Rehabilitation Outcomes In Patients Research Articles

Impact of low and high hematocrit at hospital discharge on rehabilitation outcome in patients after cardiac and major aortic surgery

Impact of low and high hematocrit at hospital discharge on rehabilitation outcome in patients after cardiac and major aortic surgery

The influence of obesity on pulmonary rehabilitation outcomes in patients with COPD

Although obesity is increasing in prevalence, relatively little attention has been given to its impact on outcomes in patients with chronic obstructive pulmonary disease (COPD) completing pulmonary rehabilitation. We conducted a retrospective chart review of 114 patients with COPD who completed outpatient pulmonary rehabilitation at our center. Body habitus categories were determined based on body mass index (BMI). Underweight patients (BMIA <A 21A kg/m(2)) were excluded from the analysis. Normal weight and overweight patients were classified as non-obese. Obese patients (BMIA >30A kg/m(2)) were compared with non-obese patients in the following areas: forced expiratory volume in 1A s (FEV(1)) percent predicted, the 6-min walk distance (6MWD), health status, the number of unsupported arm lifts per minute, and functional performance. Health status was determined using the Self-Reported Chronic Respiratory Questionnaire (CRQ-SR), which has dimensions of dyspnea, fatigue, emotion, and mastery. Functional performance was determined using the Pulmonary Functional Status Scale Daily Activities subscore. Compared with non-obese patients, obese patients had a higher FEV(1) percent-predicted (44A +/-A 15% vs 52A +/-A 16%; PA =A 0.01), yet had lower 6MWD (269A +/-A 11 vs 203A +/-A 13; PA =A 0.0002), lower functional status, and greater fatigue at initial evaluation. However, the two groups had similar walk-work, which adjusts for differences in weight. Despite the baseline differences, both groups improved similarly following pulmonary rehabilitation (change in 6MWD was 52A +/-A 7A m in the non-obese patients versus 47A +/-A 9 in the obese patients; PA =A 0.65). Our study suggests that obese COPD patients are referred to pulmonary rehabilitation at an earlier spirometric stage of their disease, but have a poorer exercise performance, a greater degree of functional impairment and greater fatigue levels. This is probably, largely because of the effect of an increased weight burden. However, obesity did not seem to adversely affect the pulmonary rehabilitation outcomes.

Der Einfluss von Depressivität und Geschlecht auf den Rehabilitationserfolg bei chronischem Rückenschmerz: Eine Pilotstudie

Currently, little is known about the influence of depressive symptoms and gender-specific aspects in rehabilitation outcome of patients with chronic low back pain. Effects of gender and depressive symptoms on rehabilitation outcome were examined immediately after rehabilitation, as well as three and six months after rehabilitation in 116 patients with chronic low back pain (43 women, 73 men; M=48 yrs.; ICD-10 diagnoses: M45.4/M45.5, M54.4/M54.5). Immediately after rehabilitation, general improvements with medium effect sizes in all rehabilitation measures were found. In contrast, six months after rehabilitation, only pain-related measures showed moderate improvements. Additionally, the mid-term outcomes were influenced by gender and depressive symptoms; women showed more stable rehabilitation outcomes in pain intensity, in the impaired function related to family/leisure, and the coping with pain strategies of "perceived self-competence" and "relaxation". In contrast, especially male patients with severe depressive symptoms revealed regressive rehabilitation outcomes, both in pain-related variables as well as marginally in the coping with pain strategy of "cognitive restructuring". In post-hoc analyses, in the mid-term, they even showed a deterioration of functional capacity and somatisation compared to prior to rehabilitation. Our results suggest that the outcome of orthopaedic rehabilitation may be persistently improved by implementing gender-specific treatments in general and elements of depression treatments for the patients with severe but sub-clinical depressive symptoms.

Dementia as a cofactor for geriatric rehabilitation-outcome in patients with osteosynthesis of the proximal femur: A retrospective, matched-pair analysis of 250 patients

A raising number of patients with osteosynthesis of the proximal femur and additional dementia will be seen in hospitals in the future due to demographic changes. There is an ongoing discussion, if and to what extent cognitive abilities do influence functional outcome in geriatric rehabilitation. We therefore compared 250 patients with osteosynthesis of the proximal femur of whom one half had additional dementia, by a matched-pair analysis for the improvement of mobility assessed by the mobility items of the Barthel Index and the Tinetti mobility index. Dementia was an important cofactor for the success of geriatric rehabilitation. Patients with additional dementia reached lower mobility scores at discharge. Also, patients with dementia had significantly more in-hospital falls. Furthermore, the study revealed that demented patients received less individual and group therapy per hospital day. The study underlines the need for specialized wards treating demented patients with additional illnesses.

Poster 62: The Comparison of Rehabilitation Outcomes for Patients With Spinal Cord Injury Before and After Prospective Payment System Implementation

Poster 62: The Comparison of Rehabilitation Outcomes for Patients With Spinal Cord Injury Before and After Prospective Payment System Implementation

Functional Independence Measure as a predictor of expected rehabilitation outcome in patients with total endoprosthesis replacement and after apoplectic infarct

Functional Independence Measure (FIM) is a method for uniformly recording functional status in rehabilitation patients. It has been under development in the USA since 1985. In this study, the prognostic value of function tests by FIM on admission to the rehabilitation clinic was investigated in two groups (45 patients in all). Thirty-three patients were admitted for rehabilitation following apoplectic shock, the remaining 12 following treatment of fractures of the femoral neck by total hip replacement. A highly significant correlation was found between the total FIM score on admission and the patient's status on discharge. Of the individual functions studied, the activities "dressing and undressing" and "walking/riding in wheelchair" were found have the highest predictive value.

A Clarion to Recommit and Reaffirm Burn Rehabilitation

Burn rehabilitation has been a part of burn care and treatment for many years. Yet, despite of its longevity, the rehabilitation outcome of patients with severe burns is less than optimal and appears to have leveled off. Patient survival from burn injury is at an all-time high. Burn rehabilitation must progress to the point where physical outcomes parallel survival statistics in terms of improved patient well-being. This position article is a treatise on burn rehabilitation and the state of burn rehabilitation patient outcomes. It describes burn rehabilitation interventions in brief and why a need is felt to bring this issue to the forefront. The article discusses areas for change and the challenges facing burn rehabilitation. Finally, the relegation and acceptance of this responsibility are addressed.

Effects of Anemia on the Rehabilitation Outcomes in Elderly Patients in the Post-Acute Care Setting.

Background - More than 3 million people in the United States over the age of 65 are anemic. The evidence indicates that older people with anemia suffer hospitalizations, physical decline and disability more than people without anemia. Additionally there are reports that anemia is an independent risk factor for this decline in physical performance in those over the age of 65.Objective - The goal of this study was to detail if anemia significantly affects patient's rehabilitation outcomes by focusing on the ability to perform activities of daily living (ADL) as assessed by the physical therapist, the disposition upon discharge (meeting the therapy goals) and an analysis of length of stay (LOS) in relation to anemia.Methods - We conducted a chart review of 260 medical records of patients who underwent rehabilitation therapy at the North Chicago Veterans Affairs Medical Center, and detailed the progress of 69 of these patients who received ADL therapy. The study is ongoing with a projected chart review of 437 medical records, and with an estimated final sample size of 150. Univariate and multivariate analysis was conducted in relation to our outcome measures.Results - The anemic group had 43 patients and the non-anemic 26. Average values for anemic patients were: Hgb 11 Hct 32, MCV 88, MCH 29.2, RDW 15.6, Platelets 259, the non-anemic patients values were: Hgb 13.4, Hct 39, MCV 89, MCH 33.3, RDW 14.3, platelets 229. The patients with anemia had a median change in ADL scores of 9 versus non-anemic patients' median change in scores of 12 (p=0.154). Length of stay was 51 days (median) for anemic patients and 36 days (median) for non-anemic patients (p=0.108) Of the non-anemic patients, 19 out of 26 (73%) met the goals of therapy and 21 out of 43 (49%) of the anemic patients met the goals of therapy (p=0.055). Surprisingly, only 3 out of the 43 (7%) anemic patients were treated for their anemia or had work up done to identify the cause of the anemia. The multivariate model for length of stay indicated that anemia was not significant (p=0.842), the morbidity of the patient was marginally not significant (p=0.089), however, the patients' age was statistically significant at p=0.05. For the multivariate model of ADL improvement the results were: anemia p=0.186, sex p=0.298, Charlson index p=0.50.Conclusion - There is a definite lack in the identification and treatment of anemia in patients undergoing rehabilitation. Anemia exerts an influence on the course of patient therapy/recovery and should be addressed as an individual problem. Anemic patients undergoing rehabilitation are scoring lower, and are admitted longer to the hospital.

PR_203: Functional Outcomes Comparing Interlaminar and Transforaminal Lumbar Epidural Steroid Injections

Objective: To investigate whether there is a difference in Oswestry Disability Index (ODI) scores in those patients with lumbar radiculopathy who receive either an interlaminar (LESI) or a transforaminal (TFESI) lumbar epidural steroid injection to the epidural space. Design: Retrospective cohort study. Pre- and post-ODI self-assessment questionnaires for patients who had either LESI (n=25) or TFESI (n=24) were reviewed after a follow-up at a mean of 8.6 weeks. Setting: Outpatient pain management center in a Veterans Administration hospital. Participants: 49 patients with lumbar radiculopathy were evaluated for ESI. Intervention: Lumbar ESI. Main Outcome Measure: ODI. Results: Pre-ODI scores for LESI ± SD (50.48±15) and TFESI (50.42±15) did not differ significantly (P>.05). Of the 49 subjects (mean age, 62y) screened, 26 improved according to the ODI while 23 did not improve or worsened. Of the improved patients, the post-ODI scores of 11 LESI patients and 12 TFESI patients did not differ significantly from their pre-ODI scores (P>.05). ODI change between TFESI (12.5±12.8) and LESI scores (9.5±5.7) differed significantly (t=-.744, P=.047). Conclusions: 50% of patients showed improved ODI scores after epidurals, and there appears to be a difference in the ODI scores of patients with lumbar radiculopathy who received the TFESI approach to the epidural space when compared with LESI approach. Because ODI scores changed more than 10 points, TFESI may lead to better functional rehabilitation outcomes in patients with radiculopathy symptoms. A larger cohort of subjects must be evaluated to confirm this finding and stricter criteria for spine pathology should be used in such an evaluation.

PR_259: A Pilot Study of the Interaction Between Spirituality and Rehabilitation Outcome in Patients With Spinal Cord Injury or Disease

Objective: To determine if spirituality (spiritual well-being, spiritual and religious practices, positive religious coping) impacts rehabilitation outcomes for persons with spinal cord injury or severe neurologic illness. Design: Prospective observational survey using 3 patient self-reported spirituality instruments: the Duke Religious Index, the Spirituality Well-Being Scale, and the Brief Religious Coping Scale were used to measure spirituality. Setting: Academic medical center rehabilitation unit. Participants: 103 subjects admitted to an acute inpatient rehabilitation unit between January 2003 and June 2005. The exclusion criteria were: age less than 18, Folstein Mini-Mental Status Examination score less than 22, diagnosis of an acquired brain disorder that could impair cognition or perception, or status as a federal medical center prisoner. Interventions: Not applicable. Main Outcome Measures: FIM instrument, rehabilitation length of stay (LOS), and discharge location. Results: Diagnoses were paraplegia in 50 subjects; tetraplegia in 31 subjects; and neurologic disease in 15 subjects. 10 patients failed to complete data collection after enrollment. Admission FIM score was 66.4±15.9 and discharge FIM score was 95.0±18.0. Rehabilitation LOS was 19.8±14 days. 87% of participants went home. Except for a relationship between negative religious coping and reduced LOS, linear regression was unable to identify any relationship between the measures of spirituality and any rehabilitation outcome. Conclusions: There does not appear to be a relationship between these measures of spirituality and rehabilitation outcomes (rehabilitation LOS, FIM score change, discharge location). The relationship between negative religious coping and LOS is of questionable significance.

