Abstract Reprint: RWW Demonstrates Effectiveness of Approach, Durability of Outcomes

Archives of Physical Medicine and Rehabilitation
(2010; Vol 91: 1697-1704)

Irwin M. Altman PhD, MBAa, Shannon Swick MAb, Devan Parrot BSc and James F. Malec PhD, ABPP-Cn, Rpc,d

a.) Gentiva Rehab Without Walls® , Phoenix, AZ
b.) Gentiva Rehab Without Walls® , Marshall, MI
c.) Rehabilitation Hospital of Indiana, Indianapolis, IN
d.) Indiana University School of Medicine, Indianapolis, IN

Abstract

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.

Objective

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

Design

Retrospective analysis of program evaluation data for treatment completers and non-completers.

Setting

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

Participants

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).

Intervention

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.

Results

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.

Conclusions

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