Trajectory of Functional Independent Measurements during First Five Years after Moderate and Severe Traumatic Brain Injury

A better understanding of long-term functional recovery process for patients with traumatic brain injury (TBI) facilitates effective rehabilitations. The aim of this study was to classify and characterize patients with moderate-to-severe TBI based on their functional trajectories up to 5 years post-injury. The study included 121 patients with moderate-to-severe TBIs (International Classification of Diseases, Tenth Revision [ICD-10], S06.0-S06.9), 16-55 years of age, and admitted at Trauma Referral Hospital within 24h of injury between 2005 and 2007. Demographics and injury characteristics were documented at the admission, and functional status was recorded at 3 months and 1 and 5 years post-injury using Functional Independence Measure motor (FIM-M) and cognitive (FIM-C) subscales. We used group-based trajectory models to classify patients' functional trajectories over a 5-year period. For FIM-M, three trajectories were identified: 8.2% of patients showed stable low recovery (13.6 +/- 1.5, 17.9 +/- 8.8, and 21.0 +/- 17.9), 9.2% elevated good recovery (35.8 +/- 14.5, 75.5 +/- 12.4, and 85.5 +/- 8.1), and 82.6% stable good recovery (89.0 +/- 3.6, 90.3 +/- 1.9, and 90.8 +/- 1.0) at the three follow-up points, respectively. For FIM-C, four trajectories were revealed: 4.1% of patients showed stable low recovery (5.0 +/- 0, 5.0 +/- 0, and 5.0 +/- 0), 12.6% delayed moderate recovery (8.9 +/- 3.5, 20.6 +/- 4.6, and 28.3 +/- 3.8), 28.7% elevated good recovery (27.0 +/- 3.8, 30.4 +/- 7.3, and 31.1 +/- 2.3), and 54.6% stable good recovery (32.8 +/- 2.3, 34.6 +/- 1.0, and 34.7 +/- 1.0). The results suggest that three FIM-M and four FIM-C trajectories described various patterns of functional recovery 5 years after moderate-to-severe TBI, with stable good recovery being the most common trajectory. Identifying and characterizing the trajectory memberships should enable targeted rehabilitation programs, inform patient-centered care, and improve long-term outcomes.