Comprehensive Day Treatment Research Articles

Achievement of client-centred goals by persons with acquired brain injury in comprehensive day treatment is associated with improved functional outcomes

Objectives: To study the relationship between goal achievement and vocational and independent living at discharge and 1-year follow-up in persons with acquired brain injury (ABI) participating in a Comprehensive Day Treatment (CDT) programme.Design: A retrospective review of longitudinal data.Methods: One hundred and fifty-four participants with ABI were included in the analyses. Personal, short-term and graduation goals were generated for each participant. A graduation goal was generated in each of four primary domains of the intervention (Orientation, Cognitive, Social Awareness and Communication). Participants who achieved all graduation goals at discharge were classified as ‘goals met’, while those who did not meet all goals were classified as ‘goals unmet’.Results: Forty-eight percent of participants were classified into the goals met group and 52% were classified into the goals unmet group. There were no group differences at programme admission. A significantly greater percentage of individuals in the goals met group were both living independently and engaging in community-based employment at programme discharge than individuals in the goals unmet group. These group differences were maintained or exceeded at 1-year follow-up.Conclusions: The results demonstrate that achievement of individualized CDT graduation goals is associated with greater levels of vocational and residential independence following acquired brain injury.

Point of Entry and Functional Outcomes After Comprehensive Day Treatment Participation

Micklewright JL, Yutsis M, Smigielski JS, Brown AW, Bergquist TF. Point of entry and functional outcomes after comprehensive day treatment participation. Objectives To explore the relationship between point of entry into a comprehensive day treatment (CDT) program and outcomes after acquired brain injury (ABI). We hypothesized that participants entering our program 0 to 6 months postinjury would demonstrate greater declines in neurobehavioral sequelae and improvements in residential/vocational independence than those entering >6 to 12 and >12 to 24 months postinjury. Design Retrospective examination of admission, discharge, and 1-year follow-up data from a CDT program. Setting A large Midwestern academic medical center. Participants Adult CDT participants with traumatic brain injuries (TBI) (n=54) or cerebrovascular accidents (CVAs) (n=29). Interventions A CDT rehabilitation program. Main Outcome Measures Portland Adaptability Inventory/Mayo-Portland Adaptability Inventory (percent change scores between admission and discharge) and the Independent Living and Vocational Independence Scales. Results Time since injury was categorically coded into the 3 aforementioned point of entry groups. A 2 (injury type) × 3 (point of entry) between subjects analysis of covariance revealed a significant main effect for the point of entry ( P<.001). Post hoc tests indicated that individuals entering the program 0 to 6 months postinjury demonstrated significantly greater treatment gains than those entering 6 to 12 or 12 to 24 months postinjury. Within group chi-square analyses revealed that a significantly higher percentage of the early entry participants were living and working independently at discharge and 1-year follow-up. Conclusions Entry into a CDT program (0–6mo postinjury) is associated with significantly greater declines in neurobehavioral sequelae and improvements in residential and vocational independence in participants with TBI or CVA. Sustainable modest treatment gains were also observed in the late entry groups, suggesting that these individuals also benefit significantly from CDT program participation.

Characteristics of successful and unsuccessful completers of 3 postacute brain injury rehabilitation pathways

Malec JF, Degiorgio L. Characteristics of successful and unsuccessful completers of 3 postacute brain injury rehabilitation pathways. Arch Phys Med Rehabil 2002;83:1759-64. Objective: To determine whether successful participants along different postacute brain injury rehabilitation pathways differ on demographic, injury-related, disability, and outcome variables. Design: Secondary analysis of pre- and posttreatment, and 1-year follow-up data obtained in a previous study of specialized vocational services (SVS) for persons with brain injury. Setting: Outpatient brain injury rehabilitation clinic. Participants: One hundred fourteen persons with acquired brain injury. Interventions: Participants in 3 distinct rehabilitation pathways were studied: SVS only; SVS and a 3-h/wk community reintegration outpatient group; and SVS and 6-h/d comprehensive day treatment (CDT). Main Outcome Measures: Mayo-Portland Adaptability Inventory (MPAI); Vocational Independence Scale; and “success,” as defined by community-based employment (CBE) at 1-year follow-up. Results: The percentage (77%–85%) of participants in CBE at 1-year follow-up did not differ among the 3 pathways. CDT participants had more limited educational backgrounds, were less recently injured, and showed greater disability and more impaired self-awareness than those receiving limited intervention (ie, SVS or community reintegration outpatient group). MPAI scores for limited-intervention participants who were unsuccessful were similar in level to successful participants in CDT. Logistic regression models were developed to predict the probability of success with limited intervention and CDT. Conclusion: Different rehabilitation pathways result in CBE for a large percentage of persons with brain injury if the intensity of service is appropriately matched to the severity of the disability, the time since injury, and other participant characteristics. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Impact of comprehensive day treatment on societal participation for persons with acquired brain injury

Malec JF. Impact of comprehensive day treatment on societal participation for persons with acquired brain injury. Arch Phys Med Rehabil 2001;82:885-95. Objectives: To evaluate comprehensive day treatment (CDT) for survivors of brain injury by time since injury and to identify outcome predictors. Design: Before and after. Setting: Rehabilitation center. Participants: Ninety-six program graduates; 17 dropouts with acquired brain injury. Interventions: Comprehensive Day Treatment Program: daily group sessions to build cognitive and behavioral skills through a transdisciplinary approach, supportive feedback, and a variety of therapeutic modalities. Obtained outcome measures before and after the program, and at 1-year follow-up. Main Outcome Measures: Outcome: Independent living status, vocational independence scale at program end and 1-year follow-up; and Rasch-analyzed Mayo-Portland Adaptability Inventory (MPAI-22) and goal attainment scaling (GAS) at program end. Predictors: age, education, severity of initial injury, time since injury, and preadmission MPAI-22. Results: Significant goal achievement on GAS and improvement on MPAI-22; increased societal participation at 1-year follow-up for those treated postacutely and many years after injury: 72% of graduates living independently; 39% working independently, 10% in transitional placements, and 18% in supported or volunteer work. Long-term outcomes were modestly related linearly to preadmission MPAI-22 and nonlinearly to time since injury. Conclusions: CDT improves societal participation even among persons with a long history of limited participation after brain injury. This de facto extended baseline analysis indicates the effectiveness of CDT and paves the way for randomized control trials of active treatment components. Relationships of predictors to outcomes are not sufficiently strong for patient selection. More effective interventions for vocational reintegration are needed for those most severely disabled after brain injury. © 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation