title: Effectiveness of home- and community-based rehabilitation in a large cohort of patients disabled by cerebrovascular accident: evidence of a dose-response relationship.
abstract: OBJECTIVE
  To (1) assess the effectiveness of home- and community-based rehabilitation (HCBR) in a large cohort of individuals with disabilities secondary to cerebrovascular accident (CVA); and (2) evaluate the responsiveness to treatment of the Mayo-Portland Adaptability Inventory (MPAI-4) to changes resulting from HCBR in this patient group.
  
  
  METHODS
  Retrospective analysis of program evaluation data for treatment completers and noncompleters.
  
  
  METHODS
  HCBR conducted in 7 geographically distinct U.S. cities.
  
  
  METHODS
  Individuals with CVA (n=738) who completed the prescribed course of rehabilitation (completed course of treatment [CCT]) compared with 150 individuals who were precipitously discharged (PD) before program completion.
  
  
  METHODS
  HCBR delivered by certified professional staff on an individualized basis.
  
  
  METHODS
  Mayo-Portland Adaptability Inventory (MPAI-4) completed by professional consensus on admission and at discharge.
  
  
  RESULTS
  With the use of analysis of covariance, MPAI-4 total scores at discharge for CCT participants were compared with those of PD participants, with admission MPAI-4, age, length of stay, and time since event as covariates. CCT participants showed greater improvement than PD participants (F=99.48, P<.001) with a moderate effect size (partial η(2)=.10). Group differences and effect sizes were similar for the 3 index scores: Ability (F=75.96, P<.001; partial η(2)=.08), Adjustment (F=99.67, P<.001; partial η(2)=.10), and Participation (F=69.15, P<.001; partial η(2)=.07).
  
  
  CONCLUSIONS
  Individuals in the CCT group who received the entire planned course of HCBR showed greater improvement on all MPAI-4 indexes than those in the PD group who were discharged before completing the prescribed program. This dose-response relationship provides evidence of a causal relationship between treatment and outcome.
authors: Rehab Without Walls, Phoenix, AZ, USA.
authors: Irwin M
authors: IM
authors: Altman
authors: Shannon
authors: S
authors: Swick
authors: James F
authors: JF
authors: Malec
mesh_terms: D000328:Adult; D000367:Age Factors; D003153:Community Health Services / Q000706:statistics & numerical data*; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012737:Sex Factors; D000071939:Stroke Rehabilitation; D013997:Time Factors
keywords: ABI; ANCOVA; CCT; CVA; Cerebrovascular accident; HCBR; IRB; MPAI-4; Mayo-Portland Adaptability Inventory; PD; RCT; Rehabilitation; Stroke; TBI; acquired brain injury; analysis of covariance; cerebrovascular accident; completed course of treatment; home- and community-based rehabilitation; institutional review board; precipitously discharged; randomized controlled trial; traumatic brain injury