Predictors of Recovery of Gait of People with Severe Traumatic Brain Injury: A Prospective Study of 470 Patients

Research Objectives: To identify predictors of gait recovery in patients with Traumatic Brain Injury (TBI) up to 12 months after trauma and investigate the functionality of patients with TBI admitted to the ICU, ward and in the 3, 6 and 12 month follow-up

Design: Prospective cohort observational study

Setting: State Hospital of Urgency and Emergency/Trauma Reference Center.

Participants: All 470 individuals with severe TBI admitted to the emergency room or ICU of the trauma reference hospital between May 2021 and May 2023 who survived the hospitalization period were included. The 470 patients successfully completed 1 year of follow-up. N=470.

Interventions: N/A.

Main Outcome Measures: Outcome gait recovery assessed using the Functional Ambulation Categories Scale (FAC) in person at hospital discharge and by telephone after 3, 6 and 12 months after severe TBI.

Results: The individuals included in the analysis were mostly male (84%) with an average age of 49 years. Of these individuals, 128 (43%) had high school education. At discharge from the ICU, the majority (73%) of patients did not present inability to walk independently (DRS 0-3). Regarding cognitive status, approximately (85%) who obtained a good score (RLA >6) developed functional gait, behaving like this upon hospital discharge. During the follow-up period, we found an association between the MRS modified Rankin Scale and the FAC, possibly our work is the first to make this association, we showed that in the 3 months (70%), 6 months (83%) and 12 months (64 %) recovery of functional gait. Finally, advanced age, female gender, lower anticipated scores on the MRS, DRS and Glasgow - Extended GOSE scales were associated with an increased risk of a functional gait at ICU discharge, hospital discharge and at follow-up at 3. 6 and 12 months after severe TBI.

Conclusions: According to this study, patients with severe TBI present gait changes during ICU and hospital discharge and during follow-up. Although the results demonstrate that gait recovery peaks after 3 months, non-functional gait rates after the monitored periods were still considerably high in this population. In multivariate analyses, the independent predictive factors for a stage unfavorable for long-term return to walking were advanced age, female gender, adjusted lows in MRS, DRS and GOSE. This study has limitations such as unicentric configuration, data collection in electronic medical records, collected by care professionals and not by an examiner.

Author(s) Disclosures: All authors denied conflicts of interests.