A comparative study of functional independence in activities of daily living among patients with moderate to severe traumatic brain injury undergoing intermediate care: network-based vs telemedicine follow-up
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Abstract
BACKGROUND: Traumatic brain injury (TBI) patients require continuous rehabilitation during the intermediate care (IMC) phase, typically up to six months post-discharge. Chiangrai Prachanukroh hospital implemented two follow-up systems led by physical therapists: a network-based system in 2022 and a telemedicine system during 2023–2024. The Barthel Index (BI) was used to assess patients' functional independence. However, no prior study has compared the effectiveness of these two follow-up approaches during the IMC phase.
OBJECTIVE: To compare the functional independence of patients with moderate to severe TBI who were followed up via a network-based system versus telemedicine during the IMC phase, and to identify common complications occurring during this period.
METHODS: This retrospective study reviewed electronic medical records from 2022 to 2024, dividing patients into two groups: network-based follow-up (2022) and telemedicine follow-up (2023–2024). Baseline characteristics and six-month outcomes were analyzed using the Mann-Whitney U test, Fisher’s Exact Test, and Gaussian regression. Statistical significance was set at p<0.05.
RESULTS: A total of 96 patients met inclusion criteria, with 52 in the network group and 44 in the telemedicine group. No statistically significant differences in BI changes were found between the two groups. However, during the period from discharge to the third month, the telemedicine group showed a greater increase in BI scores compared to the network group by 0.98 points (95% CI; -2.22 - 4.17, p=0.550). Common complications observed during the rehabilitation phase included cognitive impairment (63.6%), pressure ulcers (27.3%), malnutrition (4.6%), and socioeconomic issues (4.6%).
CONCLUSIONS AND RECOMMENDATIONS: Patients who followed up via telemedicine showed a trend toward better functional independence during the first three months after discharge. The most common complications during the rehabilitation phase were cognitive impairment and pressure ulcer. Therefore, during the first three months of follow-up in the patients during the IMC phase should be done telemedicine rather than via network-based.
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