Impairment and Partial Recovery of Medical Decision-Making Capacity in Traumatic Brain Injury: A 6-Month Longitudinal Study
Marson DC, Dreer LE, Krzywanski S, Huthwaite JS, DeVivo MJ, Novack TA. Impairment and partial recovery of medical decision-making capacity in traumatic brain injury: a 6-month longitudinal study. To investigate empirically change in medical decision-making capacity (MDC) in patients with traumatic b...
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| Veröffentlicht in: | Archives of physical medicine and rehabilitation 2005-05, Vol.86 (5), p.889-895 |
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| creator | Marson, Daniel C. Dreer, Laura E. Krzywanski, Sara Huthwaite, Justin S. DeVivo, Michael J. Novack, Thomas A. |
| description | Marson DC, Dreer LE, Krzywanski S, Huthwaite JS, DeVivo MJ, Novack TA. Impairment and partial recovery of medical decision-making capacity in traumatic brain injury: a 6-month longitudinal study.
To investigate empirically change in medical decision-making capacity (MDC) in patients with traumatic brain injury (TBI).
Longitudinal study comparing control and TBI groups at hospitalization and at 6 months postinjury.
Inpatient brain injury rehabilitation unit.
Twenty healthy controls and 24 patients with moderate to severe TBI.
Not applicable.
MDC was measured by using the Capacity to Consent to Treatment Instrument (CCTI). The CCTI evaluates performance on a series of 4 accepted consent abilities, or standards: S1 (evidencing/communicating choice), S3 (appreciating consequences), S4 (reasoning about treatment), and S5 (understanding the treatment situation and choices), and 1 experimental standard [S2] (making the reasonable treatment choice when the alternative choice is unreasonable). In addition, TBI patients were assigned 1 of 3 capacity outcomes (capable, marginally capable, incapable) for each standard.
At hospitalization, TBI patients performed equivalently with controls on standards S1 and [S2] but significantly below controls on S3 (
P |
| doi_str_mv | 10.1016/j.apmr.2004.09.020 |
| format | Article |
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To investigate empirically change in medical decision-making capacity (MDC) in patients with traumatic brain injury (TBI).
Longitudinal study comparing control and TBI groups at hospitalization and at 6 months postinjury.
Inpatient brain injury rehabilitation unit.
Twenty healthy controls and 24 patients with moderate to severe TBI.
Not applicable.
MDC was measured by using the Capacity to Consent to Treatment Instrument (CCTI). The CCTI evaluates performance on a series of 4 accepted consent abilities, or standards: S1 (evidencing/communicating choice), S3 (appreciating consequences), S4 (reasoning about treatment), and S5 (understanding the treatment situation and choices), and 1 experimental standard [S2] (making the reasonable treatment choice when the alternative choice is unreasonable). In addition, TBI patients were assigned 1 of 3 capacity outcomes (capable, marginally capable, incapable) for each standard.
At hospitalization, TBI patients performed equivalently with controls on standards S1 and [S2] but significantly below controls on S3 (
P<.001), S4 (
P<.02), and S5 (
P<.001). At 6-month follow-up, TBI patients showed significant within-group improvement on these 3 standards (S3, S4, S5) but continued to fall significantly below controls on S3 (
P<.006) and S5 (
P<.001). A group by time interaction emerged on S5 (
P<.02). The TBI group showed increasing proportions of capable outcomes on all standards over the 6 months.
Patients with TBI showed initial impairment and subsequent partial recovery of MDC over a 6-month period. Complex consent abilities of appreciation, reasoning, and understanding were significantly impaired in hospitalized acute TBI patients. At follow-up, TBI patients showed substantial recovery of reasoning and partial recovery of appreciation and understanding consent abilities. The study suggests the importance in the rehabilitation setting of serial evaluations of MDC in patients with TBI.]]></description><identifier>ISSN: 0003-9993</identifier><identifier>EISSN: 1532-821X</identifier><identifier>DOI: 10.1016/j.apmr.2004.09.020</identifier><identifier>PMID: 15895333</identifier><identifier>CODEN: APMHAI</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adult ; Biological and medical sciences ; Brain injuries ; Brain Injuries - physiopathology ; Brain Injuries - rehabilitation ; Case-Control Studies ; Decision Making ; Female ; Humans ; Injuries of the nervous system and the skull. Diseases due to physical agents ; Longitudinal Studies ; Male ; Medical sciences ; Mental Competency ; Miscellaneous ; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) ; Recovery of Function ; Rehabilitation ; Traumas. Diseases due to physical agents</subject><ispartof>Archives of physical medicine and rehabilitation, 2005-05, Vol.86 (5), p.889-895</ispartof><rights>2005 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation</rights><rights>2005 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c416t-91a40d889ccf08a350bca7d9981fede2de334370f16811971d81aa3ffaec64023</citedby><cites>FETCH-LOGICAL-c416t-91a40d889ccf08a350bca7d9981fede2de334370f16811971d81aa3ffaec64023</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0003999304014170$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=16784903$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15895333$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Marson, Daniel C.</creatorcontrib><creatorcontrib>Dreer, Laura E.</creatorcontrib><creatorcontrib>Krzywanski, Sara</creatorcontrib><creatorcontrib>Huthwaite, Justin S.</creatorcontrib><creatorcontrib>DeVivo, Michael J.</creatorcontrib><creatorcontrib>Novack, Thomas A.</creatorcontrib><title>Impairment and Partial Recovery of Medical Decision-Making Capacity in Traumatic Brain Injury: A 6-Month Longitudinal Study</title><title>Archives of physical medicine and rehabilitation</title><addtitle>Arch Phys Med Rehabil</addtitle><description><![CDATA[Marson DC, Dreer LE, Krzywanski S, Huthwaite JS, DeVivo MJ, Novack TA. Impairment and partial recovery of medical decision-making capacity in traumatic brain injury: a 6-month longitudinal study.
