Clinical and cost effectiveness of post-acute neurobehavioural rehabilitation.

The value of post-acute, community based social and behavioural rehabilitation for people with serious neurobehavioural disability has been the subject of a dispute for a number of years. Some authorities doubt that major changes in social adaptability and independence is possible several years post-injury. This paper attempts to assess both the clinical and cost effectiveness of such rehabilitation on a group who have suffered serious brain injury and display behaviour problems and cognitive deficits which prevent them living as independent members of the community. The discharge and follow-up data on 76 people who have received rehabilitation indicates that, with a minimum of 6 months rehabilitation, many severely damaged individuals can progress to less dependent placements in the community, and maintain higher levels of social activity (independence) with fewer hours of care support. This can amount to a per capita lifetime reduction of over 1 million pounds per annum in the cost of supporting such people in the community. Time between injury and the beginning of rehabilitation is a factor influencing outcome but longer periods of rehabilitation (beyond 12 months for the most seriously disabled) is not associated with a better outcome, measured by a reduction in care hours. The cost effectiveness of rehabilitation is greater for those who receive treatment within 2 years of injury. However, those who received rehabilitation at later stages also achieved significant social outcomes and savings on care hours.