Progress assessed with the Mayo-Portland Adaptability Inventory in 604 participants in 4 types of post-inpatient rehabilitation brain injury programs.
OBJECTIVE
To compare progress in 4 types of post-inpatient rehabilitation brain injury programs.


METHODS
Quasiexperimental observational cohort study.


METHODS
Community and residential.


METHODS
Individuals (N=604) with acquired brain injury.


METHODS
Four program types within the Pennsylvania Association of Rehabilitation Facilities were compared: intensive outpatient and community-based rehabilitation (IRC; n=235), intensive residential rehabilitation (IRR; n=78), long-term residential supported living (SLR; n=246), and long-term community-based supported living (SLC; n=45). With the use of a commercial web-based data management system developed with federal grant support, progress was examined on 2 consecutive assessments.


METHODS
Mayo-Portland Adaptability Inventory (MPAI-4).


RESULTS
Program types differed in participant age (F=10.69, P<.001), sex (χ(2)=22.38, P<.001), time from first to second assessment (F=20.71, P<.001), initial MPAI-4 score (F=6.89, P<.001), and chronicity (F=13.43, P<.001). However, only initial MPAI-4 score and chronicity were significantly associated with the second MPAI-4 rating. On average, SLR participants were 9.1 years postinjury compared with 5.1 years for IRR, 6.0 years for IRC, and 6.8 years for SLC programs. IRR participants were more severely disabled per MPAI-4 total score on admission than the other groups. Controlling for these variables, program types varied significantly on second MPAI-4 total score (F=5.14, P=.002). Both the IRR and IRC programs resulted in significant functional improvement across assessments. In contrast, both the SLR and SLC programs demonstrated relatively stable MPAI-4 scores.


CONCLUSIONS
Results are consistent with stated goals of the programs; that is, intensive programs resulted in functional improvements, whereas supported living programs produced stable functioning. Further studies using data from this large, multiprovider measurement collaboration will potentially provide the foundation for developing outcome expectations for various types of postacute brain injury programs.
ReMed, Paoli, PA, USA.
Vicki
V
Eicher
Mary Pat
MP
Murphy
Thomas F
TF
Murphy
James F
JF
Malec
D000222:Adaptation, Physiological; D000223:Adaptation, Psychological; D000328:Adult; D001930:Brain Injuries / Q000175:diagnosis / Q000534:rehabilitation*; D015331:Cohort Studies; D003153:Community Health Services / Q000458:organization & administration; D003266:Continuity of Patient Care / Q000458:organization & administration*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D016014:Linear Models; D008134:Long-Term Care / Q000458:organization & administration; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000706:statistics & numerical data*; D011379:Prognosis; D015397:Program Evaluation; D012046:Rehabilitation / Q000458:organization & administration*; D012047:Rehabilitation Centers / Q000458:organization & administration; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult