The Relationship Between Functional Mobility and the Intensity of Physical Therapy Intervention in Children with Traumatic Brain Injury

Abstract

The purposes of this study were to describe the types of physical therapy (PT) procedural interventions used during inpatient rehabilitation for children and adolescents with traumatic brain injury (TBI) and to examine the relationship between intensity of intervention and mobility changes. We examined a consecutive series of 80 records of children and adolescents (mean age = 10.3 years) with TBI. Intensity of PT was calculated as the number of 15-minute PT units of service per day/length of stay. We used the Pediatric Evaluation of Disability Inventory (PEDI) to calculate mobility change scores between admission and discharge and the achievement of a minimal clinically important difference (MCID) consisting of an 11-point change. We used a series of hierarchical and logistic regression analyses to identify the relationship of PT intensity to mobility changes, while controlling for potential confounding variables. Therapeutic exercise was the most frequently recorded intervention. On average, PT intensity was provided at a level of 3.1 units (46.5 minutes) per day. After controlling for severity and age, intensity was significantly related to change in PEDI mobility scores; this effect was removed when controlling for admission scores. The MCID was related to PT intensity, even when controlling for initial status. Although the magnitude of the correspondence is small, the intensity of PT intervention in an inpatient rehabilitation hospital is related to positive changes in functional mobility scores and the achievement of an MCID. However, initial mobility status is an essential factor in the interpretation of change scores. Future studies are needed to determine whether controlled variations of PT service intensity have a differential effect on mobility recovery during inpatient rehabilitation.