Article

OBJECTIVE: To compare progress in 4 types of post-inpatient rehabilitation brain
injury programs. DESIGN: Quasiexperimental observational cohort study. SETTING:
Community and residential. PARTICIPANTS: Individuals
(N=604) with acquired brain
injury. INTERVENTIONS: 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. MAIN OUTCOME MEASURE: Mayo-Portland
Adaptability Inventory (MPAI-4). RESULTS: Program types differed in participant
age (F=10.69, P<.001), sex (chi(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.
CI - Copyright (c) 2012 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS