Residential and home-based postacute rehabilitation of individuals with traumatic brain injury: a case control study.
OBJECTIVE
To compare the outcomes of severely brain-injured individuals treated in a postacute residential rehabilitation program with a matched sample of individuals receiving limited services in their homes or on an outpatient basis.


METHODS
Controlled study using a matched design in a before-and-after trial and a 1-year follow-up trial.


METHODS
A postacute community-based residential rehabilitation program or in the homes of patients.


METHODS
The treatment group included all persons admitted consecutively for rehabilitation to the postacute residential program over a 3-year period (n = 23). All subjects had severe traumatic brain injury. The comparison group was selected from the roster of a support group on the basis of a systematic matching procedure. Matching variables included gender, age, length of coma, time since injury, and level of disability. Subjects of the two groups were matched on an individual basis.


METHODS
A functional assessment instrument (modified Health andActivity Limitations Survey [HALS]) and the Community Integration Questionnaire (CIQ).


RESULTS
Individuals with traumatic brain injury who received residential-based postacute rehabilitation displayed a statistically significant increase in functional abilities when compared with a traditional (home-based) service group. More specifically, treatment subjects showed significantly greater improvement in motor skills and cognitive abilities. Treatment subjects also showed greater improvement in community integration, although this may have been accounted for by initial group differences.


CONCLUSIONS
Postacute rehabilitation appears to be effective in improving function for individuals with severe brain injury. Residential-based services appear to produce greater functional improvement, whereas home-based services are more effective at maintaining community integration.
Willer
B
B
State University of New York at Buffalo, USA.
Button
J
J
Rempel
R
R
D000328:Adult; D001925:Brain Damage, Chronic / Q000534:rehabilitation*; D016022:Case-Control Studies; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D016489:Head Injuries, Closed / Q000534:rehabilitation*; D018575:Home Care Services, Hospital-Based; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission; D010348:Patient Care Team; D012917:Social Adjustment