title: Successful outcomes following neurorehabilitation in military traumatic brain injury patients in the United Kingdom.
abstract: BACKGROUND
  The Defence Medical Rehabilitation Centre Headley Court is the UK military rehabilitation unit. A pilot study identified the Mayo-Portland Adaptability Inventory-4 (MPAI-4) as the most appropriate rehabilitation outcome measure in young military patients with acquired brain injury.
  
  
  METHODS
  MPAI-4 scores were prospectively recorded for patients on admission and discharge. At 4 months, independent living and employment status were recorded. Inclusion criteria were all new admissions with traumatic brain injury (TBI). Before injury, all patients were fully employed and lived independently.
  
  
  RESULTS
  In a 3-year period from April 2011, there were 91 TBI patients with complete admission-discharge episodes: by US Department of Defense criteria, 21 were mild, 35 were moderate, and 35 were severe. There was a significant positive relationship between TBI severity and MPAI-4 score on admission (χ = 12.77, df = 2, p = 0.0017).Median age was 27 years, and median duration of admission was 63 days. Employment and independent living status were available for 79 patients at 4 months. Seventy-three patients (92%) were in community-based employment, with 64 (81%) employed in a competitive or transitional work; 6 (8%) were unemployed or in sheltered work. Sixty-nine (87%) were living independently, and 10 (13%) were living with support in their own home, with no one requiring institutional care.Complete MPAI-4 scores were available for 79 patients. There were statistically and clinically significant improvements in MPAI-4 scores between admission and discharge for the overall group: median admission T score was 40.0 (95% confidence interval, 36.0-42.0) and on discharge was 31.0 (95% confidence interval, 27.0-36.0), a nine-point change (Z = 6.53, p < 0.0001). These improvements with rehabilitation were sustained when patients were subdivided by TBI severity or MPAI-4 limitations.
  
  
  CONCLUSIONS
  This study demonstrates significant functional improvements in military TBI patients following intensive inpatient multidisciplinary rehabilitation, which includes substantial vocational rehabilitation. At 4 months, 92% were employed, and 87% were living independently.
  
  
  METHODS
  Therapeutic study, level V; prognostic/epidemiologic study, level IV.
authors.affiliation: From the Defence Medical Rehabilitation Centre, Headley Court, Epsom, Surrey, United Kingdom.
authors.forename: Shreshth
authors.initials: S
authors.lastname: Dharm-Datta
authors.forename: Michael R C
authors.initials: MR
authors.lastname: Gough
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Porter
authors.forename: Jennifer
authors.initials: J
authors.lastname: Duncan-Anderson
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Olivier
authors.forename: Emer
authors.initials: E
authors.lastname: McGilloway
authors.forename: John
authors.initials: J
authors.lastname: Etherington
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000534:rehabilitation*; D004185:Disability Evaluation; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008889:Military Personnel; D000066530:Neurological Rehabilitation; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function; D006113:United Kingdom