Rehabilitation Outcomes in Patients with Brain Tumors and Acute Stroke

To investigate functional outcomes after hospital rehabilitation of patients surviving craniotomy for primary brain tumor excision compared with post-stroke patients. The database of the Neurological Rehabilitation Department "C" of Loewenstein Rehabilitation Center was used to investigate primary brain tumors and first ischemic and hemorrhagic stroke patients admitted for hospital rehabilitation during an 11-yr period, between January 1993 and August 2004. Particular attention was paid to age and sex distribution, onset-to-admission interval, length of stay, functional status at admission and discharge, functional gain (DeltaFI change) as measured by the FIM instrument. A total of 168 patients with craniotomy for primary brain tumor excision (128 intracranial meningiomas and 40 cerebral gliomas) and 1660 first-stroke patients were admitted to the department for rehabilitation during the study period. Mean patient age was 59.9 yrs in meningioma group, 54.1 yrs in the glioma group, and 60.4 yrs in the stroke group. In the meningioma and stroke groups, male patients were in the majority (62 and 70%); in the glioma group, there was equal sex distribution. On average, patients were admitted to rehabilitation treatment 13 days after meningioma excision, 34 days after glioma operation, and 21.6 days after stroke. Functional variables during inpatient rehabilitation were found to be similar in the all groups. Average FIM rating at admission was 80.07 in the meningioma group, 68.2 in the glioma group, and 70.4 in the stroke group. Average discharge FIM rating was 90.3 for patients with meningiomas, 80.7 for patients with gliomas, and 87.8 for stroke patients. Functional gain was 17.9 for meningioma patients, 17.2 for glioma patients, and 21.8 for stroke patients. Average length of stay was 24 days for the meningioma group, 23 days for the glioma group, and 75.4 days for stroke patients; 88.1% of stroke patients, 91.7% of meningioma patients, and 82.7% of glioma patients were discharged to their homes, and 5.4, 3.4, and 8.6%, respectively, were discharged to nursing homes. Patients with brain tumors can achieve good functional outcomes with a shorter length of stay.

Predictors for response to rehabilitation in patients with hip or knee osteoarthritis: a comparison of logistic regression models with three different definitions of responder

To identify pre-treatment predictors of who will benefit from a 3-4-week comprehensive rehabilitation intervention in patients with osteoarthritis (OA) of the knee or hip. A prospective cohort study with assessments at admission to the clinic and after 6 months was conducted. Two hundred and fifty patients from the rehabilitation clinic Rehaclinic Zurzach, Switzerland, were included. Three different measures of response to a 3-4-week comprehensive rehabilitation intervention were used: one indirect measure (minimal clinically important difference (MCID) in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) global score=18% improvement), one direct measure (transition question) and a combination of both criteria. Responders were predicted by a sequential logistic regression analysis with nine personal variables, five lifestyle risk factors, seven psychological status variables and the WOMAC global baseline score. The set of statistically significant predictors was dependent on the definition of response. The comparison of predictors that were statistically significant in any of the prediction models showed similar odds ratios (ORs) for the majority of predictors across three regression models with the different response definitions as dependent variable. Female gender, absence of depressive symptoms (dep), history of complementary medicine (cm) and low comorbidity (com) were the most stable predictors and had ORs above 2.0 (female) and above 1.5 (dep, cm, com) across the three regression models with different response definitions. A set of predictors for the outcome of rehabilitation in patients with OA was identified. If these predictors could be confirmed in future research, this knowledge might help to adopt and individualize the treatment of patients who are, at present, less likely to respond.

Clinical Characteristics and Rehabilitation Outcomes of Patients With Posterior Cerebral Artery Stroke

Ng YS, Stein J, Salles SS, Black-Schaffer RM. Clinical characteristics and rehabilitation outcomes of patients with posterior cerebral artery stroke. Objectives To describe the demographics, clinical profile, and functional outcomes in posterior cerebral artery (PCA) stroke and to identify factors associated with functional change during rehabilitation and discharge disposition. Design Retrospective study of patients with PCA stroke admitted to a rehabilitation hospital over an 8-year period. Setting Free-standing urban rehabilitation hospital in the United States. Participants Eighty-nine consecutive patients with PCA stroke (48 men, 41 women; mean age, 71.5y) met inclusion criteria. Intervention Inpatient multidisciplinary comprehensive rehabilitation program. Main Outcome Measures Demographic, clinical, and discharge disposition information were collected. Functional status was measured using the FIM instrument, recorded at admission and discharge. The main outcome measures were the discharge total FIM score, the change in total FIM score (ΔFIM), and the discharge disposition. Multiple and logistic regression analyses were performed to identify factors associated with the main outcome measures. Results The most common impairments were motor paresis (65%), followed by visual field defects (54%) and confusion or agitation (43%). The mean discharge total FIM score ± standard deviation was 88.3±28.2. The mean ΔFIM was 23.3±16.4. Fifty-five (62%) patients were discharged home. On multiple regression analysis, higher admission total FIM score, longer length of stay (LOS), and a rehabilitation stay free of interruptions were associated with higher discharge total FIM score and greater ΔFIM. Absence of diabetes mellitus and younger age were also associated with higher discharge total FIM scores, and male sex had greater ΔFIM. On logistic regression analysis, younger patients, higher discharge FIM scores, presence of a caregiver, and the nonnecessity for 24-hour support were associated with a discharge to home. Conclusions Motor, visual, and cognitive impairments are common in PCA stroke, and good functional gains are achievable after comprehensive rehabilitation. Higher admission FIM scores, longer LOS, and younger and male patients were associated with better functional outcomes. Most patients were discharged home, particularly those with caregivers and those for whom 24-hour support was not required. Further research should aim at the development of functional outcome measures of greater breadth and sensitivity to visual and cognitive deficits and should compare PCA stroke outcomes with outcomes of strokes in other vascular territories.

