Staged residential post-acute rehabilitation for adults following acquired brain injury: A comparison of functional gains rated on the UK Functional Assessment Measure (UK FIM+FAM) and the Mayo-Portland Adaptability Inventory (MPAI-4)

Jackson, Diana; Seaman, Karla; Sharp, Kristylee; Singer, R. B.; Wagland, Janet; Turner-Stokes, Lynne

doi:10.1080/02699052.2017.1350998

Cited by 16 publications

(27 citation statements)

References 21 publications

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“…Overall, our study findings add to a growing body of evidence supporting the effectiveness of SCBIR for postacute functional rehabilitation after brain injury (10)(11)(12). The rehabilitation cohort demonstrated clinically significant gains in motor and cognitive function at discharge with a mean gain of +20.3 in FIM+FAM score.…”

Section: Discussionsupporting

confidence: 74%

“…Staged community-based brain injury rehabilitation (SCBIR) is a novel model of post-acute rehabilitation for ABI developed at the Oats Street Rehabilitation Center in Western Australia (WA) ( 9 ), in which individuals complete slow-stream rehabilitation whilst living on-site at a community-based residential facility over 12–24 months ( 10 ). Slow-stream rehabilitation is defined as low-intensity extended-duration rehabilitation, in contrast to high-intensity, short-duration inpatient models ( 9 ).…”

Section: Introductionmentioning

confidence: 99%

“…Slow-stream rehabilitation is defined as low-intensity extended-duration rehabilitation, in contrast to high-intensity, short-duration inpatient models ( 9 ). The SCBIR model involves 10 sequential stages of rehabilitation based on level of functioning, with individuals “ graduating ” through different stages with functional improvement ( 10 ). The primary focus of SCBIR is on creating a safe environment in which physical (e.g., movement, fine and gross motor tasks) and cognitive skills (e.g., planning, memory, spatial ability) are relearnt and rehearsed through real-world participation such as self-care, domestic tasks, shopping, meal preparation, and public transport training, alongside traditional multidisciplinary therapy including physiotherapy, occupational therapy, speech therapy, psychotherapy, and cognitive therapy.…”

Section: Introductionmentioning

confidence: 99%

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Rehabilitation outcomes at discharge from staged community-based brain injury rehabilitation: A retrospective cohort study (ABI-RESTaRT), Western Australia, 2011–2020

Troeung¹,

Mann²,

Cullinan

et al. 2022

Front. Neurol.

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ObjectiveTo evaluate change in functional independence, psychosocial functioning, and goal attainment at discharge from a slow-stream Staged Community-Based Brain Injury Rehabilitation (SCBIR) service in Western Australia, 2011–2020.MethodsRetrospective cohort study of n = 323 adults with acquired brain injury (ABI) enrolled in a post-acute SCBIR service compared against a control cohort of n = 312 with ABI admitted to three non-rehabilitation programs. Outcome measures were the UK Functional Independence Measure and Functional Assessment Measure (FIM+FAM), Mayo Portland Adaptability Inventory-4 (MPAI-4), and Goal Attainment Scale. Change in FIM+FAM and MPAI-4 scores and predictors of goal attainment at discharge were evaluated using multilevel mixed-effects regression.ResultsMedian SCBIR length of stay was 20.5 months. Rehabilitation clients demonstrated clinically significant functional gains at discharge, adjusted mean change = +20.3, p < 0.001 (FIM+FAM). Peak gains of +32.3 were observed after 24–30 months and clinically significant gains were observed 5 years post-admission. Individuals discharged ≤6 months had the smallest functional gains (+12.7). Small psychosocial improvements were evidenced at discharge, mean reduction = −2.9T, p < 0.001 (MPAI-4) but not clinically significant. 47% of rehabilitation clients achieved their goals at the expected level or higher at discharge. Compared to the control, rehabilitation clients evidenced significantly greater functional gains and psychosocial improvement but lower goal attainment. Significant predictors of goal attainment at discharge were >2 years since injury, higher cognitive function and higher emotional adjustment at admission.ConclusionsFunctional recovery after ABI is a gradual and ongoing process. SCBIR is effective for functional rehabilitation post-injury but can be improved to achieve clinically meaningful psychosocial improvement.

