title: Selection and visualisation of outcome measures for complex post-acute acquired brain injury rehabilitation interventions.
abstract: BACKGROUND
  Outcome measurement challenges rehabilitation services to select tools that promote stakeholder engagement in measuring complex interventions.
  
  
  OBJECTIVE
  To examine the suitability of outcome measures for complex post-acute acquired brain injury (ABI) rehabilitation interventions, report outcomes of a holistic, neuropsychological ABI rehabilitation program and propose a simple way of visualizing complex outcomes.
  
  
  METHODS
  Patient/carer reported outcome measures (PROMS), experience measures (PREMS) and staff-rated measures were collected for consecutive admissions over 1 year to an 18-week holistic, neuropsychological rehabilitation programme at baseline, 18 weeks and 3- and 6-month follow-up.
  
  
  RESULTS
  Engagement with outcome measurement was poorest for carers and at follow-up for all stakeholders. Dependence, abilities, adjustment, unmet needs, symptomatology including executive dysfunction, and self-reassurance showed improvements at 18 weeks. Adjustment, social participation, perceived health, symptomatology including dysexecutive difficulties, and anxiety were worse at baseline for those who did not complete rehabilitation, than those who did. A radar plot facilitated outcome visualization.
  
  
  CONCLUSIONS
  Engagement with outcome measurement was best when time and support were provided. Supplementing patient- with staff-rated and attendance measures may explain missing data and help quantify healthcare needs. The MPAI4, EBIQ and DEX-R appeared suitable measures to evaluate outcomes and distinguish those completing and not completing neuropsychological rehabilitation.
authors.affiliation: The Oliver Zangwill Centre for Neuropsychological Rehabilitation, Cambridgeshire Community Services NHS Trust, Princess of Wales Hospital, Ely, UK.
authors.forename: Catherine Elaine Longworth
authors.initials: CE
authors.lastname: Ford
authors.affiliation: The Oliver Zangwill Centre for Neuropsychological Rehabilitation, Cambridgeshire Community Services NHS Trust, Princess of Wales Hospital, Ely, UK.|National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care East of England at Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK.
authors.forename: Donna
authors.initials: D
authors.lastname: Malley
authors.affiliation: The Oliver Zangwill Centre for Neuropsychological Rehabilitation, Cambridgeshire Community Services NHS Trust, Princess of Wales Hospital, Ely, UK.|National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care East of England at Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Bateman
authors.affiliation: National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care East of England at Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK.|Cambridgeshire & Peterborough NHS Foundation Trust, Fulbourn Hospital, Cambridge, UK.|Cambridge Intellectual & Developmental Disabilities Research Group, Department of Psychiatry, University of Cambridge, Cambridge, UK.
authors.forename: Isabel C H
authors.initials: IC
authors.lastname: Clare
authors.affiliation: National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care East of England at Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK.|Cambridge Intellectual & Developmental Disabilities Research Group, Department of Psychiatry, University of Cambridge, Cambridge, UK.
authors.forename: Adam P
authors.initials: AP
authors.lastname: Wagner
authors.affiliation: The Oliver Zangwill Centre for Neuropsychological Rehabilitation, Cambridgeshire Community Services NHS Trust, Princess of Wales Hospital, Ely, UK.|National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care East of England at Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK.|Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK.
authors.forename: Fergus
authors.initials: F
authors.lastname: Gracey
mesh_terms: D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation; D001930:Brain Injuries / Q000175:diagnosis / Q000523:psychology* / Q000534:rehabilitation*; D017028:Caregivers / Q000523:psychology / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D057566:Self Report; D055815:Young Adult
keywords: Brain injuries; health services research; neuropsychology; outcome and process assessment; rehabilitation; stroke