King Regan, Seeger Trevor, Wang Meng, Li Pi Shan Rodney, McGovern Christine, Knox Jason, Patel Lisa, Fung Tak, Sajobi Tolulope, Debert Chantel
Calgary Brain Injury Program, Alberta Health Services, Calgary, AB, Canada.
Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Front Neurol. 2020 Nov 30;11:596526. doi: 10.3389/fneur.2020.596526. eCollection 2020.
Early Supported Discharge (ESD) is a clinical flow management service offering interdisciplinary rehabilitation, wherein patients are provided supported in-home rehabilitation treatment; in comparison to conventional hospital-based rehabilitation model of service delivery. There has been little research into the functional outcomes for other types of acquired brain injury (ABI). In this prospective cohort study, ABI patients presenting at a level I trauma center in Calgary, Canada were placed in either an ESD program or conventional inpatient rehabilitation (IPR) program based on their medical history and presentation. A small number of patients completed both programs (ESD+IPR group). ESD therapies were designed to emulate IPR. Participants completed professionally-rated Mayo-Portland Adaptability Index-4 (MPAI), Quality of Life after Brain Injury (QOLIBRI), Generalized Anxiety Questionnaire-7 (GAD7), Montreal Cognitive Assessment (MoCA), and Patient Health Questionnaire-9 (PHQ9) surveys at 1, 3, and 6 months following initial assessment pre-rehabilitation. Caregivers completed the Zarit Burden Interview (ZBI) at the same time points. The Supervision Rating Scale (SRS) and Disability Rating Scale (DRS) were completed at admission to rehabilitation and all follow-ups. Generalized estimate equations models were used to describe the three groups over time, including age as a covariate. Significant effects of time were reported in the MPAI participant sub-score in the ESD and IPR groups ( = 42.429, < 0.000; = 9.773, = 0.008), showing significantly higher scores between 1 and 3 month timepoints for both groups. ZBI scores were significantly lower in the ESD group at 1 month compared to 3 and 6 months ( = 31.252, < 0.001). The proportion of patients with medical complications during rehabilitation was 25.3% in ESD compared to 74.7% patients in IPR. Improvements in functional outcomes were evident in patients participating in ESD and IPR, with more medical complications reported in the IPR group. Caregiver burden lessened over time in the ESD group but not in the IPR group. Both ESD and ESD+IPR groups can be considered viable alternatives to traditional inpatient rehabilitation. A randomized control trial would be required to properly compare rehabilitation streams. Further investigation into affective and lifestyle elements of ABI recovery would also improve our understanding of targeted neurorehabilitation in this population.
早期支持性出院（ESD）是一项提供跨学科康复的临床流程管理服务，即患者可在家中接受支持性康复治疗；相较于传统的基于医院的康复服务模式。对于其他类型的获得性脑损伤（ABI）的功能结局，研究较少。在这项前瞻性队列研究中，加拿大卡尔加里一家一级创伤中心的ABI患者根据其病史和临床表现被纳入ESD项目或传统住院康复（IPR）项目。少数患者完成了两个项目（ESD+IPR组）。ESD疗法旨在模仿IPR。参与者在康复前初始评估后的1、3和6个月完成专业评定的梅奥-波特兰适应性指数-4（MPAI）、脑损伤后生活质量（QOLIBRI）、广泛性焦虑问卷-7（GAD7）、蒙特利尔认知评估（MoCA）和患者健康问卷-9（PHQ9）调查。护理人员在相同时间点完成扎里特负担访谈（ZBI）。在康复入院时及所有随访时完成监督评定量表（SRS）和残疾评定量表（DRS）。使用广义估计方程模型来描述三组随时间的变化情况，将年龄作为协变量。ESD组和IPR组的MPAI参与者子评分报告有显著的时间效应（=42.429，<0.000；=9.773，=0.008），表明两组在1至3个月时间点之间的评分显著更高。与3个月和6个月相比，ESD组在1个月时的ZBI评分显著更低（=31.252，<0.001）。康复期间有医疗并发症的患者比例，ESD组为25.3%，而IPR组为74.7%。参与ESD和IPR的患者功能结局有明显改善，IPR组报告的医疗并发症更多。ESD组护理人员的负担随时间减轻，而IPR组则没有。ESD组和ESD+IPR组均可被视为传统住院康复的可行替代方案。需要进行随机对照试验来恰当比较康复流程。对ABI恢复的情感和生活方式因素进行进一步调查也将增进我们对该人群针对性神经康复的理解。
