Change in Activity Performance Mediates the Relationship between Occupational Therapy Utilization and Discharge Disposition among Adults with Traumatic Brain Injuries.

A retrospective cross-sectional study was conducted on 435 adults with TBI who received occupational therapy services in an acute care trauma center hospital. Outcome measures were (1) occupational therapy utilization based on billed minutes of occupational therapy evaluation and treatment (low vs. high); (2) Activity Measure for Post-Acute Care (AM-PAC) "6-Clicks" to assess activities of daily living level of assistance; and (3) Discharge disposition (community vs. institution). Community discharge included home and supported living facilities. Institutional discharge involved long term care, rehabilitation facility, short term hospital, and skilled nursing facility. Results indicated that change in ADL performance, between admission and discharge, partially mediated the relationship between occupational therapy utilization and community discharge (OR= 0.80, = .003). High occupational therapy utilization (vs. low) was associated with greater change in ADL performance ( = 0.39, < .001). Greater change in ADL performance was associated with lower odds of community discharge (OR= 0.96, <.001). Independent of change in ADL performance, higher occupational therapy utilization was associated with significantly lower odds for community discharge (OR = 0.57,  = 0.023). In conclusion, patients who received more occupational therapy were less likely to be community discharged, as mediated by change in ADL performance. This result can provide direction for future research exploring acute care occupational therapy utilization and discharge disposition.