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Section: Discussionsupporting

confidence: 74%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Rehabilitation outcomes at discharge from staged community-based brain injury rehabilitation: A retrospective cohort study (ABI-RESTaRT), Western Australia, 2011–2020

Troeung¹,

Mann²,

Cullinan

et al. 2022

Front. Neurol.

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“… 22–24 On admission, clients are allocated to a house with levels of assistance appropriate for their needs, ranging from 24-hour continuous care to full independence, and graduate through stages with decreasing levels of support as their independence and functional abilities improve. 24 The programme is able to support all stages of brain injury rehabilitation, from profound physical disability (including those in a minimally conscious state, in which there is reduced consciousness with evidence of environmental awareness 25 ) to higher-level cognitive rehabilitation.…”

Section: Cohort Descriptionmentioning

confidence: 99%

Cohort profile: the Acquired Brain Injury Community REhabilitation and Support Services OuTcomes CohoRT (ABI-RESTaRT), Western Australia, 1991–2020

Mann¹,

Troeung²,

Wagland³

et al. 2021

BMJ Open

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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.

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“…10–14 The multifaceted structure of the MPAI-4 makes it a useful tool for planning and assessing interventions, and studies have demonstrated the MPAI-4’s clinical sensitivity to the effect of rehabilitation. 15–17 The MPAI-4 is best completed by consensus of the rehabilitation team, but can be completed by caregivers, significant others or by the patients themselves. For example, Malec 18 compared MPAI-4 scores between rehabilitation professionals, significant others and TBI patients, which revealed satisfactory internal consistency and interrater agreement.…”

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confidence: 99%

Validation of the Mayo-Portland Adaptability Inventory-4 (MPAI-4) and reference norms in a French-Canadian population with traumatic brain injury receiving rehabilitation

Guerrette

McKerral²

2020

Preprint

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Objective: To validate the factor structure and establish internal consistency reliability of the French-Canadian version of the Mayo-Portland Adaptability Inventory (MPAI-4), using a Canadian sample of adults with traumatic brain injury (TBI) receiving post-acute rehabilitation services. Design: Psychometric analysis of prospectively collected French-Canadian MPAI-4 data. Setting: Inpatient and outpatient TBI rehabilitation programs. Participants: Adults (N = 1012) with a mild, moderate or severe TBI who received inpatient or outpatient rehabilitation interventions and for whom a first French-Canadian MPAI-4 measure was completed between 2016 and 2020. Interventions: Not applicable. Main Outcome Measure: French-Canadian MPAI-4 questionnaire. Results: To evaluate the factor structure of the French-Canadian MPAI-4, an exploratory factor analysis using a varimax rotation method was conducted on z-scores for all items. The final and best solution was a three-factor solution, which accounted for 48.68% of the variance. The internal consistency of the French-Canadian MPAI-4 was determined using Cronbach's alpha and all three subscales showed good internal consistency (all alpha values between .70 and .89). Reference norms for the TBI sample are provided in the form of T scores for subscales and total score, as well as descriptive raw data according to sex, age, TBI severity and rehabilitation setting. Conclusions: The three factors extracted using data from the French-Canadian MPAI-4 are similar, but not entirely identical to the three subscales of the original MPAI-4. Overall, the French-Canadian MPAI-4 factor structure is validated. The questionnaire shows good psychometric properties and represents a suitable tool to measure functional evolution and social participation of TBI adults receiving rehabilitation services in a French-Canadian context. The provided reference norms will also help guide the clinical use of the MPAI-4 in French-Canadian TBI populations.

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Staged residential post-acute rehabilitation for adults following acquired brain injury: A comparison of functional gains rated on the UK Functional Assessment Measure (UK FIM+FAM) and the Mayo-Portland Adaptability Inventory (MPAI-4)

Abstract: 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.

Cited by 16 publications

References 21 publications

Rehabilitation outcomes at discharge from staged community-based brain injury rehabilitation: A retrospective cohort study (ABI-RESTaRT), Western Australia, 2011–2020

Rehabilitation outcomes at discharge from staged community-based brain injury rehabilitation: A retrospective cohort study (ABI-RESTaRT), Western Australia, 2011–2020

Cohort profile: the Acquired Brain Injury Community REhabilitation and Support Services OuTcomes CohoRT (ABI-RESTaRT), Western Australia, 1991–2020

Validation of the Mayo-Portland Adaptability Inventory-4 (MPAI-4) and reference norms in a French-Canadian population with traumatic brain injury receiving rehabilitation

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