Self-Report of Outpatient Therapy Dose at 6 and 12 Months After Severe Traumatic Brain Injury

Abstract

Objective: Determine agreement between self-reported dose and dose reflected in administrative records of outpatient physical, occupational, and speech therapies at 6 and 12 months after severe traumatic brain injury (TBI), for the purpose of examining accuracy and predictors of accuracy of self-reported health care utilization in this population.

Design: Secondary analysis of survey used in a larger study; participants were queried about therapy doses using a structured interview, either alone or assisted by relatives if they so chose, with responses compared to administrative records.

Setting: Rehabilitation center providing outpatient TBI therapies.

Participants: Sixty-five people with severe TBI living in the community provided 6-month data (N=65); 54 provided 12-month data.

Interventions: Not applicable.

Main outcome measures: Degree of agreement with administrative records of scheduled and billed therapy appointments, measured using intraclass correlation coefficients (ICCs), with linear regression used to predict accuracy from demographic variables and cognitive status.

Results: ICCs were in the moderate range at 6 months, but were more variable, with some in the poor range, at 12 months. Agreement was higher for scheduled than for billed (attended) appointments. Assisted and unassisted patients provided comparable agreement with records. No demographic factors were associated with accuracy, but lower cognitive FIM scores, as hypothesized, tended to predict lower agreement at 6 months.

Conclusions: People with severe TBI can provide reasonable estimates of commonly prescribed outpatient therapy doses at 6 months postinjury. Accuracy may be improved by inviting patients to request assistance from relatives and by asking them to consider attended (vs scheduled) sessions.

Keywords: Rehabilitation; Traumatic brain injuries.