Outcome evaluation and prediction in a comprehensive-integrated post-acute outpatient brain injury rehabilitation programme.
Outcomes for 29 individuals with brain injuries (BI) were examined following a comprehensive-integrated rehabilitation programme. From programme admission to completion, proportion living with no supervision increased from 59% to 93%; proportion in transitional or competitive work placements increased from 7% to 59%; unemployment decreased from 76% to 31%. Significant changes in behaviour and functional abilities and achievement of individual goals were also documented with the Portland Adaptability Inventory (PAI) and Goal Attainment Scaling. One year follow-up of 21 graduates indicated general maintenance of gains in independent living and work. At follow-up 86% were living without supervision; 48% were in competitive work; one in transitional work; and 29% unemployed. Although individuals entering treatment less than 1 year after injury showed greater gains than those injured more than 1 year prior to admission, both early and late intervention groups showed significant changes on outcome measures. More extensive disabilities as measured by the PAI had a negative impact on programme outcome. Except for reading ability, neuropsychological measures obtained prior to admission did not significantly predict outcome. Programme costs are reported. Results indicate that the group-oriented comprehensive-integrated approach to post-acute brain injury rehabilitation is effective and cost-effective, and recommend early intervention for optimal outcomes.
Malec
J F
JF
Mayo Clinic and Foundation, Rochester, Minnesota 55905.
Smigielski
J S
JS
DePompolo
R W
RW
Thompson
J M
JM
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care; D001925:Brain Damage, Chronic / Q000534:rehabilitation*; D001930:Brain Injuries / Q000534:rehabilitation*; D003131:Combined Modality Therapy; D003191:Comprehensive Health Care; D016832:Employment, Supported; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team; D012050:Rehabilitation, Vocational