Economic evaluation of activities of daily living retraining during posttraumatic amnesia for inpatient rehabilitation following severe traumatic brain injury

Duncan Mortimer, Jessica Trevena-Peters, Adam McKay, Jennie Ponsford

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objective: To evaluate the cost-effectiveness of structured activities of daily living (ADL) retraining during posttraumatic amnesia (PTA) plus treatment as usual (TAU) vs TAU alone for inpatient rehabilitation following severe traumatic brain injury (TBI). Design: Trial-based economic evaluation from a health-system perspective. Setting: Inpatient rehabilitation center. Participants: Participants (N=104) admitted to rehabilitation and in PTA for >7 days following severe TBI. Interventions: Structured ADL retraining during PTA plus TAU vs TAU alone. Structured ADL retraining was manualized to minimize the risk of agitation and maximize functional improvement, following principles of errorless and procedural learning and targeting individualized therapy goals. TAU included physiotherapy and/or speech therapy during PTA plus ADL retraining after PTA emergence. Main Outcome Measures: FIM total scores at baseline, PTA emergence, hospital discharge, or final follow-up (2mo postdischarge) where FIM total scores were calculated as the sum of 5 FIM motor self-care items and a FIM meal-preparation item. Results: Structured ADL retraining during PTA significantly increased functional independence at PTA emergence (mean difference: 4.90, SE: 1.4, 95% confidence interval [CI]: 1.5, 8.3) and hospital discharge (mean difference: 5.22, SE: 1.4, 95% CI: 1.8, 8.7). Even in our most pessimistic scenario, structured ADL retraining was cost-saving as compared to TAU (mean: -$7762; 95% CI: -$8105, -$7419). Together, these results imply that structured ADL retraining dominates (less costly but no less effective) TAU when effectiveness is evaluated at PTA emergence and hospital discharge. Conclusions: Structured ADL retraining during PTA yields net cost-savings to the health system and offers a cost-effective means of increasing functional independence at PTA emergence and hospital discharge.

Original languageEnglish
Pages (from-to)648-655
Number of pages8
JournalArchives of Physical Medicine and Rehabilitation
Volume100
Issue number4
DOIs
Publication statusPublished - Apr 2019

Keywords

  • Activities of daily living
  • Brain injuries, traumatic
  • Cost and Cost Analysis
  • Rehabilitation

Cite this

@article{bca4737688af44488f62d0966e530570,
title = "Economic evaluation of activities of daily living retraining during posttraumatic amnesia for inpatient rehabilitation following severe traumatic brain injury",
abstract = "Objective: To evaluate the cost-effectiveness of structured activities of daily living (ADL) retraining during posttraumatic amnesia (PTA) plus treatment as usual (TAU) vs TAU alone for inpatient rehabilitation following severe traumatic brain injury (TBI). Design: Trial-based economic evaluation from a health-system perspective. Setting: Inpatient rehabilitation center. Participants: Participants (N=104) admitted to rehabilitation and in PTA for >7 days following severe TBI. Interventions: Structured ADL retraining during PTA plus TAU vs TAU alone. Structured ADL retraining was manualized to minimize the risk of agitation and maximize functional improvement, following principles of errorless and procedural learning and targeting individualized therapy goals. TAU included physiotherapy and/or speech therapy during PTA plus ADL retraining after PTA emergence. Main Outcome Measures: FIM total scores at baseline, PTA emergence, hospital discharge, or final follow-up (2mo postdischarge) where FIM total scores were calculated as the sum of 5 FIM motor self-care items and a FIM meal-preparation item. Results: Structured ADL retraining during PTA significantly increased functional independence at PTA emergence (mean difference: 4.90, SE: 1.4, 95{\%} confidence interval [CI]: 1.5, 8.3) and hospital discharge (mean difference: 5.22, SE: 1.4, 95{\%} CI: 1.8, 8.7). Even in our most pessimistic scenario, structured ADL retraining was cost-saving as compared to TAU (mean: -$7762; 95{\%} CI: -$8105, -$7419). Together, these results imply that structured ADL retraining dominates (less costly but no less effective) TAU when effectiveness is evaluated at PTA emergence and hospital discharge. Conclusions: Structured ADL retraining during PTA yields net cost-savings to the health system and offers a cost-effective means of increasing functional independence at PTA emergence and hospital discharge.",
keywords = "Activities of daily living, Brain injuries, traumatic, Cost and Cost Analysis, Rehabilitation",
author = "Duncan Mortimer and Jessica Trevena-Peters and Adam McKay and Jennie Ponsford",
year = "2019",
month = "4",
doi = "10.1016/j.apmr.2018.08.184",
language = "English",
volume = "100",
pages = "648--655",
journal = "Archives of Physical Medicine and Rehabilitation",
issn = "0003-9993",
publisher = "Elsevier",
number = "4",

