Early versus later admission to postacute rehabilitation: impact on functional outcome after traumatic brain injury.

OBJECTIVE

To examine the impact of participation in a postacute community reentry program on functional outcome after traumatic brain injury (TBI).

DESIGN

Cohort, nonrandomized, intervention study. Pretest-posttest, follow-up design.

SETTING

Nonprofit outpatient community reentry program affiliated with an inpatient rehabilitation hospital.

PARTICIPANTS

Three groups of persons with moderate to severe TBI differing in length of time between injury and admission. The first group entered postacute rehabilitation within 6 months of injury (n=115); the second group, between 6 and 12 months (n=23); and the third group, greater than 12 months (n=29).

INTERVENTIONS

Persons with TBI participated in a postacute community reentry program (average, 4.3mo) that emphasized (1) teaching compensatory strategies to address residual cognitive deficits; (2) arranging environmental supports to maximize functioning; (3) counseling and education to address personal and family adjustment and to improve accurate self-awareness; and (4) transition from simulated activities in the clinic to productive activities in the community.

MAIN OUTCOME MEASURES

Disability Rating Scale, Supervision Rating Scale, and the Community Integration Questionnaire.

RESULTS

All groups showed improvements between admission and discharge on measures of overall disability, independence, home competency, and productivity, and these gains were maintained at follow-up. For the group beginning postacute rehabilitation the earliest (<6mo postinjury) independence continued to improve after discharge. Community integration total score and home competency also continued to improve even after discharge.

CONCLUSIONS

The results point toward the effectiveness of postacute rehabilitation in improving functional outcome after TBI even for persons who have reached stable neurologic recovery at 12 or more months postinjury.