To investigate empirically change in medical decision-making capacity (MDC) in patients with traumatic brain injury (TBI).
Longitudinal study comparing control and TBI groups at hospitalization and at 6 months postinjury.
Inpatient brain injury rehabilitation unit.
Twenty healthy controls and 24 patients with moderate to severe TBI.
Not applicable.
MDC was measured by using the Capacity to Consent to Treatment Instrument (CCTI). The CCTI evaluates performance on a series of 4 accepted consent abilities, or standards: S1 (evidencing/communicating choice), S3 (appreciating consequences), S4 (reasoning about treatment), and S5 (understanding the treatment situation and choices), and 1 experimental standard [S2] (making the reasonable treatment choice when the alternative choice is unreasonable). In addition, TBI patients were assigned 1 of 3 capacity outcomes (capable, marginally capable, incapable) for each standard.
At hospitalization, TBI patients performed equivalently with controls on standards S1 and [S2] but significantly below controls on S3 (
P<.001), S4 (
P<.02), and S5 (
P<.001). At 6-month follow-up, TBI patients showed significant within-group improvement on these 3 standards (S3, S4, S5) but continued to fall significantly below controls on S3 (
P<.006) and S5 (
P<.001). A group by time interaction emerged on S5 (
P<.02). The TBI group showed increasing proportions of capable outcomes on all standards over the 6 months.
Patients with TBI showed initial impairment and subsequent partial recovery of MDC over a 6-month period. Complex consent abilities of appreciation, reasoning, and understanding were significantly impaired in hospitalized acute TBI patients. At follow-up, TBI patients showed substantial recovery of reasoning and partial recovery of appreciation and understanding consent abilities. The study suggests the importance in the rehabilitation setting of serial evaluations of MDC in patients with TBI.]]></description><subject>Adult</subject><subject>Biological and medical sciences</subject><subject>Brain injuries</subject><subject>Brain Injuries - physiopathology</subject><subject>Brain Injuries - rehabilitation</subject><subject>Case-Control Studies</subject><subject>Decision Making</subject><subject>Female</subject><subject>Humans</subject><subject>Injuries of the nervous system and the skull. Diseases due to physical agents</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Mental Competency</subject><subject>Miscellaneous</subject><subject>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</subject><subject>Recovery of Function</subject><subject>Rehabilitation</subject><subject>Traumas. Diseases due to physical agents</subject><issn>0003-9993</issn><issn>1532-821X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU1v1DAQhi0EotvCH-CAfIGeEsZx4sSIS1m-VtoVCIrEzZraTvGycYKdVIr48zjalXrryR7rmRnrfQh5wSBnwMSbfY5DF_ICoMxB5lDAI7JiFS-ypmC_HpMVAPBMSsnPyHmM-1SKirOn5IxVjaw45yvyb9MN6EJn_UjRG_oNw-jwQL9b3d_ZMNO-pTtrnE5vH6x20fU-2-Ef52_pGgfUbpyp8_Q64NTh6DR9HzDVG7-fwvyWXlGR7Xo__qbb3t-6cTLOp1E_0mV-Rp60eIj2-em8ID8_fbxef8m2Xz9v1lfbTJdMjJlkWIJpGql1Cw3yCm401kbKhrXW2MJYzkteQ8tEw5ismWkYIm9btFqUUPALcnmcO4T-72TjqDoXtT0c0Nt-iqqumZBFKRby9YOkqJtCVDUksDiCOvQxBtuqIbgOw6wYqEWO2qtFjlrkKJAqyUlNL0_Tp5vOmvuWk40EvDoBGFPgbUCfEr_n0vpSwsK9O3I2pXbnbFBRO-t18hSsHpXp3UP_-A8t0q2c</recordid><startdate>20050501</startdate><enddate>20050501</enddate><creator>Marson, Daniel C.</creator><creator>Dreer, Laura E.</creator><creator>Krzywanski, Sara</creator><creator>Huthwaite, Justin S.</creator><creator>DeVivo, Michael J.</creator><creator>Novack, Thomas A.</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20050501</creationdate><title>Impairment and Partial Recovery of Medical Decision-Making Capacity in Traumatic Brain Injury: A 6-Month Longitudinal Study</title><author>Marson, Daniel C. ; Dreer, Laura E. ; Krzywanski, Sara ; Huthwaite, Justin S. ; DeVivo, Michael J. ; Novack, Thomas A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c416t-91a40d889ccf08a350bca7d9981fede2de334370f16811971d81aa3ffaec64023</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Adult</topic><topic>Biological and medical sciences</topic><topic>Brain injuries</topic><topic>Brain Injuries - physiopathology</topic><topic>Brain Injuries - rehabilitation</topic><topic>Case-Control Studies</topic><topic>Decision Making</topic><topic>Female</topic><topic>Humans</topic><topic>Injuries of the nervous system and the skull. Diseases due to physical agents</topic><topic>Longitudinal Studies</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Mental Competency</topic><topic>Miscellaneous</topic><topic>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</topic><topic>Recovery of Function</topic><topic>Rehabilitation</topic><topic>Traumas. Diseases due to physical agents</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Marson, Daniel C.