The UK FIM+FAM and MPAI-4 provide complementary evaluation across functional tasks ranging from self-care to participation. This study supports their use for longitudinal outcome evaluation in community residential rehabilitation services that take patients at different stages of recovery.
Purpose
Transition back into the community following acute management of
acquired brain injury (ABI) is a critical part of recovery. Post-acute
rehabilitation and transitional care can significantly improve outcomes.
The Acquired Brain Injury Community REhabilitation and Support Services
OuTcomes CohoRT (ABI-RESTaRT) is a novel whole-population cohort formed
to better understand the needs of individuals with ABI receiving
post-acute rehabilitation and disability services in Western Australia
(WA), and to improve their outcomes. To do this a unique combination of
(1) internal clinical/rehabilitation data, and (2) externally linked
health data from the WA Data Linkage System was used, including
hospitalisations, emergency department presentations, mental health
service use and death records, to measure longitudinal needs and
outcomes of individuals with ABI over 29 years, making this the largest,
most diverse post-acute ABI cohort in Australia to date.
Participants
Whole-population cohort of individuals (n=1011) with an ABI who
received post-acute community-based neurorehabilitation or disability
support services through Brightwater Care Group from 1991 to
2020.
Findings to date
Comprehensive baseline demographic, clinical and rehabilitation
data, outcome measures and linked health data have been collected and
analysed. Non-traumatic brain injury (eg, stroke, hypoxia) was the main
diagnostic group (54.9%, n=555), followed by traumatic brain injury
(34.9%, n=353) and eligible neurological conditions (10.2%, n=103). Mean
age at admission was 45.4 years, and 67.5% were men (n=682). The cohort
demonstrated significant heterogeneity, socially and clinically, with
differences between ABI groups across a number of domains.
Future plans
ABI-RESTaRT is a dynamic whole-population cohort that will be
updated over time as individuals enrol in the service. Future analyses
will assess longitudinal brain injury outcomes, the changing health and
social needs of individuals with ABI and evaluate and inform post-acute
services to best support these individuals.
Registration
This cohort is not linked to a clinical trial, and is not
registered.
Objective
To determine the differences in functional and cognitive rehabilitation gains made in community-based rehabilitation following a stroke based on stroke diagnosis (left or right hemisphere, hemorrhagic, or ischemic).
Design
A 12-month follow-up observational retrospective cohort study.
Setting
Staged community-based brain injury rehabilitation.
Participants
Clients (N=61) with hemorrhagic left brain stroke (n=10), hemorrhagic right brain stroke (n=8), ischemic left brain stroke (n=27), or ischemic right brain stroke (n=16) participating in rehabilitation for at least 12 months.
Intervention
Not applicable.
Main Outcome Measures
The Mayo-Portland Adaptability Inventory-4 (MPAI-4) was completed at admission and 12 months post admission to staged community-based brain injury rehabilitation by consensus of a multidisciplinary team.
Results
After 12 months in staged community-based brain injury rehabilitation, the study population made significant gains in Total (
P
<.001) and across Ability (
P
<.001) and Participation (
P
<.001) subscales of the MPAI-4. All diagnostic groups made significant gains in Participation T-scores, and no groups made significant gains in Adjustment. The ischemic left and right hemisphere stroke groups also made significant gains in Ability and Total T-scores from admission to 12 months. Clients with ischemic left hemisphere stroke had more severe limitations in motor speech (
P
<.05) than clients with right hemisphere stroke at admission and/or review and were also more impaired in verbal communication (
P
<.01) than the hemorrhagic right hemisphere group at admission.
Conclusions
There are some differences in outcomes on presentation to rehabilitation based on type of stroke; there are also differences in rehabilitation gains. Improvement in physical ability does not always translate to improvement in social participation and independence; those with right brain stroke need further assistance to translate physical gains into participatory outcomes.
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