Group Therapy Use and Its Impact on the Outcomes of Inpatient Rehabilitation After Traumatic Brain Injury: Data From Traumatic Brain Injury–Practice Based Evidence Project

Abstract

Objective To describe the amount and content of group therapies provided during inpatient rehabilitation for traumatic brain injury (TBI), and assess the relationships of group therapy with patient, injury, and treatment factors as well as outcomes. Design Prospective observational cohort. Setting Inpatient rehabilitation. Participants 2,130 consecutive admissions for initial TBI rehabilitation at 10 inpatient rehabilitation facilities (9 in US and 1 Canada) from October 2008 to September 2011. Interventions n/a Main Outcome Measure(s) proportion of sessions that were group therapy (two or more patients were treated simultaneously by one or more clinicians); proportion of patients receiving group therapy; type of activity performed and amount of time spent in group therapy, by discipline; rehabilitation length of stay (RLOS); discharge location; FIM Cognitive and Motor scores at discharge. Results 79% of patients received at least 1 session of group therapy, with group therapy accounting for 13.7% of all therapy sessions and 15.8% of therapy hours. On average, patients spent 2.9 hours per week in group therapy. The greatest proportion of treatment time in group format was in Therapeutic Recreation (25.6%), followed by Speech Therapy (16.2%), Occupational Therapy (10.4%), Psychology (8.1%), and Physical Therapy (7.9%). Group therapy time and type of treatment activities varied among admission FIM cognitive subgroups and treatment sites. Several factors appear to be predictive of receiving group therapy, with treatment site being a major influence. However, group therapy as a whole offered little explanation of differences in the outcomes studied. Conclusion(s) Group therapy is commonly used in TBI rehabilitation, to varying degrees among disciplines, sites, and cognitive impairment subgroups. Various therapeutic activities take place in group therapy, indicating its perceived value in addressing many domains of functioning. Variation in outcomes is not explained well by overall percent of therapy time delivered in groups.

Participant evaluation of an inpatient occupational therapy groups programme in brain injury rehabilitation

“…Groups are commonly practiced in brain injury rehabilitation, contributing to rehabilitation programmes and patient outcomes (Hammond et al, 2015). Currently there is limited information to guide therapists in the processes for facilitating groups and evaluating group participation.…”

“…Measuring specific outcomes of group participation within comprehensive, multifaceted rehabilitation programmes presents a challenge to clinicians and researchers (Hammond et al, 2015). Impaired selfawareness is common following TBI, and impacts on a patient's ability to set realistic goals and ultimately participate in rehabilitation programmes (Cicerone et al, 2011;Tate et al, 2014).…”

“…Group interventions are relatively common in brain injury rehabilitation. In a study of 2130 consecutive admissions in 10 inpatient rehabilitation sites in the United States, Hammond et al (2015) found that 79.9% of patients participated in at least one group session during their admission, and that groups accounted for 13.7% of patients' therapy sessions and 15.8% of all therapy time. An Australian survey of multidisciplinary clinicians working in TBI rehabilitation, found that all disciplines used group-based interventions in their practice, for example, 43.37% of occupational therapists (Pagan et al, 2015).…”

“…Furthermore, group interventions often target multiple functional deficits utilising a variety of approaches and interventions. This results in challenges in the evaluation of outcomes from group participation (Hammond et al, 2015;Scanlan et al, 2015), and the development of measures of group participation is somewhat limited (Scanlan et al, 2015). As well as objective measures, the importance of consumer perspectives in service evaluation should not be overlooked (McCarthy & Hart, 2011).…”

Diffuse Axonal Injury: A Devastating Pathology

“…Within this form of therapy, highly trained canines may be utilized as well as more hobby-like activities such as gardening, recreational sports, and even holiday functions, such as decorating or baking [70,71]. While this form of therapy is less aggressive and directed, data has continuously shown the remarkable outcomes that recreational therapy has not only on the patient's physical abilities but also on the overall happiness of the patient and their quality of life, a truly life-changing treatment in the posttraumatic realm [72].…”