title: Bio-psycho-social effects of a coordinated neurorehabilitation programme: A naturalistic mixed methods study.
abstract: OBJECTIVE
  Best practice guidelines for neurorehabilitation recommend coordinated rehabilitation programmes to ensure seamless service transitions and comprehensive rehabilitation practices. However, this recommendation for practice and the evidence informing its advancement is based on unexamined assumptions. Therefore, this study investigates bio-psycho-social outcomes and perceptions of a coordinated rehabilitation programme.
  
  
  METHODS
  In a prospective, naturalistic mixed methods study, rehabilitation outcomes for 82 adults (18-66 years) with moderate to severe acquired brain injury were investigated. Clients who received the coordinated rehabilitation programme KORE (n = 27) were compared to clients from the same area who received standard rehabilitation prior to the implementation of the KORE programme (n = 37) and clients who received other coordinated efforts elsewhere (n = 18). The study employed quantitative data from standardized tests (Functional Independence Measure, Major Depression Inventory, Quality of life, and Impact on Participation and Autonomy Questionnaire, as well as information on return to work and qualitative interviews with clients (n = 82) and their relatives (n = 40).
  
  
  RESULTS
  Outcomes did not improve from hospital discharge to two years later. Notably, physiological recovery had probably been achieved to the extent possible, but depression and reduced psychological well-being remained prevalent across groups. Qualitative interviews suggested several barriers to improvement, such as identity dilemmas and unmet needs for psychological support, while rehabilitation services focused on physical and practical training.
  
  
  CONCLUSIONS
  Coordinated interventions do not guarantee comprehensive rehabilitation and better outcomes for clients with acquired brain injury. Psychological support seems to be important and largely unaddressed.
authors.forename: Chalotte
authors.initials: C
authors.lastname: Glintborg
authors.forename: Tia G B
authors.initials: TG
authors.lastname: Hansen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000534:rehabilitation; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000209:etiology / Q000523:psychology; D005190:Family; D005260:Female; D006801:Humans; D057187:Independent Living; D008297:Male; D008875:Middle Aged; D000066530:Neurological Rehabilitation / Q000379:methods*; D009483:Neuropsychological Tests; D026684:Personal Autonomy; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D062707:Return to Work; D016896:Treatment Outcome; D055815:Young Adult
keywords: ABI; bio-psycho-social outcome; psychological rehabilitation; quality of life