Association of Falls and Infections with Functional Outcomes in Patients with Traumatic Brain Injury During Long-Term Acute Care Hospital Rehabilitation

Background and Objectives: Traumatic brain injury (TBI) is a major cause of long-term disability and frequently requires prolonged postacute rehabilitation. Clinical complications, such as falls and infections, may adversely affect recovery; however, evidence on their association with functional rehabilitation outcomes in long-term acute care hospitals (LTACHs) remains limited. This study examined the association between falls, infections, and functional rehabilitation outcomes among adults with moderate-to-severe TBI receiving postacute rehabilitation in an LTACH setting. Materials and Methods: This retrospective cohort study included adults with moderate-to-severe TBI who received multidisciplinary rehabilitation in an LTACH between January 2017 and December 2024. Of the 272 eligible patients, 239 met the inclusion criteria after excluding those with a short length of stay, incomplete evaluations, duplicate records, death during rehabilitation, or full independence at admission. Functional goal attainment in mobility and activities of daily living (ADLs) was measured using CMS Section GG assessments. Falls and hospitalization-related infections were evaluated as dichotomous predictors. Logistic regression analyses examined associations between clinical complications and functional goal attainment while adjusting for demographic covariates. Results: Among the 239 participants, falls occurred in 11.3%, infections in 15.9%, and functional goal attainment in 33.1%. In the original model adjusted for age, gender, and race/ethnicity, falls (OR = 0.31; 95% CI: 0.10–0.98; p = 0.046) and infections (OR = 0.38; 95% CI: 0.15–0.97; p = 0.042) were statistically significantly associated with lower odds of goal attainment. Neither association remained statistically significant after additional adjustment for admission functional status (falls: OR = 0.37, p = 0.085; infections: OR = 0.43, p = 0.078). In the sensitivity analysis, infections remained statistically significantly associated with reduced admission-to-discharge functional gain, whereas falls did not. Conclusions: Associations between falls, infections, and functional goal attainment were sensitive to baseline adjustment. Infections showed a more consistent association with reduced functional recovery than falls. These findings highlight the importance of baseline function and outcome selection in LTACH rehabilitation and warrant further investigation.