Predictors of Functional Independence After Traumatic Brain Injury: Prospective Cohort Study

Abstract

Background:
Traumatic brain injury is a major cause of long-term disability, often resulting in reduced independence and prolonged rehabilitation needs. Although survival rates have improved, predicting functional recovery remains challenging due to wide variability in outcomes. Identifying early predictors of functional independence is essential for guiding rehabilitation planning, resource allocation and patient counseling, particularly in low- and middle-income healthcare settings.

Objective:
To identify clinical and rehabilitation-related predictors of functional independence at three months following traumatic brain injury.

Methods:
A prospective cohort study was conducted across tertiary care hospitals and rehabilitation centers in Peshawar, Khyber Pakhtunkhwa, between April and November 2022. One hundred patients with confirmed traumatic brain injury were enrolled within two weeks of injury, and 92 completed follow-up. Functional independence was assessed using the Functional Independence Measure at rehabilitation admission and at three months post-injury. Predictor variables included age, injury severity measured by admission Glasgow Coma Scale, baseline functional status, length of hospital stay and time to rehabilitation initiation. Data were analyzed using correlation analysis and multiple linear regression, assuming normal distribution, with significance set at p < 0.05.

Results:
At three-month follow-up, 58.7% of participants achieved functional independence. Higher admission Glasgow Coma Scale scores and higher baseline Functional Independence Measure scores were strongly associated with better outcomes. Earlier initiation of rehabilitation was independently associated with higher follow-up functional scores, while longer hospital stay showed a negative association. The final regression model explained 52% of the variance in functional independence outcomes.

Conclusion:
Functional independence after traumatic brain injury was primarily influenced by injury severity, early functional status and timely rehabilitation initiation. Early assessment and prompt rehabilitation may improve outcome prediction and support more effective neurorehabilitation planning.

Keywords:
Brain Injuries, Functional Independence, Neurorehabilitation, Outcome Assessment, Prognosis, Rehabilitation, Traumatic Brain Injury