Effectiveness of Community-Based Rehabilitation After Traumatic Brain Injury for 489 Program Completers Compared With Those Precipitously Discharged

Abstract

Altman IM, Swick S, Parrot D, Malec JF. Effectiveness of community-based rehabilitation after traumatic brain injury for 489 program completers compared with those precipitously discharged. Objective To evaluate outcomes of home- and community-based postacute brain injury rehabilitation (PABIR). Design Retrospective analysis of program evaluation data for treatment completers and noncompleters. Setting Home- and community-based PABIR conducted in 7 geographically distinct U.S. cities. Participants Patients (N=489) with traumatic brain injury who completed the prescribed course of rehabilitation (completed-course-of-treatment [CCT] group) compared with 114 who were discharged precipitously before program completion (precipitous-discharge [PD] group). Intervention PABIR delivered in home and community settings by certified professional staff on an individualized basis. Main Outcome Measures Mayo-Portland Adaptability Inventory (MPAI-4) completed by means of professional consensus on admission and at discharge; MPAI-4 Participation Index at 3- and 12-month follow-up through telephone contact. Results Analysis of covariance (CCT vs PD group as between-subjects variable, admission MPAI-4 score as covariate) showed significant differences between groups at discharge on the full MPAI-4 (F=82.25; P<.001), Ability Index (F=50.24; P<.001), Adjustment Index (F=81.20; P<.001), and Participation Index (F=59.48; P<.001). A large portion of the sample was lost to follow-up; however, available data showed that group differences remained statistically significant at follow-up. Conclusions Results provided evidence of the effectiveness of home- and community-based PABIR and that treatment effects were maintained at follow-up.