Long-term outcomes of prolonged disorders of consciousness: a prospective cohort study in specialized neurorehabilitation - 25/09/26
, Cecile M.A. Utens a, b, Gerard M. Ribbers a, c, Liselotte W.Z. de Boer-Schellekens b, Willemijn S. van Erp b, d, e, Majanka H. Heijenbrok-Kal a, cHighlights |
• | Prolonged disorders of consciousness (PDOC) require specialized care pathways. |
• | Consciousness recovery rate is 62% within 2 years after specialized rehabilitation. |
• | 41% of the conscious people reach functional independence within 2 years. |
• | Most improvement occurs in the first 9 months of specialized neurorehabilitation. |
• | Specialized PDOC care during the first 2 years after brain injury is important. |
Abstract |
Background |
There is limited information on the course of recovery and long-term outcome of people with prolonged disorders of consciousness (PDOC).
Objective |
To determine long-term outcomes (mortality, recovery of consciousness, disability, functioning, and independence) in people with PDOC after early intensive neurorehabilitation (EIN) within a novel nationwide PDOC care pathway.
Methods |
Prospective cohort study with 2-year follow-up. All people with PDOC admitted to EIN at a single rehabilitation center in the Netherlands were screened for inclusion. Baseline measurements of level of consciousness (CRS-R), disability (DRS), and functioning (FIM) were collected at rehabilitation admission, and follow-up was at 14, 28, 40, 52 and 104 weeks post admission.
Results |
Of 129 participants included (mean age 38.1 years, SD 16.4), 33 (26%) patients died, and 80 (62%) regained consciousness within the 2-year follow-up. From them, 56 (43%) regained consciousness during 14 weeks of EIN, 14 (11%) within 6 months after admission, and 10 (8%) between 6- and 24-month follow-up. Mean level of disability and functioning significantly increased over time, with the largest improvement between 14- and 28-week post admission. Amongst responders who regained consciousness, the proportion of participants functioning independently (FIM total score ≥78) increased from 4% (3/78) at 14 weeks to 41% (25/61) at 2-year follow-up.
Conclusions |
Improvement of level of consciousness, disability, and functioning in people with PDOC occurs beyond the early stages of specialized neurorehabilitation until 2 years post injury, despite substantial mortality. These results highlight the need for specialized care for people with PDOC during the first 2 years after their injury, which focuses on both functional recovery and personalized decision-making.
Protocol registration number |
International Clinical Trial registry Platform (ICTRP) of the World Health Organization (WHO): NL-OMON23779.
Le texte complet de cet article est disponible en PDF.Keywords : Acquired brain injury, Disorders of consciousness, Neurorehabilitation, Long-term outcome
Abbreviations : CRS-R, DOCTOR, DRS, EIN, e-MCS, FIM, GEE, LOC, MCS, NTBI, PDOC, PIN, TBI, TPI, UWS
Plan
Vol 69 - N° 6
Article 102143- septembre 2026 Retour au numéro
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