Summarized by Theresa Ebo, MA
March 2024
Traumatic brain injury (TBI) is a life-changing event that can produce anywhere from mild life functioning impairments to lasting disability. The natural course of recovery for individuals who have experienced a moderate to severe TBI (msTBI) differs from the acute to chronic phases of recovery. While the initial impairment and associated need for care may be profound, this presentation does not necessarily translate into an unfavorable long-term functional outcome. The Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study aimed to systematically monitor patients’ functional outcomes after a TBI. The patients were observed from two weeks post-injury to 12-months, during which they received inpatient or outpatient rehabilitation services. The goal of the study was to assess the frequency and extent of recovery, from two weeks to 12 months, for patients who suffered moderate to severe TBI. The study included 484 individuals who presented to a level-one trauma center within 24 hours of their injury. The cause of injury included being an occupant or pedestrian in a motor vehicle crash, motorcycle crash, fall, assault, or other reason.
The results provide a positive outlook on recovery for patients with moderate to severe TBI. While 94% of the severe TBI and 79% of the moderate TBI group reported moderate to severe disability and required assistance with the basic aspects of their everyday lives at 12 months post-injury (i.e., feeding, using the toilet, and grooming themselves), a significant portion of the participants with msTBI had major improvements in life functioning, with many regaining their independence between 2 weeks to 12 months after their injury. More specifically, half of the severe group and three-quarters of the moderate group were able to function independently at home for at least eight hours per day. By 12 months, 62 out of 79 participants who were in a vegetative state at two weeks post-injury regained consciousness and 14 regained their orientation.
The article’s findings suggest that patients with msTBI experienced significant functional improvement as early as two weeks post-injury. By the end of the study (i.e., 12 months), patients saw improvement, though variable across participants, including independence at home; ability to shop; and improved work capacity and social functioning. While many participants’ impairments persisted at 12-months post injury, this study revealed that a significant percentage of patients with grave impairment during the early stage of recovery achieved favorable outcomes months later. Thus, impairments in patients with msTBI at two weeks post injury does not necessarily translate to poor long-term recovery.
The study investigates long-term outcomes (i.e., 12 months post-injury) of patients with moderate to severe TBI. The authors acknowledged some limitations, including that the definition of a favorable outcome varies from person to person. Additionally, while the study’s measures are widely accepted in TBI outcome research, they do not reflect all aspects and variables of clinical recovery. Further, two-week outcome ratings may have been influenced by sedating medications administered to the participants at that time. Finally, the study was conducted in settings with established clinical systems of care (i.e., level 1 trauma centers), which may limit the generalizability of the results to patients who may receive care in other settings.