Rehabilitation outcomes after brain injury: disability measures or goal achievement?
BACKGROUND
The outcome of rehabilitation interventions following brain injury is commonly rated by disability scales. Goal-setting and achievement are important in inpatient rehabilitation, but seldom assessed as outcomes.


OBJECTIVE
To compare the information acquired from using disability ratings and goal attainment/variances as outcome measures in brain injury rehabilitation.


METHODS
An inpatient regional neurological rehabilitation unit.


METHODS
One hundred and seventy-seven patients admitted after single incident brain injury over a three-year period.


METHODS
(1) Disability outcomes by the Barthel Index and the Functional Independence Measure, (2) goal achievement and variance distribution, and (3) the influence of diagnosis and demographics on these measures.


RESULTS
Patients improved significantly on all disability scales employed (p < 0.0001), with the baseline admission scores being inversely correlated with changes in dependency by discharge (rho approximately -0.4). The median attainment rate of long-term goals was 75% per patient. Nonachievement was most frequently due to cognitive problems (38%), followed by behavioural difficulties and physical limitations (18% each). Goal achievement correlated poorly with disability outcome at discharge (rho < 0.3). Patients who accomplished all their goals tended to be less disabled at admission. Diagnostic groups and demographic factors had little influence on either disability or goal achievement outcomes.


CONCLUSIONS
The use of a simple goal achievement and variance coding scheme has been relatively straightforward to incorporate into the daily practice of the unit. It provides useful information on rehabilitation process and outcome after brain injury that is complementary to the utilization of disability measures.
Liu
Clarence
C
Regional Neurological Rehabilitation Unit, Homerton Hospital, Queen Square, London, UK.
McNeil
Jane E
JE
Greenwood
Richard
R
D000124:Achievement; D000328:Adult; D001927:Brain Diseases / Q000534:rehabilitation*; D001930:Brain Injuries / Q000534:rehabilitation; D002543:Cerebral Hemorrhage / Q000534:rehabilitation; D002544:Cerebral Infarction / Q000534:rehabilitation; D016009:Chi-Square Distribution; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013345:Subarachnoid Hemorrhage / Q000534:rehabilitation; D016896:Treatment Outcome