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Outcomes of Six Specific Types of Post-Hospital Brain Injury Rehabilitation Programs
David B Salisbury1, Devan Parrott, G Joseph Walters
1Author Affiliations: Director of Clinical Operations, Pate NeuroRehabilitation/Rehab Without Walls, Irving, Texas (Dr Salisbury); Data Scientist, Foundation to Advance Brain Rehabilitation (FABR), Wilmington, Delaware, and Associate Research Professor, Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana (Dr Parrott); Director of Analytics, On With Life, Ankeny, Iowa (Mr Walters); Senior Director of Clinical Services Bancroft NeuroRehab, Cherry Hill, New Jersey (Dr McGrath); Director of Performance Improvement and Quality Management, On With Life, Ankeny, Iowa (Mr Logan); National Director of Outcomes, Collage Rehabilitation Partners, Paoli, Pennsylvania (Dr Altman); and Chief Scientific Officer, Foundation to Advance Brain Rehabilitation (FABR), Wilmington, Delaware, Senior Research Professor Emeritus, Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana, and Emeritus Professor of Psychology, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota (Dr Malec).
Objective:
Evaluate outcomes of intensive posthospital brain injury rehabilitation programs compared to supported living (SL) programs; explore variations in outcome by diagnostic category (traumatic brain injury, stroke, and other acquired brain injury [ABI]) and specific program type.
Setting:
Data were obtained from Residential Neurobehavioral, Residential Neurorehabilitation, Home and Community Neurorehabilitation, Day Treatment, Outpatient Neurorehabilitation, and SL programs serving individuals with ABI.
Participants:
A total of 2120 individuals with traumatic brain injury, stroke, or other ABI participated in this study.
Main Measures:
The main measures are sex, age, time since injury, and Mayo-Portland Adaptability Inventory (4th edition; MPAI-4).
Design:
Retrospective analyses of demographic variables and MPAI-4 Total, index, and subscale Rasch-derived T-scores on admission and discharge.
Results:
Gains on MPAI-4 Total T-scores were significantly greater for the intensive rehabilitation (IR) group in comparison to stable functioning in the SL group ( F = 236.69, P < .001, partial η 2 = .101) while controlling for admission/time 1 scores; similar results were found for MPAI-4 indices and subscales. For the IR cohort, discharge scores differed by diagnostic category after controlling for admission scores for the Total MPAI-4 T-score ( F = 22.65, P < .001, partial η 2 = .025), as well as all indices and subscales. A statistically significant interaction between program type and diagnostic group on discharge MPAI-4 Total T-scores ( F = 2.55, P = .018, partial η 2 = .01) after controlling for admission scores indicated that differing outcomes across diagnoses also varied by program type. Varying significant main effects and interactions were apparent for MPAI-4 indices and subscales with generally small effect sizes.
Conclusions:
Significant gains on MPAI-4 variables across IR program types compared to no change over a comparable period of time for SL programs supports the effectiveness of posthospital brain injury rehabilitation. This finding in the presence of small effect sizes on outcome variables for program type and for significant interactions between program type and diagnostic category suggests that participants generally were appropriately matched to program type and benefited from interventions provided through specific program types.
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