Poster 70: Rehabilitation Outcomes in Patients at Rancho Los Amigos Level II/III

Poster 70: Rehabilitation Outcomes in Patients at Rancho Los Amigos Level II/III

Unilateral spatial neglect: Relation to rehabilitation outcomes in patients with right hemisphere stroke

Gillen R, Tennen H, McKee T. Unilateral spatial neglect: relation to rehabilitation outcomes in patients with right hemisphere stroke. Arch Phys Med Rehabil 2005;86: 763–7. Objective To examine the relation between left unilateral spatial neglect (USN) and rehabilitation outcomes in patients with right hemisphere stroke. Design A retrospective analysis of a database of right hemisphere stroke patients. Setting Acute inpatient rehabilitation hospital. Participants Patients (N=175) with a diagnosis of right hemisphere stroke who had undergone a neuropsychologic screening including assessment of USN and depressive symptoms at time of admission to an inpatient rehabilitation program. Interventions Not applicable. Main outcome measures Functional status was evaluated with the FIM instrument at admission and discharge. The relationship between USN, depressive symptoms, cognitive functioning, length of stay (LOS), and rate of progress in rehabilitation was examined via univariate (correlational) and multivariate (Cox regression) analyses. Results Patients with USN had longer LOS and progressed more slowly compared with those without USN. When matched against patients with equally poor functional status at admission, USN patients still had longer admissions and progressed more slowly. Conclusions USN is a unique predictor of rehabilitation outcomes in patients with right hemisphere stroke. Identification of those specific functional skill areas most affected by USN may make possible the development of targeted interventions aimed at these key areas.

Nutritional status of cancer patients and its relationship to function in an inpatient rehabilitation setting

Malnutrition is associated with prolonged hospitalization, lower survival rate, and various medical complications. However, little is known about malnutrition and its relationship with the functional status. We undertook this retrospective study to examine whether or not malnutrition affects rehabilitation outcome in patients who had undergone cancer rehabilitation. We conducted a review of the charts of 30 consecutive cancer patients who had been admitted to the inpatient rehabilitation unit in a tertiary cancer center, from the beginning of March 2001 to the end of April 2001. The patients' mean rehabilitation stay was 9 days and their mean age was 58 years (range 22-86 years). On rehabilitation admission, 15 of the patients (50%) had a below normal prealbumin (<18 mg/dl) level (95% confidence interval 31-69%), and on discharge 10 of the patients (33%) had a below normal prealbumin level (95% CI 17-54%). The serum prealbumin concentration level correlated with motor functional independence measure scores on admission. After inpatient rehabilitation, statistically significant gains in functional independence measure scores (P<0.0001) were obtained in patients with below normal admission prealbumin, as well as in those whose prealbumin levels were within the normal range; no statistically significant difference was found in functional gain between these two groups. Our study showed that a large number of cancer rehabilitation patients had malnutrition. Nevertheless, functional gain was achieved in all patients after rehabilitation, whether or not malnutrition was present. We conclude that malnourished patients should still be considered candidates for rehabilitation.

