Rehabilitation outcomes at discharge from staged community-based brain injury rehabilitation: A retrospective cohort study (ABI-RESTaRT), Western Australia, 2011–2020

Abstract

ObjectiveTo evaluate change in functional independence, psychosocial functioning, and goal attainment at discharge from a slow-stream Staged Community-Based Brain Injury Rehabilitation (SCBIR) service in Western Australia, 2011–2020.MethodsRetrospective cohort study of n = 323 adults with acquired brain injury (ABI) enrolled in a post-acute SCBIR service compared against a control cohort of n = 312 with ABI admitted to three non-rehabilitation programs. Outcome measures were the UK Functional Independence Measure and Functional Assessment Measure (FIM+FAM), Mayo Portland Adaptability Inventory-4 (MPAI-4), and Goal Attainment Scale. Change in FIM+FAM and MPAI-4 scores and predictors of goal attainment at discharge were evaluated using multilevel mixed-effects regression.ResultsMedian SCBIR length of stay was 20.5 months. Rehabilitation clients demonstrated clinically significant functional gains at discharge, adjusted mean change = +20.3, p < 0.001 (FIM+FAM). Peak gains of +32.3 were observed after 24–30 months and clinically significant gains were observed 5 years post-admission. Individuals discharged ≤6 months had the smallest functional gains (+12.7). Small psychosocial improvements were evidenced at discharge, mean reduction = −2.9T, p < 0.001 (MPAI-4) but not clinically significant. 47% of rehabilitation clients achieved their goals at the expected level or higher at discharge. Compared to the control, rehabilitation clients evidenced significantly greater functional gains and psychosocial improvement but lower goal attainment. Significant predictors of goal attainment at discharge were >2 years since injury, higher cognitive function and higher emotional adjustment at admission.ConclusionsFunctional recovery after ABI is a gradual and ongoing process. SCBIR is effective for functional rehabilitation post-injury but can be improved to achieve clinically meaningful psychosocial improvement.

IMproving psYchosocial adjustment to Traumatic Brain Injury from acute to chronic injury through development and evaluation of themyTBIonline psychoeducation platform: protocol for a mixed-methods study

“…Full details of services are described elsewhere. 46 47 In brief, participants will be recruited from four different postacute services including the: (1) Transitional Rehabilitation Programme which is a slow-stream multidisciplinary Staged Community-Based Brain Injury Rehabilitation neurorehabilitation programme, 47 where individuals live onsite and complete rehabilitation over 12–24 months, (2) Transitional Accommodation Programme (TAP), which provides transitional care following discharge from hospital, (3) Capacity Building, which offers home-based supports as required, and (4) Supported Independent Living, a long-term care service for individuals with ABI who require support to carry out activities of daily living. The median time from injury to admission is 10.6 months and median length of stay is 20.5 months.…”

“…The median time from injury to admission is 10.6 months and median length of stay is 20.5 months. 47 …”

“…The median time from injury to admission is 10.6 months and median length of stay is 20.5 months. 47 Stage 1: interviews and surveys Research design and objectives Stage 1 will use qualitative methodology to: (1) understand the recovery experiences and psychosocial challenges of people with TBI over key stages of injury (acute, postacute, and chronic), and (2) identify required areas of psychosocial support to inform the psychoeducation platform development.…”

Sex/gender differences in service use patterns, clinical outcomes and mortality risk for adults with acquired brain injury: a retrospective cohort study (ABI-restart)

“…However, there is limited research specifically examining sex/gender differences in post-acute care service use and outcomes, defined as care accessed once medical or physiological stability has been reached following hospitalization (24). Prior studies have shown that engagement in post-acute care is associated with significant improvement in both functional independence and psychosocial outcomes in Australia (4)(5)(6) and internationally (25,26), and forms a critical component of long-term recovery after ABI (4). However, this research does not disaggregate outcomes by sex or gender, which is important to identify systematic differences to inform rehabilitation service planning and person-centred rehabilitation models (22).…”