Outcomes of community re-entry programmes for brain injury survivors. Part 2: Further investigations.
This report, the second part of a study of the outcomes of nine community re-entry programmes for brain injury survivors, examines more specific measures of programme and client outcome. Most results confirm those in Part 1, but some suggest qualifications or means to improve programme operations. The functioning of the client in self-care and mobility activities, in communication, and in emotional and social behaviour clearly improved. By and large these improvements cannot be attributed to chronicity or natural healing. Findings relevant to social integration, sources of stress, and client satisfaction are also presented. For a minority of cases, new behaviour problems emerged after discharge, raising issues of generalization of treatment. Though clients benefited in multiple ways, goal attainment percentages were not high and the most frequent dimensions of actual benefit (viz. improved independent living and household skills) were seldom documented as goals. Multivariate analysis identified a number of significant predictors of independent living outcomes. Finally, issues of cost-effectiveness are addressed. At over $100,000 per case, these programmes were expensive. No positive relationship between rehabilitative expense and client improvement could be identified. Means of improving cost-effectiveness are suggested.
Johnston
M V
MV
Outcome Research, Kessler Institute for Rehabilitation, West Orange, New Jersey 07052.
D000203:Activities of Daily Living / Q000523:psychology*; D000328:Adult; D000359:Aftercare / Q000191:economics; D001925:Brain Damage, Chronic / Q000523:psychology / Q000534:rehabilitation*; D001930:Brain Injuries / Q000523:psychology / Q000534:rehabilitation*; D003142:Communication; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D009483:Neuropsychological Tests; D010358:Patient Participation / Q000523:psychology; D012050:Rehabilitation, Vocational / Q000191:economics / Q000523:psychology; D012917:Social Adjustment; D012920:Social Behavior Disorders / Q000523:psychology / Q000534:rehabilitation; D012931:Social Environment