BRAIN INJURY, 1996, VOL. 10, NO. 11, 841± 848 Outcome following traumatic brain injury: a comparison between 2 and 5 years after injury J. H. OLVER, J. L. PONSFORD and C. A. CURRAN Bethesda Hospital, Melbourne, Australia (Received 31 January 1996; accepted 10 April 1996) This study examined long-term outcome in traumatically brain-injured individuals following discharge from a comprehensive rehabilitation programme. Of 254 traumatic brain injury (TBI) patients reviewed at 2 years, 103 have been followed up at 5 years using a structured interview format detailing neurological symptoms, mobility, independence in ADL, productivity status, relationship issues, com- munication and the presence of cognitive, behavioural and emotional changes. Visual difficulties, headache and fatigue were persistent in a significant number of patients. Between 2 and 5 years there was increased independence in personal, domestic and community ADL and the use of transport. Ten more patients had returned to driving. On the other hand there was a slightly higher incidence of cognitive, behavioural and emotional changes reported at 5 years. Thirty-two per cent of those working at 2 years were not employed at 5 years. Many students had also become unemployed. These findings suggest the need for intermittent lifelong intervention following TBI. Systems of rehabilitation need to be adapted to provide this. Introduction A number of longitudinal studies have highlighted ongoing cognitive, behavioural and emotional sequelae of traumatic brain injury (TBI) [1± 3]. These contribute significantly to lasting disability and handicap. However, many of the patients in these studies had limited or no access to specialized rehabilitation programmes. Over the past decade there have been significant improvements in rehabilitation services available to individuals with TBI. Programmes have become more focused on addressing psychosocial issues. The long-term impact of the provision of such services on outcome is, as yet, unknown. With the growing emphasis on cost- effectiveness of services, such an evaluation has become paramount [4]. In Melbourne, Australia, the existence of a no-fault accident compensation system has provided the opportunity to establish a comprehensive system of reha- bilitation for people who have sustained TBI. Bethesda Hospital has a specialist brain injury rehabilitation programme funded through this scheme. The interdisci- plinary inpatient and outpatient programmes offered at Bethesda are aimed at over- coming disability and handicap caused by medical, physical, cognitive and behavioural impairments. Each patient and family are offered psychosocial support as well as assistance in obtaining an optical level of community reintegration in terms of living situation, vocational productivity, social and recreational activities. The programme admits around 130 individuals each year who have sustained brain 0269± 9052/96 $12 ´ 00 Ñ 1996 Taylor & Francis Ltd. Correspondence to: Dr John H. Olver, Bethesda Hospital, 30 Erin St, Richmond, VIC 3121, Australia. Brain Inj Downloaded from informahealthcare.com by Monash University on 01/16/11 For personal use only.