Feasibility of Modifying the Hospital Environment to Reduce Length of Amnesia after Traumatic Brain Injury: a Pilot Randomised Controlled Trial.

BACKGROUND Reorientation programs have been an important component of neurotrauma rehabilitation for adults who suffer from post-traumatic amnesia (PTA) after traumatic brain injury (TBI), however research testing the efficacy of acute programs is limited. This study aimed to determine if it is feasible to provide a standardised environmental reorientation program to adults in PTA after TBI in an acute care hospital setting, and whether it is likely to be beneficial. METHODS Randomized, controlled trial with concealed allocation and intention-to-treat analysis. N=40 participants in PTA after TBI were included. The control group received usual care; the experimental group received usual care plus a standardised orientation program inclusive of an environmental cues. The primary outcome measure was time to emergence from PTA measured by the Westmead PTA scale, assessed daily from hospital admission or on regaining consciousness. RESULTS Adherence to the orientation program was high, and there were no study-related adverse responses to the environmental orientation program. Although there were no statistically significant between-group differences in time to emergence, the median time to emergence was shorter for those who received the standardised reorientation program (9.0 (6.4 to 11.6) versus 13.0 (4.5 to 21.5) days). Multivariate analysis showed GCS at scene (P = 0.041) and GCS at arrival at hospital (P = 0.0001) were significant factors longer length of PTA. CONCLUSION Providing an orientation program in acute care is feasible for adults with in PTA with TBI. A future efficacy trial would require 216 participants to detect a between-group difference of 5 days with an alpha of 0.05 and power of 80%.