were analyzed using logistic regression and bivariate analyses. SETTING: The study sample was drawn from a population-based sample of persons hospitalized in 1 of 8 hospitals in north-central Alabama. PARTICIPANTS: Criteria for inclusion were: (1) being at least 18 years of age or older when injured; (2) having sustained a TBI; (3) being discharged alive after a hospital stay of at least 3 days; (4) residing and having been injured in the state of Alabama; (5) participation in a 12-month follow-up interview. MAIN OUTCOME MEASURE: Patients' awareness of VR service programs and benefits. RESULTS: Awareness of VR service programs was associated with: (1) being Caucasian; (2) being more often employed at the time of injury; (3) being more often severely injured; and (4) more frequently receiving outpatient rehabilitation. CONCLUSION: Interventions should target non-Caucasians, those who were unemployed when injured, those less severely injured, and those not receiving outpatient rehabilitation services after hospital discharge. Periodic review of VR benefits with patients and their families should be undertaken by health care and VR professionals.

Factors associated with life satisfaction among a sample of persons with neurotrauma.

Factors were examined that are associated with life satisfaction one year post-discharge for persons with a spinal cord (SCI) or traumatic brain injury (TBI). Findings show persons with SCI or TBI should be considered as two distinct groups with regard to factors affecting life satisfaction. Different strategies might be considered to affect either group. Three psychosocial variables significantly increased life satisfaction for persons with SCI: closeness to family, the level of family activities, and blaming oneself for the injury. For persons with TBI, total family satisfaction, blaming oneself for the injury, being employed, being married, and having memory and bowel independence significantly increased life satisfaction. For persons with TBI, there was a difference in the number of factors affecting life satisfaction dependent on whether the persons blamed themselves or not. Those who do not blame themselves show a greater number of functional activities as indicators for their self-satisfaction.

Explaining quality of life for persons with traumatic brain injuries 2 years after injury.

OBJECTIVE: To model the complex effects of demographic, psychosocial, physical, and rehabilitation variables on quality of life 2 years after hospital discharge. DESIGN: Medical record and longitudinal survey data on traumatic brain injury (TBI) survivors who did or did not receive formal rehabilitation services after being injured were analyzed. SETTING: The study sample was selected from a representative sample of hospitals in north-central Alabama. PARTICIPANTS: Criteria for inclusion were: (1) 18 years and older with TBI; (2) discharged after hospital stay of 3 or more days; and (3) resided and injured in Alabama. There were 293 persons eligible for the 24-month follow-up survey, 186 (63%) of whom participated; the focus was on the 116 persons (of 186) who responded to the surveys themselves. MAIN OUTCOME MEASURE: A causal model of hypothesized direct and indirect effects of several variables on quality of life outcomes. RESULTS: Employment was the strongest contributor of improved quality of life. Persons unable to pay for health care showed less improvement in functional independence 12 to 24 months postinjury and reported a poorer quality of life. The psychosocial variables of self-blame and family support improved quality of life by reducing impairments and increasing the likelihood of employment. Family support also improved quality of life by increasing functional independence. Fewer physical impairments and gains in functional independence directly improved quality of life. CONCLUSION: The interrelationships between psychosocial and physical variables are important when examining quality of life. Interventions are recommended targeting psychosocial variables and functional independence in efforts to improve quality of life.

Social and physical factors in the referral of people with traumatic brain injuries to rehabilitation.

Using standardized data abstracted from a representative sample of hospitals in north-central Alabama, we analyze significant social and physical factors in acute care discharge referral patterns for 756 people with traumatic brain injury (TBI). When a Physical Medicine and Rehabilitation specialist is involved in the referral, patients receive more formal rehabilitation care following discharge, even after controlling for the relevant social and physical characteristics of the patient. Other significant variables predicting the level of rehabilitation care include presence of injury-related complications, abnormal computed tomography scan, longer length of acute care stay, being unmarried, older, and having an unintentional injury. Patients not seen by rehabilitation medicine specialists and/or those whose injuries provide less clinical evidence (implying greater uncertainty of diagnosis) are less likely to be referred to more formal rehabilitation. Thus, social and demographic factors may be significant in referral patterns when diagnostic uncertainty is present. Results suggest the importance of increasing availability of rehabilitation medicine consultation for TBI patients, while informing acute care providers about formal rehabilitation as a management option.