Parrott Devan, Salisbury David B, Altman Irwin M, Logan Daniel M, McGrath Claire, Walters G Joseph, Malec James F
Author Affiliations: Foundation to Advance Brain Rehabilitation (FABR), and Psychiatry and Psychology, Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana (Dr Parrott); Pate NeuroRehabilitation/Rehab Without Walls, Irving, Texas (Dr Salisbury); Collage Rehabilitation Partners, Paoli, Pennsylvania (Dr Altman); On With Life, Ankeny, Iowa (Mr Logan); Bancroft NeuroRehab, Cherry Hill, New Jersey (Dr McGrath); On With Life, Ankeny, Iowa (Mr Walters); Foundation to Advance Brain Rehabilitation (FABR); Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana; and Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota (Dr Malec).
Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana (Dr Parrott); Pate NeuroRehabilitation/Rehab Without Walls, Irving, Texas (Dr Salisbury); Collage Rehabilitation Partners, Paoli, Pennsylvania (Dr Altman); On With Life, Ankeny, Iowa (Logan); Bancroft NeuroRehab, Cherry Hill, New Jersey (Dr McGrath); On With Life, Ankeny, Iowa (Walters); Foundation to Advance Brain Rehabilitation (FABR); Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana; and Mayo Clinic, Rochester, Minnesota (Dr Malec).
J Head Trauma Rehabil. 2025;40(1):38-45. doi: 10.1097/HTR.0000000000000993. Epub 2024 Aug 5.
To further evaluate, using quasi-experimental methodologies, posthospital brain injury rehabilitation outcomes described in an accompanying report of a large observational study ( n = 2120).
Data from Intensive Rehabilitation (IR: Residential Neurobehavioral, Residential Neurorehabilitation, Home and Community Neurorehabilitation, Day Treatment, Outpatient Neurorehabilitation) and Supported Living (SL) programs serving individuals with acquired brain injury (ABI).
Two hundred twenty-eight individuals with traumatic brain injury, stroke, or other ABI in propensity score analysis; 1344 in analysis by extent of recommended treatment completed (TC) rating.
Sex, age, time since injury, Mayo-Portland Adaptability Inventory-4th edition (MPAI-4) Rasch-derived T-scores, and TC rating.
Analyses of covariance (1) of discharge MPAI-4 Total, index, and subscale T-scores on propensity score-matched samples of IR and SL participants controlling for admission scores and (2) of MPAI-4 T-scores by TC rating and diagnostic category.
Propensity score-matched groups showed superior outcomes for IR participants compared to SL participants on MPAI-4 Total T-score ( F = 77.21, P < .001; partial η 2 = 0.257) and all MPAI-4 index and subscale T-scores controlling for sex, age, and baseline scores. Participants with traumatic brain injury and stroke who completed the recommended course of rehabilitation had superior outcomes on all MPAI-4 T-scores compared to those who completed less than or much less than the recommended treatment. No additional benefit was apparent for those who completed more than the recommended course. The association between TC rating and outcome was not significant for the other ABI group.
These analyses using quasi-experimental controls provide more scientifically rigorous evidence of the benefit of IR provided through posthospital brain injury rehabilitation programs after acute inpatient care, consistent with the results of numerous observational studies. However, improved internal validity limits external validity and generalization. The absence of a significant association between TC rating and outcomes for the other ABI group most likely reflects the difficulty prescribing rehabilitation for this highly heterogeneous group.
运用准实验方法，进一步评估一项大型观察性研究（n = 2120）的随附报告中所描述的院后脑损伤康复结果。
来自强化康复（IR：住院神经行为康复、住院神经康复、家庭与社区神经康复、日间治疗、门诊神经康复）和支持性生活（SL）项目的数据，这些项目服务于后天性脑损伤（ABI）患者。
倾向得分分析中有228名创伤性脑损伤、中风或其他ABI患者；按推荐治疗完成程度（TC）评级分析中有1344名患者。
性别、年龄、受伤时间、梅奥-波特兰适应性量表第4版（MPAI-4）基于拉施模型得出的T分数，以及TC评级。
（1）对IR和SL参与者倾向得分匹配样本的出院时MPAI-4总分、指数和子量表T分数进行协方差分析，控制入院分数；（2）按TC评级和诊断类别对MPAI-4 T分数进行分析。
倾向得分匹配组显示，在控制性别、年龄和基线分数的情况下，IR参与者在MPAI-4总T分数（F = 77.21，P <.001；偏η² = 0.257）以及所有MPAI-4指数和子量表T分数方面的结果优于SL参与者。与完成少于或远少于推荐治疗的创伤性脑损伤和中风患者相比，完成推荐康复疗程的患者在所有MPAI-4 T分数方面的结果更优。对于完成超过推荐疗程的患者，未发现额外益处。对于其他ABI组，TC评级与结果之间的关联不显著。
这些使用准实验对照的分析为急性住院治疗后院后脑损伤康复项目所提供的强化康复的益处提供了更科学严谨的证据，这与众多观察性研究的结果一致。然而，内部效度的提高限制了外部效度和普遍性。其他ABI组的TC评级与结果之间缺乏显著关联很可能反映了为这个高度异质性群体制定康复方案的困难。
