THE EFFECT OF EXTENDED EARLY REHABILITATION ON THE TREATMENT OUTCOME OF PATIENTS WITH MODERATE AND SEVERE TRAUMATIC BRAIN INJURY

Nataša Keleman^1*Dragana Dragicevic-Cvjetkovic^2,3Aleksandra Mikov^4,5Dragomir Radošević⁶Đula Đilvesi^5,7Vladimir Mrđa⁸Rastislava Krasnik^4,5

• ¹Clinical Rehabilitation Service, University Clinical Center of the Republic of Srpska, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina, Banja Luka, Bosnia and Herzegovina
• ²Institute for physical medicine, rehabilitation and orthopedic surgery ”Dr Miroslav Zotović”, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina, Banja Luka, Bosnia and Herzegovina
• ³Faculty of Medicine, University of Banja Luka, The Republic of Srpska, Bosnia and Herzegovina, Banja Luka, Bosnia and Herzegovina
• ⁴Institute for Children and Youth Healthcare of Vojvodina, Novi Sad, Serbia, Novi Sad, Serbia
• ⁵Faculty of Medicine, University of Novi Sad, Serbia, Novi Sad, Serbia
• ⁶Klinikum Bad Gastein, Bad Gastein, Austria
• ⁷Clinical Center of Vojvodina, Clinic for Neurosurgery, Novi Sad, Serbia, Novi Sad, Serbia
• ⁸University Clinical Centar of Republic of Srpska, Banja Luka, Bosnia and Herzegovina, Clinic for Anesthesiology and Intensive Care, Banja Luka, Bosnia and Herzegovina

Introduction: Traumatic brain injury (TBI) is one of the leading causes of morbidity, disability and mortality in all age groups. The functional disability left by TBI, is significant for the patient, family and society. Treatment and early rehabilitation are crucial to the overall level of recovery.Objective: To compare the impact of extended early rehabilitation of patients with moderate and severe traumatic brain injury on the outcome of treatment.Material: A prospective experimental study comprised 124 patients with moderate and severe TBI, randomly divided into two groups. The patients of the experimental group had kinesitherapy seven days a week, twice a day for 45 minutes, and the patients of the control group had kinesitherapy seven days a week, twice a day for 30 minutes. The follow-up parameters were: age, sex, mechanism of injury, associated injuries, comorbidities, Glasgow Coma Scale (GCS) on admission and discharge, early rehabilitation interruptions, presence of tracheostomy, decubitus ulcers, nasogastric tube, diapers and urinary catheter at the discharge from the Intensive Care Unit and discharge from the hospital, and mortality.Results: 124 patients were randomly divided into two groups of 62 patients each.The male gender dominated 95 (76.6%). The average age was Me=62.00 (IQR=36.0) years. There was no statistically significant difference between the groups in gender, age, mechanism of injury, associated injuries and comorbidities. GCS on admission; 68 (54.8%) patients had severe, 56 (46.2%) moderate TBI, at discharge: 22 (17.7%) had severe, 11 (8.9%) moderate and 91 (73.4%) mild TBI. At discharge from the ICU, the presence of tracheostomy was (13 vs 19), (p = 0.218), nasogastric tube (33 vs 45), (p = 0.026) and decubitus ulcers (0 vs 4), (p = 0.042) were less in the experimental group. At discharge from the hospital, tracheostomy (6 vs 16), (p = 0.019), urinary catheter (38 vs 48), (p=0.051), diapers (29 vs 40), (p=0.047) were less in the experimental group. There were 5 deaths in both groups. There was no statistically significant difference in early rehabilitation interruptions between groups (5 vs 6).Extended early TBI rehabilitation is safe, effective and contributes to a positive outcome of treatment.