Malec James F, Kean Jacob
1 Department of PM&R, Indiana University School of Medicine and Rehabilitation Hospital of Indiana , Indianapolis, Indiana.
2 Center for Health Information and Communication, Department of Veterans Affairs; Regenstrief Institute, VA HSR&D Center of Innovation, Richard L. Roudebush VA Medical Center , Indianapolis, Indiana.
J Neurotrauma. 2016 Jul 15;33(14):1371-9. doi: 10.1089/neu.2015.4080. Epub 2015 Nov 19.
This study examined outcomes for intensive residential and outpatient/community-based post-inpatient brain injury rehabilitation (PBIR) programs compared with supported living programs. The goal of supported living programs was stable functioning (no change). Data were obtained for a large cohort of adults with acquired brain injury (ABI) from the OutcomeInfo national database, a web-based database system developed through National Institutes of Health (NIH) Small Business Technology Transfer (STTR) funding for monitoring progress and outcomes in PBIR programs primarily with the Mayo-Portland Adaptability Inventory (MPAI-4). Rasch-derived MPAI-4 measures for cases from 2008 to 2014 from 9 provider organizations offering programs in 23 facilities throughout the United States were examined. Controlling for age at injury, time in program, and time since injury on admission (chronicity), both intensive residential (n = 205) and outpatient/community-based (n = 2781) programs resulted in significant (approximately 1 standard deviation [SD]) functional improvement on the MPAI-4 Total Score compared with supported living (n = 101) programs (F = 18.184, p < 0.001). Intensive outpatient/community-based programs showed greater improvements on MPAI-4 Ability (F = 14.135, p < 0.001), Adjustment (F = 12.939, p < 0.001), and Participation (F = 16.679, p < 0.001) indices than supported living programs; whereas, intensive residential programs showed improvement primarily in Adjustment and Participation. Age at injury and time in program had small effects on outcome; the effect of chronicity was small to moderate. Examination of more chronic cases (>1 year post-injury) showed significant, but smaller (approximately 0.5 SD) change on the MPAI-4 relative to supported living programs (F = 17.562, p < 0.001). Results indicate that intensive residential and outpatient/community-based PIBR programs result in substantial positive functional changes moderated by chronicity.
本研究考察了强化住院以及门诊/社区型住院后脑损伤康复（PBIR）项目与支持性生活项目相比的效果。支持性生活项目的目标是功能稳定（无变化）。数据来自OutcomeInfo国家数据库中的一大群获得性脑损伤（ABI）成人，该数据库是一个基于网络的数据库系统，通过美国国立卫生研究院（NIH）小企业技术转移（STTR）资金开发，主要使用梅奥-波特兰适应性量表（MPAI-4）来监测PBIR项目的进展和结果。研究考察了2008年至2014年期间来自9个提供项目的机构、分布于美国23个设施中的病例的基于拉施模型得出的MPAI-4测量值。在控制受伤时的年龄、项目时长以及入院时受伤后的时间（慢性程度）后，强化住院项目（n = 205）和门诊/社区型项目（n = 2781）与支持性生活项目（n = 101）相比，在MPAI-4总分上均有显著（约1个标准差[SD]）的功能改善（F = 18.184，p < 0.001）。强化门诊/社区型项目在MPAI-4能力（F = 14.135，p < 0.001）、适应（F = 12.939，p < 0.001）和参与（F = 16.679，p < 0.001）指数上比支持性生活项目有更大改善；而强化住院项目主要在适应和参与方面有所改善。受伤时的年龄和项目时长对结果影响较小；慢性程度的影响为小到中等。对更慢性的病例（受伤后>1年）的检查显示，相对于支持性生活项目，MPAI-4有显著但较小（约0.5 SD）的变化（F = 17.562，p < 0.001）。结果表明，强化住院和门诊/社区型PIBR项目会带来实质性的积极功能变化，且慢性程度会对其产生调节作用。
