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 ADL retraining during PTA plus treatment as usual (TAU) versus TAU alone for inpatient rehabilitation following severe TBI.

DESIGN: Trial-based economic evaluation from a health-system perspective.

SETTING: Inpatient rehabilitation centre.

PARTICIPANTS: Participants admitted to rehabilitation and in PTA for >7 days following severe TBI.

INTERVENTIONS: Structured ADL retraining during PTA plus TAU versus TAU alone. Structured ADL retraining was manualized to minimise the risk of agitation and maximise functional improvement, following principles of errorless and procedural learning and targeting individualised therapy goals. TAU included physiotherapy and/or speech therapy during PTA plus ADL retraining after PTA emergence.

MAIN OUTCOME MEASURES: Functional Independence Measure (FIM) total scores at baseline, PTA emergence, hospital discharge, or final follow-up (2-months post-discharge) where FIM total scores were calculated as the sum of five 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%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: -$7,762; 95%CI:-$8,105, -$7,419). 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.