Abstract
Patients with traumatic brain injury (TBI) often present with disabilities associated with a high burden of care for caregivers or family members at home. When family members cannot afford to care for patients with TBI, they are often required to find them residence in long-term care institutions. To date, there are no quantitative assessment tools developed to predict institutionalization. Therefore, this study analyzed the accuracy of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) for predicting the institutionalization of patients with TBI. We designed a cross-sectional study using a nationwide disability database. We analyzed the data of 8630 patients with TBI with injury for more than six months from the Taiwan Data Bank of Persons with Disability during July 2012–October 2018. The demographic data and WHODAS 2.0 standardized scores of patients with TBI who resided in community and long-term care institutions were analyzed. Receiver operating characteristic curve (ROC) analysis was performed to investigate the predictive accuracy of WHODAS 2.0 for being institutionalized, and the optimal cut-off point was determined using the Youden index. Binary logistic regression was employed to determine the predictors of the participants being institutionalized. The WHODAS 2.0 scores in each domain were lower in the community group than in the institutionalized group. ROC analysis revealed the highest accuracy for the summary scores of WHODAS 2.0 (area under the curve = 0.769). Binary logistic regression revealed that age, gender, work status, urbanization level, socioeconomic status, severity of impairment, and WHODAS 2.0 domain scores were factors associated with the institutionalization status of patients with TBI. Our results suggest that WHODAS 2.0 may be a feasible assessment tool for predicting the institutionalization of patients with TBI.
Highlights
Traumatic brain injury (TBI) is one of the leading causes of disability and a major public health concern worldwide [1]
These patients with TBI who depend on others for their activities of daily living are referred to nursing homes, community-based programs specialized in TBI, and subacute facilities [4]
The independent t-test revealed that the institution group had higher percentages of male patients (p = 0.0010), older patients (p < 0.001), unemployed patients (p < 0.001), patients with lower education levels (p < 0.001), patients with lower family income status (p < 0.001), patients living in areas with lower urbanization levels (p = 0.0116), patients with higher severity of impairment (p < 0.001), and patients with higher disability scores of each domain and summary scores of all domains of WHODAS 2.0 (p < 0.001) (Table 1)
Summary
Traumatic brain injury (TBI) is one of the leading causes of disability and a major public health concern worldwide [1]. Physical and sensory function impairments can occur These cognitive, psychological, and physical deficits were found to be sequelae of TBI, and TBI severity was associated with long-term disability [3]. Despite intensive care and rehabilitation interventions, some patients still present with functional impairment and disability and require assistance with daily care, which cannot be provided necessarily by their previous home setting or the community. These patients with TBI who depend on others for their activities of daily living are referred to nursing homes, community-based programs specialized in TBI, and subacute facilities [4]
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