Original article| Volume 91, ISSUE 11, P1697-1704, November 2010

Effectiveness of Community-Based Rehabilitation After Traumatic Brain Injury for 489 Program Completers Compared With Those Precipitously Discharged


      Altman IM, Swick S, Parrot D, Malec JF. Effectiveness of community-based rehabilitation after traumatic brain injury for 489 program completers compared with those precipitously discharged.


      To evaluate outcomes of home- and community-based postacute brain injury rehabilitation (PABIR).


      Retrospective analysis of program evaluation data for treatment completers and noncompleters.


      Home- and community-based PABIR conducted in 7 geographically distinct U.S. cities.


      Patients (N=489) with traumatic brain injury who completed the prescribed course of rehabilitation (completed-course-of-treatment [CCT] group) compared with 114 who were discharged precipitously before program completion (precipitous-discharge [PD] group).


      PABIR delivered in home and community settings by certified professional staff on an individualized basis.

      Main Outcome Measures

      Mayo-Portland Adaptability Inventory (MPAI-4) completed by means of professional consensus on admission and at discharge; MPAI-4 Participation Index at 3- and 12-month follow-up through telephone contact.


      Analysis of covariance (CCT vs PD group as between-subjects variable, admission MPAI-4 score as covariate) showed significant differences between groups at discharge on the full MPAI-4 (F=82.25; P<.001), Ability Index (F=50.24; P<.001), Adjustment Index (F=81.20; P<.001), and Participation Index (F=59.48; P<.001). A large portion of the sample was lost to follow-up; however, available data showed that group differences remained statistically significant at follow-up.


      Results provided evidence of the effectiveness of home- and community-based PABIR and that treatment effects were maintained at follow-up.

      Key Words

      List of Abbreviations:

      ANCOVA (analysis of covariance), CARF (Commission on Accreditation of Rehabilitation Facilities), CCT (completed-course-of-treatment), GCS (Glasgow Coma Scale), LOC (loss of consciousness), LOS (length of stay), MPAI-4 (Mayo-Portland Adaptability Inventory), PABIR (postacute brain injury rehabilitation), PD (precipitous-discharge), PTA (posttraumatic amnesia), RCT (randomized controlled trial), TBI (traumatic brain injury)
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