ReMed, Paoli, PA, USA.
Arch Phys Med Rehabil. 2012 Jan;93(1):100-7. doi: 10.1016/j.apmr.2011.06.038.
To compare progress in 4 types of post-inpatient rehabilitation brain injury programs.
Quasiexperimental observational cohort study.
Community and residential.
Individuals (N=604) with acquired brain injury.
Four program types within the Pennsylvania Association of Rehabilitation Facilities were compared: intensive outpatient and community-based rehabilitation (IRC; n=235), intensive residential rehabilitation (IRR; n=78), long-term residential supported living (SLR; n=246), and long-term community-based supported living (SLC; n=45). With the use of a commercial web-based data management system developed with federal grant support, progress was examined on 2 consecutive assessments.
Mayo-Portland Adaptability Inventory (MPAI-4).
Program types differed in participant age (F=10.69, P<.001), sex (χ(2)=22.38, P<.001), time from first to second assessment (F=20.71, P<.001), initial MPAI-4 score (F=6.89, P<.001), and chronicity (F=13.43, P<.001). However, only initial MPAI-4 score and chronicity were significantly associated with the second MPAI-4 rating. On average, SLR participants were 9.1 years postinjury compared with 5.1 years for IRR, 6.0 years for IRC, and 6.8 years for SLC programs. IRR participants were more severely disabled per MPAI-4 total score on admission than the other groups. Controlling for these variables, program types varied significantly on second MPAI-4 total score (F=5.14, P=.002). Both the IRR and IRC programs resulted in significant functional improvement across assessments. In contrast, both the SLR and SLC programs demonstrated relatively stable MPAI-4 scores.
Results are consistent with stated goals of the programs; that is, intensive programs resulted in functional improvements, whereas supported living programs produced stable functioning. Further studies using data from this large, multiprovider measurement collaboration will potentially provide the foundation for developing outcome expectations for various types of postacute brain injury programs.
比较 4 种住院后康复脑损伤项目的进展。
准实验观察性队列研究。
社区和住宅。
患有后天性脑损伤的个体（N=604）。
在宾夕法尼亚州康复设施协会内比较 4 种项目类型：强化门诊和社区康复（IRC；n=235）、强化住院康复（IRR；n=78）、长期住院支持生活（SLR；n=246）和长期社区支持生活（SLC；n=45）。使用联邦资助开发的商业网络数据管理系统，在连续 2 次评估中检查进展情况。
明尼苏达州多相人格检查表（MPAI-4）。
不同项目类型的参与者年龄（F=10.69，P<.001）、性别（χ(2)=22.38，P<.001）、从第一次评估到第二次评估的时间（F=20.71，P<.001）、初始 MPAI-4 评分（F=6.89，P<.001）和慢性程度（F=13.43，P<.001）存在差异。然而，只有初始 MPAI-4 评分和慢性程度与第二次 MPAI-4 评分显著相关。平均而言，SLR 参与者的发病后时间为 9.1 年，IRR 为 5.1 年，IRC 为 6.0 年，SLC 为 6.8 年。IRR 参与者在入院时的 MPAI-4 总分中残疾程度更严重。在控制这些变量后，不同项目类型在第二次 MPAI-4 总分上差异显著（F=5.14，P=.002）。IRR 和 IRC 两个项目在两次评估中均显示出显著的功能改善。相比之下，SLR 和 SLC 两个项目的 MPAI-4 评分均相对稳定。
结果与各项目的既定目标一致，即强化项目导致功能改善，而支持性生活项目则产生稳定的功能。使用来自这个大型多提供者测量协作的数据进一步研究可能为制定各种急性后脑损伤项目的结果预期提供基础。
