Changes in aspects of social functioning depend upon prior changes in neurodisability in people with acquired brain injury undergoing post-acute neurorehabilitation

Abstract

Post-acute community-based rehabilitation is effective in reducing disability. However, while social participation and quality of life are valued as distal outcomes of neurorehabilitation, it is often not possible to observe improvements on these outcomes within the limited time-frames used in most investigations of rehabilitation. The aim of the current study was to examine differences in the sequence of attainments for people with acquired brain injury (ABI) undergoing longer term post-acute neurorehabilitation. Participants with ABI who were referred to comprehensive home and community-based neurorehabilitation were assessed at induction to service, at 6 months and again at 1.5 years while still in service on the Mayo-Portland Adaptability Index (MPAI-4), Community Integration Questionnaire, Hospital Anxiety and Depression Scale, and World Health Organisation Quality of Life measure. At 6 months post-induction to service, significant differences were evident in MPAI abilities, adjustment, and total neurodisability; and in anxiety and depression. By contrast, there was no significant effect at 6 months on more socially oriented features of experience namely quality of life (QoL), Community Integration and Participation. Eighteen month follow-up showed continuation of the significant positive effects with the addition of QoL-related to physical health, Psychological health, Social aspects of QoL and Participation at this later time point. Regression analyses demonstrated that change in QoL and Participation were dependent upon prior changes in aspects of neurodisability. Age, severity or type of brain injury did not significantly affect outcome. Results suggest that different constructs may respond to neurorehabilitation at different time points in a dose effect manner, and that change in social aspects of experience may be dependent upon the specific nature of prior neurorehabilitation attainments.

Activity Performance, Participation, and Quality of Life Among Adults in the Chronic Stage After Acquired Brain Injury—The Feasibility of an Occupation-Based Telerehabilitation Intervention

“…The MPAI-4 has well-documented psychometric properties. Previous studies have described good internal consistency, construct and concurrent validity, as well as predictive validity (15, 81–83). In addition, the MPAI-4 was found to be sensitive to clinical change following rehabilitation (84, 85).…”

“…There is evidence that home and community-based rehabilitation after ABI is effective in reducing disability (12–14), and that longer-term rehabilitation programs lead to improved global outcomes such as social participation and quality of life (QoL) (15). In addition, there is evidence supporting the use of occupation-based interventions to improve daily activity performance (16).…”

The TBI-CareQOL Measurement System: Development and Preliminary Validation of Health-Related Quality of Life Measures for Caregivers of Civilians and Service Members/Veterans With Traumatic Brain Injury

“…Reliability for this measure has been established in caregivers of persons with TBI. [55][56][57][58][59] Data capture-PROs were completed through Assessment Center (https:// www.assessmentcenter.net), either at a designated computer at the site, or on a personal or publically available computer with an internet connection. Study participants typically completed the survey within a 2-week time frame.…”

Assessing Cognitive Estimation and Its Effects on Community Integration in People with Acquired Brain Injury Undergoing Rehabilitation

“…The CIQ comprises 15 items assessing effective role performance in three domains: Home integration (active participation in the operation of the home or household), Social integration (participation in social activities outside the home) and Productivity (regular performance of work, school or volunteer activities). Internal consistency in previous studies has been reported as good, with Cronbach's alpha's ranging from 0.76–0.84 for total scale scores [ 41 , 52 ]. The CIQ is predominately linked to the major life areas (35%), community, social and civic life (31%) and domestic life (19%) chapters of the WHO ICF [ 53 ].…”