</creatorcontrib><creatorcontrib>Dreer, Laura E.</creatorcontrib><creatorcontrib>Krzywanski, Sara</creatorcontrib><creatorcontrib>Huthwaite, Justin S.</creatorcontrib><creatorcontrib>DeVivo, Michael J.</creatorcontrib><creatorcontrib>Novack, Thomas A.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Archives of physical medicine and rehabilitation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Marson, Daniel C.</au><au>Dreer, Laura E.</au><au>Krzywanski, Sara</au><au>Huthwaite, Justin S.</au><au>DeVivo, Michael J.</au><au>Novack, Thomas A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impairment and Partial Recovery of Medical Decision-Making Capacity in Traumatic Brain Injury: A 6-Month Longitudinal Study</atitle><jtitle>Archives of physical medicine and rehabilitation</jtitle><addtitle>Arch Phys Med Rehabil</addtitle><date>2005-05-01</date><risdate>2005</risdate><volume>86</volume><issue>5</issue><spage>889</spage><epage>895</epage><pages>889-895</pages><issn>0003-9993</issn><eissn>1532-821X</eissn><coden>APMHAI</coden><abstract><![CDATA[Marson DC, Dreer LE, Krzywanski S, Huthwaite JS, DeVivo MJ, Novack TA. Impairment and partial recovery of medical decision-making capacity in traumatic brain injury: a 6-month longitudinal study.
To investigate empirically change in medical decision-making capacity (MDC) in patients with traumatic brain injury (TBI).
Longitudinal study comparing control and TBI groups at hospitalization and at 6 months postinjury.
Inpatient brain injury rehabilitation unit.
Twenty healthy controls and 24 patients with moderate to severe TBI.
Not applicable.
MDC was measured by using the Capacity to Consent to Treatment Instrument (CCTI). The CCTI evaluates performance on a series of 4 accepted consent abilities, or standards: S1 (evidencing/communicating choice), S3 (appreciating consequences), S4 (reasoning about treatment), and S5 (understanding the treatment situation and choices), and 1 experimental standard [S2] (making the reasonable treatment choice when the alternative choice is unreasonable). In addition, TBI patients were assigned 1 of 3 capacity outcomes (capable, marginally capable, incapable) for each standard.
At hospitalization, TBI patients performed equivalently with controls on standards S1 and [S2] but significantly below controls on S3 (
P<.001), S4 (
P<.02), and S5 (
P<.001). At 6-month follow-up, TBI patients showed significant within-group improvement on these 3 standards (S3, S4, S5) but continued to fall significantly below controls on S3 (
P<.006) and S5 (
P<.001). A group by time interaction emerged on S5 (
P<.02). The TBI group showed increasing proportions of capable outcomes on all standards over the 6 months.
Patients with TBI showed initial impairment and subsequent partial recovery of MDC over a 6-month period. Complex consent abilities of appreciation, reasoning, and understanding were significantly impaired in hospitalized acute TBI patients. At follow-up, TBI patients showed substantial recovery of reasoning and partial recovery of appreciation and understanding consent abilities. The study suggests the importance in the rehabilitation setting of serial evaluations of MDC in patients with TBI.]]></abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>15895333</pmid><doi>10.1016/j.apmr.2004.09.020</doi><tpages>7</tpages></addata></record> |
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| source | MEDLINE; Elsevier ScienceDirect Journals Complete; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Adult Biological and medical sciences Brain injuries Brain Injuries - physiopathology Brain Injuries - rehabilitation Case-Control Studies Decision Making Female Humans Injuries of the nervous system and the skull. Diseases due to physical agents Longitudinal Studies Male Medical sciences Mental Competency Miscellaneous Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) Recovery of Function Rehabilitation Traumas. Diseases due to physical agents |
| title | Impairment and Partial Recovery of Medical Decision-Making Capacity in Traumatic Brain Injury: A 6-Month Longitudinal Study |
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