Logan Daniel M, Parrott Devan, Altman Irwin M, Eicher Vicki, McGrath Claire, Salisbury David B, Walters G Joseph, Malec James F
Author Affiliations: Director of Performance Improvement and Quality Management (Mr Logan), Analytics (Mr Walters), On With Life, Ankeny, Iowa; Foundation to Advance Brain Rehabilitation (FABR), Wilmington, Delaware and Physical Medicine and Rehabilitation (Drs Parrott and Malec), Indiana University School of Medicine, Indianapolis, Indiana; National Director of Outcomes, Collage Rehabilitation Partners, Paoli, Pennsylvania (Dr Altman); Quality Management, ReMed Recovery Care Centers, Paoli, Pennsylvania (Ms Eicher); Senior Director of Clinical Services, Bancroft NeuroRehab, Cherry Hill, New Jersey (Dr McGrath); Clinical Operations, Pate NeuroRehabilitation/Rehab Without Walls, Irving, Texas (Dr Salisbury); and Department of Psychology, Mayo Clinic, Rochester, Minnesota (Dr Malec).
J Head Trauma Rehabil. 2025;40(1):46-52. doi: 10.1097/HTR.0000000000001009. Epub 2024 Sep 13.
(1) To determine the proportion of participants admitted to supported community living (SCL) programs over the course of 5 years who improve, decline, or maintain functioning and community integration and (2) to examine the associations of time since injury, time in program, and age to their functional trajectory.
Data from SCL programs serving individuals with acquired brain injury (ABI).
104 individuals with traumatic brain injury (TBI), stroke, or other ABI.
Sex, age, time since injury, Mayo-Portland Adaptability Inventory (4th edition; MPAI-4).
Retrospective analyses of MPAI-4 total and MPAI-4 indices using Linear Mixed Models (LMM) of Rasch-derived T-scores from admission to 5 years into service delivery.
MPAI-4 total, index, and subscale scores for yearly intervals of SCL services from admission to 5 years showed a high degree of stability in function (defined using the standard error of measurement (SEM) for the MPAI-4, defined as change ≥3 T-score points) with all intervals showing at least 89% of patients with improved scores or no change. The rate of change over time did not significantly vary by time since injury, time in the program, or age.
The expectations for services in the SCL portion of the care continuum for ABI are unique. Unlike intensive rehabilitation programs which focus on improvement often earlier in the course of recovery, the goal of SCL services is sustained functioning over the long term. Analyses reported here indicate this can be achieved for at least 5 years, potentially mitigating the increased risk for rehospitalization and increased care needs in the ABI population. This study highlights a key finding of MPAI-4 stability within these understudied brain injury service lines. Additional exploration of comorbidities and more nuanced delineation of diagnostic information could further clarify factors influencing outcome stability over time.
（1）确定在5年期间入住支持性社区生活（SCL）项目的参与者中功能改善、下降或维持以及社区融合的比例；（2）研究受伤时间、项目参与时间和年龄与其功能轨迹之间的关联。
来自为获得性脑损伤（ABI）患者提供服务的SCL项目的数据。
104名患有创伤性脑损伤（TBI）、中风或其他ABI的个体。
性别、年龄、受伤时间、梅奥-波特兰适应性量表（第4版；MPAI-4）。
使用从入院到服务提供5年期间Rasch衍生的T分数的线性混合模型（LMM）对MPAI-4总分和MPAI-4指数进行回顾性分析。
从入院到5年期间SCL服务的年度间隔的MPAI-4总分、指数和子量表分数显示功能具有高度稳定性（使用MPAI-4的测量标准误差（SEM）定义，定义为变化≥3个T分数点），所有间隔显示至少89%的患者分数提高或无变化。随时间的变化率在受伤时间、项目参与时间或年龄方面没有显著差异。
ABI护理连续体中SCL部分的服务期望是独特的。与通常在恢复过程早期侧重于改善的强化康复项目不同，SCL服务的目标是长期维持功能。此处报告的分析表明，这至少可以在5年内实现，有可能降低ABI人群再次住院风险增加和护理需求增加的情况。本研究突出了在这些研究不足的脑损伤服务领域中MPAI-4稳定性的一项关键发现。对合并症的进一步探索以及对诊断信息更细致的描述可能会进一步阐明影响结果随时间稳定性的因素。
