Date of Conferral

4-10-2026

Degree

Ph.D.

School

Health Sciences

Advisor

Srikanta Banerjee

Abstract

Traumatic brain injury (TBI) is a major public health concern associated with long-term disability and high healthcare utilization. Evidence guiding post-acute rehabilitation for medically complex TBI populations remains limited, particularly in long-term acute care hospital (LTACH) settings serving medically unstable patients. This study examined clinical and system-level factors associated with functional rehabilitation outcomes among adults with moderate-to-severe TBI in LTACHs. Guided by the Socioecological Model, recovery was conceptualized as interactions across individual, clinical, and organizational levels. This dissertation included three manuscripts using cross-sectional logistic regression and CMS Section GG measures. In Manuscript 1, longer time from injury to LTACH admission was associated with lower odds of functional improvement; compared with ≤30 days, admission at 31–60 days (OR = 0.53, p = .045) and >60 days (OR = 0.26, p = .006) reduced improvement, while male gender increased odds (OR = 2.18, p = .036). In Manuscript 2, comorbidity burden was not associated with outcomes (OR = 0.79, p = .410), although depression/anxiety increased odds (OR = 1.85, p = .034). In Manuscript 3, falls (OR = 0.31, p = .046) and infections (OR = 0.38, p = .042) reduce the odds of improvement. No significant interaction effects were observed. Overall, outcomes in LTACHs are driven by modifiable system-level factors. Timely access to rehabilitation and prevention of complications are critical to optimizing recovery. These findings inform practice, care coordination, and equitable recovery for medically complex TBI patients.

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