Change in care hours, cost, and functional independence following continence and assistive technology intervention in an acquired brain injury population

Abstract

Purpose

After acquired brain injury (ABI) dependence on intervention for continence management is common. This preliminary investigation aimed to (i) quantify toileting care hours and costs in a community-based ABI rehabilitation and disability setting, and (ii) measure change in care needs, costs, and functional independence after intervention with assistive technologies (ATs).

Method

Pragmatic pre-post intervention pilot study of 14 adults with ABI and toileting disability accessing community-based neurorehabilitation or disability support in Western Australia. Toileting and functional independence were assessed monthly from baseline (T₀) to 3-month follow-up (T₃). Basic and nursing care hours (Northwick Park Dependency Score), cost of care estimates (Northwick Park Care Needs Assessment), functional independence (Functional Independence and Assessment Measure), and cost of consumables were examined pre- and post-intervention with ATs. Multilevel mixed-effects models with bootstrap estimation were conducted.

Results

Cost of consumables significantly declined (AU$69/week), and functional independence significantly improved following intervention (+23.5 points). There was a non-significant reduction in care needs for toileting (4 h/week) and in the cost of toileting care (AU$633/week).

Conclusion

Toileting disability substantially impacts care hours and costs. This study provides preliminary evidence that comprehensive continence management is beneficial in reducing costs and supporting people with an ABI to increase their independence.

IMPLICATIONS FOR REHABILITATION

• A comprehensive continence assessment and management plan reduces the number of care hours, cost of care, and cost of continence products in a neurorehabilitation and disability support sample for people with acquired brain injury (ABI).

• Assistive technologies for continence management are beneficial in supporting people with ABI to increase independence, and reduce costs.

• Providing comprehensive continence assessment and management plan reduces reliance on staff for continence care, and improves functional independence.

Keywords:

• Brain injury
• disability
• rehabilitation
• continence
• toileting
• assistive technology

Acknowledgements

The authors would like to thank and acknowledge the clients, families, and staff at Brightwater who participated in this project, including Marcin Kiszko, and the Insurance Commission of Western Australia staff, including Kane Blackman, Care Service Coordinators, and management from the Motor Injury Division. We also thank and acknowledge the advice and guidance provided by Professor Lynne Turner-Stokes in the development of the modified algorithm for the NPCNA.

Disclosure statement

The authors report no conflict of interest.

Data availability statement

Due to the nature of this research, participants of this study did not agree for their data to be shared publicly, so supporting data is not available.

Additional information

Funding

This research was funded by the Insurance Commission of Western Australia.