Muscle Adaptations with Immobilization and Rehabilitation after Ankle Fracture

INTRODUCTION/ PURPOSE: The widespread occurrence of muscular atrophy during immobilization and its reversal presents an important challenge to rehabilitation medicine. We used 3D-magnetic resonance imaging (MRI) in patients with surgically-stabilized ankle mortise fractures to quantify changes in plantarflexor and dorsiflexor muscle size during immobilization and rehabilitation, as well as to evaluate changes in force generating capacity (specific torque). Twenty-individuals participated in a 10 wk rehabilitation program after 7 wk of immobilization. MRIs were acquired at baseline, 2, and 7 wk of immobilization, and at 5 and 10 wk of rehabilitation. Isometric plantarflexor muscle strength testing was performed at 0, 5, and 10 wk of rehabilitation. Dorsiflexors and plantarflexors atrophied 18.9% and 24.4% respectively, the majority of which occurred during the first 2 wk of immobilization (dorsiflexors: 9.6%; plantarflexors: 14.1%). Likewise, more than 50% of hypertrophy during rehabilitation occurred within the first 5 wk of rehabilitation for both the dorsiflexors (12.9%) and plantarflexors (13.2%), when compared to the total amount of hypertrophy over 10 wk of rehabilitation (dorsiflexors: 17.6%, plantarflexors: 22.5%). There were no significant differences in hypertrophy or atrophy of the dorsiflexor or plantarflexor muscles, despite a rehabilitation emphasis on the plantarflexors. Patients had significantly lower plantarflexor specific torque (torque/CSA) than healthy, control subjects immediately after cast immobilization, which did not return to normal after 10 wk of rehabilitation (P < 0.05). Our investigation of the consequences of limb immobilization on rehabilitation outcomes in patients can be applied directly to optimizing rehabilitation programs. Although muscle hypertrophy occurred early during rehabilitation, plantarflexor muscle function (specific torque) should remain the focus of rehabilitation programs because although CSA recovered quickly, specific torque still lagged behind that of control subjects.

Abstract 43 comparison of rehabilitation outcomes in patients with total knee arthroplasty utilizing postoperative continuous femoral nerve catheter analgesia versus intravenous patient controlled analgesia: a retrospective study. Kevin E. Brueilly, MPT (St. Luke’s Hosp/Mayo Clin, Jacksonville, FL); Martin L. De Ruyter, MD; Roy A. Greengrass, MD. Brueilly is now affiliated with Texas Tech Univ Sch Allied Health Sci., e-mail: kevin.brueilly@ttuhsc.edu

Abstract 43 comparison of rehabilitation outcomes in patients with total knee arthroplasty utilizing postoperative continuous femoral nerve catheter analgesia versus intravenous patient controlled analgesia: a retrospective study. Kevin E. Brueilly, MPT (St. Luke’s Hosp/Mayo Clin, Jacksonville, FL); Martin L. De Ruyter, MD; Roy A. Greengrass, MD. Brueilly is now affiliated with Texas Tech Univ Sch Allied Health Sci., e-mail: kevin.brueilly@ttuhsc.edu

Awareness of activity limitations, goal setting and rehabilitation outcome in patients with brain injuries

Primary objective: To examine the relationship between self-awareness, goal setting ability (i.e. ability to set realistic goals) and performance/outcome in a cognitive task and for rehabilitation.Research design: Regression analyses were conducted to compare the predictive power of self-awareness and demographic/neuropsychological variables on goal setting ability and performance/outcome.Methods and procedures: Self-awareness of 63 patients with brain injuries was measured by direct clinicians’ rating and the difference between patient and staff ratings in a questionnaire.Results: The awareness measures predicted 32% of the variance for goal setting ability in the rehabilitation context but only 4% of the goal setting variance in the cognitive task. Similarly, self-awareness predicted 33% of the variance for rehabilitation outcome but only 5% of the performance in the cognitive task.Conclusions: Self-awareness seems to be related to goal setting ability and outcome in a long-term rehabilitation process but less in short-term experimental tasks.

Long term outcomes after moderate to severe traumatic brain injury

Objective: This research examined the long-term outcomes of rehabilitation patients with moderate to severe traumatic brain injury (TBI).Design: Retrospective cohort study.Setting and subjects: We examined consecutive records of persons with moderate to severe traumatic brain injury who were discharged from a large rehabilitation hospital in Pennsylvania from 1973 to 1989. We interviewed consenting participants (n = 306) up to 24 years post-injury.Main outcome measures: Self-rated health, activity limitations, employment, living arrangements, marital status, Community Integration Questionnaire, and use of rehabilitation services.Results: Participants were most limited in activities such as managing money and shopping. Twenty-nine per cent of our participants were working full time. There were significant relationships between activity limitations and residual cognitive impairment at follow-up. Self-rated health was correlated with most instrumental activities of daily living.Conclusion: Our findings document health and function in a large post acute TBI population and implications for rehabilitation are discussed.