}

TY - JOUR

T1 - Economic evaluation of activities of daily living retraining during posttraumatic amnesia for inpatient rehabilitation following severe traumatic brain injury

AU - Mortimer, Duncan

AU - Trevena-Peters, Jessica

AU - McKay, Adam

AU - Ponsford, Jennie

PY - 2019/4

Y1 - 2019/4

N2 - Objective: To evaluate the cost-effectiveness of structured activities of daily living (ADL) retraining during posttraumatic amnesia (PTA) plus treatment as usual (TAU) vs TAU alone for inpatient rehabilitation following severe traumatic brain injury (TBI). Design: Trial-based economic evaluation from a health-system perspective. Setting: Inpatient rehabilitation center. Participants: Participants (N=104) admitted to rehabilitation and in PTA for >7 days following severe TBI. Interventions: Structured ADL retraining during PTA plus TAU vs TAU alone. Structured ADL retraining was manualized to minimize the risk of agitation and maximize functional improvement, following principles of errorless and procedural learning and targeting individualized therapy goals. TAU included physiotherapy and/or speech therapy during PTA plus ADL retraining after PTA emergence. Main Outcome Measures: FIM total scores at baseline, PTA emergence, hospital discharge, or final follow-up (2mo postdischarge) where FIM total scores were calculated as the sum of 5 FIM motor self-care items and a FIM meal-preparation item. Results: Structured ADL retraining during PTA significantly increased functional independence at PTA emergence (mean difference: 4.90, SE: 1.4, 95% confidence interval [CI]: 1.5, 8.3) and hospital discharge (mean difference: 5.22, SE: 1.4, 95% CI: 1.8, 8.7). Even in our most pessimistic scenario, structured ADL retraining was cost-saving as compared to TAU (mean: -$7762; 95% CI: -$8105, -$7419). Together, these results imply that structured ADL retraining dominates (less costly but no less effective) TAU when effectiveness is evaluated at PTA emergence and hospital discharge. Conclusions: Structured ADL retraining during PTA yields net cost-savings to the health system and offers a cost-effective means of increasing functional independence at PTA emergence and hospital discharge.

AB - Objective: To evaluate the cost-effectiveness of structured activities of daily living (ADL) retraining during posttraumatic amnesia (PTA) plus treatment as usual (TAU) vs TAU alone for inpatient rehabilitation following severe traumatic brain injury (TBI). Design: Trial-based economic evaluation from a health-system perspective. Setting: Inpatient rehabilitation center. Participants: Participants (N=104) admitted to rehabilitation and in PTA for >7 days following severe TBI. Interventions: Structured ADL retraining during PTA plus TAU vs TAU alone. Structured ADL retraining was manualized to minimize the risk of agitation and maximize functional improvement, following principles of errorless and procedural learning and targeting individualized therapy goals. TAU included physiotherapy and/or speech therapy during PTA plus ADL retraining after PTA emergence. Main Outcome Measures: FIM total scores at baseline, PTA emergence, hospital discharge, or final follow-up (2mo postdischarge) where FIM total scores were calculated as the sum of 5 FIM motor self-care items and a FIM meal-preparation item. Results: Structured ADL retraining during PTA significantly increased functional independence at PTA emergence (mean difference: 4.90, SE: 1.4, 95% confidence interval [CI]: 1.5, 8.3) and hospital discharge (mean difference: 5.22, SE: 1.4, 95% CI: 1.8, 8.7). Even in our most pessimistic scenario, structured ADL retraining was cost-saving as compared to TAU (mean: -$7762; 95% CI: -$8105, -$7419). Together, these results imply that structured ADL retraining dominates (less costly but no less effective) TAU when effectiveness is evaluated at PTA emergence and hospital discharge. Conclusions: Structured ADL retraining during PTA yields net cost-savings to the health system and offers a cost-effective means of increasing functional independence at PTA emergence and hospital discharge.

KW - Activities of daily living

KW - Brain injuries, traumatic

KW - Cost and Cost Analysis

KW - Rehabilitation

UR - http://www.scopus.com/inward/record.url?scp=85055754381&partnerID=8YFLogxK

U2 - 10.1016/j.apmr.2018.08.184

DO - 10.1016/j.apmr.2018.08.184

M3 - Article

VL - 100

SP - 648

EP - 655

JO - Archives of Physical Medicine and Rehabilitation

JF - Archives of Physical Medicine and Rehabilitation

SN - 0003-9993

IS - 4

ER -