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Quasi-Contextualized Speech Treatment in Traumatic Brain Injury Inpatient Rehabilitation: Effects on Outcomes During
Cynthia L Beaulieu1, Juan Peng, Erinn M Hade
1Division of Rehabilitation Psychology, Department of Physical Medicine and Rehabilitation, The Ohio State University College of Medicine, Columbus (Drs Beaulieu, Corrigan, and Bogner); Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus (Dr Hade and Ms Peng); Department of Rehabilitation Services, The Ohio State University Medical Center, Columbus (Ms Montgomery); Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (Dr Horn); and Speech Pathology Department, Intermountain Medical Center, Murray, Utah (Ms Gilchrist).
Objective:
To evaluate the effect of providing quasi-contextualized speech therapy, defined as metacognitive, compensatory, or strategy training applied to cognitive and language impairments to facilitate the performance of future real-life activities, on functional outcomes up to 1 year following traumatic brain injury (TBI).
Setting:
Acute inpatient rehabilitation.
Participants:
Patients enrolled during the TBI-Practice-Based Evidence (TBI-PBE) study (n = 1760), aged 14 years or older, who sustained a severe, moderate, or complicated mild TBI, received speech therapy in acute inpatient rehabilitation at one of 9 US sites, and consented to follow-up 3 and 9 months postdischarge from inpatient rehabilitation.
Design:
Propensity score methods applied to a database consisting of multisite, prospective, longitudinal observational data.
Main Measures:
Participation Assessment with Recombined Tools-Objective-17, FIM Motor and Cognitive scores, Satisfaction With Life Scale, and Patient Health Questionnaire-9.
Results:
When at least 5% of therapy time employed quasi-contextualized treatment, participants reported better community participation during the year following discharge. Quasi-contextualized treatment was also associated with better motor and cognitive function at discharge and during the year after discharge. The benefit, however, may be dependent upon a balance of rehabilitation time that relied on contextualized treatment.
Conclusions:
The use of quasi-contextualized treatment may improve outcomes. Care should be taken, however, to not provide quasi-contextualized treatment at the expense of contextualized treatment.
