Abstract
Post-acute community-based rehabilitation is effective in reducing disability. However, while social participation and quality of life are valued as distal outcomes of neurorehabilitation, it is often not possible to observe improvements on these outcomes within the limited time-frames used in most investigations of rehabilitation. The aim of the current study was to examine differences in the sequence of attainments for people with acquired brain injury (ABI) undergoing longer term post-acute neurorehabilitation. Participants with ABI who were referred to comprehensive home and community-based neurorehabilitation were assessed at induction to service, at 6 months and again at 1.5 years while still in service on the Mayo-Portland Adaptability Index (MPAI-4), Community Integration Questionnaire, Hospital Anxiety and Depression Scale, and World Health Organisation Quality of Life measure. At 6 months post-induction to service, significant differences were evident in MPAI abilities, adjustment, and total neurodisability; and in anxiety and depression. By contrast, there was no significant effect at 6 months on more socially oriented features of experience namely quality of life (QoL), Community Integration and Participation. Eighteen month follow-up showed continuation of the significant positive effects with the addition of QoL-related to physical health, Psychological health, Social aspects of QoL and Participation at this later time point. Regression analyses demonstrated that change in QoL and Participation were dependent upon prior changes in aspects of neurodisability. Age, severity or type of brain injury did not significantly affect outcome. Results suggest that different constructs may respond to neurorehabilitation at different time points in a dose effect manner, and that change in social aspects of experience may be dependent upon the specific nature of prior neurorehabilitation attainments.
Highlights
Acquired brain injury (ABI) is the leading cause of death and disability in young people aged 18–24 years: it disproportionately affects children and people aged over 65 years (Yates et al, 2006)
We examined whether the significant changes in quality of life (QoL) and Participation from 6 months to 1.5 years were dependent upon prior changes in neurodisability and mental health
The first two objectives of the study were to examine whether and to what extent people in receipt of home and communitybased neurorehabilitation showed improvements in terms of neuro-disability, community integration, mental health and QoL over time in service, and secondly to investigate whether changes in the more distal outcomes of QoL, Community Integration and Participation occurred at a later stage than changes in more general aspects of neurodisability and mental health
Summary
Acquired brain injury (ABI) is the leading cause of death and disability in young people aged 18–24 years: it disproportionately affects children (up to 4 years-old) and people aged over 65 years (Yates et al, 2006). Changes in neurodisability is one of the most prominent outcomes and in addition to targeting changes in physical and cognitive abilities and mental health, rehabilitation programs increasingly utilize more socially moderated factors such as quality of life and participation in society (Eicher et al, 2012; Stiers et al, 2012; Altman et al, 2013; Malec et al, 2015) Such social/community integration factors are becoming important features of outcome (Haslam et al, 2008; Cicerone et al, 2011; Algurén et al, 2012; Brasure et al, 2012; Stalder-Lüthy et al, 2013; Walsh et al, 2015)
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