Time between acquired brain injury and admission to community-based rehabilitation: differences in cognitive and functional gains

ABSTRACT

Objective

To determine differences in rehabilitation gains made by people with an acquired brain injury undergoing staged community-based brain injury rehabilitation (SCBIR) at different times between injury and admission.

Method

Retrospective cohort analysis of routinely collected demographic and rehabilitation data from clients admitted to SCBIR service 2011-2017 (n=92). Outcome measures: Mayo-Portland Adaptability Inventory-4 (MPAI-4) and UK Functional Assessment Measure (UK FIM+FAM) collected on admission and annually thereafter until discharge. Analysis was stratified by time since injury on admission: ‘Early’ (<1 year (n=36)), ‘Middle’ (1–2 years (n=34)) and ‘Late’ (>2 years (n=22)). Between-group differences were tested using bootstrapped one-way ANOVA. Within-group differences were tested using paired T tests.

Results

Total cohort made significant gains in MPAI-4 and UK FIM+FAM total and all subscales (p = .001). Early group made greatest change in all subscales of both outcome measures (p < .01). Middle cohort improved significantly in all subscales (p < .02) excluding MPAI-4 Adjustment. Late cohort still made statistically significant gains in all UK FIM+FAM subscales (p < .05) and MPAI-4 Participation (p < .01). Item level changes are presented.

Conclusion

More than 2 years after injury, people are able to make improvements in participation and functional independence following SCBIR.

KEYWORDS:

• Brain injuries
• time factors
• neurologic rehabilitation
• outcome assessment
• recovery of function

Acknowledgments

We would like to acknowledge the clients who provided data for the evaluation, as well as the many members of clinical staff who collected and recorded the information in the course of their clinical practice. The authors also wish to acknowledge the earlier work of Karla Seaman, whose initial effort established the dataset used in this research.

Disclosure of interest

There are no significant competing personal interests, other than the general desire of clinicians to demonstrate the effectiveness of services and to improve the overall quality of care offered to our patients. Outcome measurement in clinical practice is a specific research interest of the authors, but none of the authors has any personal financial interests in the work undertaken or the findings reported.

• LT-S was the lead developer of the UK FIM+FAM, but neither she nor her employing institution has any financial interest in the tool which is disseminated free of charge. LT-S is the Director of the UK Rehabilitation Outcomes Collaborative Programme which represents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research programme (RPPG-0407-10185). She has received financial support from the NIHR to disseminate the findings and implement the outcome tools developed from the UKROC programme in the wider context of rehabilitation healthcare. However, the views expressed in this article are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

We do not consider that any of these relationships or activities have influenced the submitted work.