The efficacy of community-based rehabilitation programmes for adults with TBI

Abstract

Aims: The aim of this systematic review was to investigate the factors that infl uence the efficacy of community-based rehabilitation programmes in improving the quality of life and daily functioning of adults with severe traumatic brain injury. Methods: A systematic review of the literature was conducted. In keeping with the principles of best evidence synthesis, the findings from the studies were analysed according to their methodological quality. Findings: Eleven studies were included in the review; synthesis of these studies revealed that the outcomes of community rehabilitation programmes are mediated by a complex interaction between programme characteristics, participant characteristics and the methods used to assess outcomes. Variations in study methodology and quality further impact the extent to which treatment effectiveness can be demonstrated. There was evidence to support the use of telephone counselling nd interdisciplinary team rehabilitation. There was moderate strength evidence indicating the psychosocial benefits of engaging in group rehabilitation programme Conclusions: Outcome measures designed specifically for use with traumatic brain injury clients in community settings need to be validated. The clinical and cost benefits of telephone counselling, peer support groups and interdisciplinary team rehabilitation programmes warrant further research.

Call for an Integrative and Multi-Disciplinary Approach to Traumatic Brain Injury (TBI)

“…A range of community-based TBI rehabilitation programs have been explored and include interdisplinary team rehabilitation (Ponsford et al, 2006;Ponsford, Oliver, & Nelms, 2003;Powell, Heslin, & Greenwood, 2002;Smith et al, 2006), home based behavioral management program (Carnevale, Anselmi, Busichio, & Millis, 2002;Carnevale, Anselmi, Johnston, Busichio, & Walsh, 2006), outdoor experiential education programs (Thomas, 2004;Walker, Onus, Doyle, Clare, & McCarthy 2005), telephone counseling (Bell et al, 2005), client and caregiver educational training program (Sinnakaruppan, Downey, & Morrison, 2005) and community-based peer support (Hibbard et al, 2002). While the efficacy of these programs depended on an interaction of program and participant characteristics, and the methods used to assess outcomes (Evans & Brewis, 2008), the greatest treatment effects were seen in quality of life and functional independence measures and were associated with interdisplinary team rehabilitation programs as, telephone counseling, educational group training, and a group outward bound course. Overall, those programs that involved group interventions, demonstrated greater treatment effects than those involving individual therapy programs on measures of quality of life and functional independence (Evans & Brewis, 2008).…”

“…While the efficacy of these programs depended on an interaction of program and participant characteristics, and the methods used to assess outcomes (Evans & Brewis, 2008), the greatest treatment effects were seen in quality of life and functional independence measures and were associated with interdisplinary team rehabilitation programs as, telephone counseling, educational group training, and a group outward bound course. Overall, those programs that involved group interventions, demonstrated greater treatment effects than those involving individual therapy programs on measures of quality of life and functional independence (Evans & Brewis, 2008).…”

“…First, is the choice of outcome measure, its clinical meaningfulness, and sensitivity mat be unclear. As an example of the complexity of this question, in a review of community-based TBI therapies, the authors reported that there were 41 standardized assessment tools, self-report measures and qualitative techniques used in the 11 studies reviewed for treatment effectiveness (Evans & Brewis, 2008). Further complicating the question of which outcome measures may be appropriate is the range of sensitivities and specificities of each of these measures, which vary with sample population and research setting.…”

“…Currently, only limited data is available for the effectiveness of brief behavioral interventions (Nie-meier, Kreutzer, Marwitz, Gary, & Ketchum, 2011) or alternate interventions, as educational programs, internet-based therapies, virtual reality-based therapies, in the treatment of TBI (Cernich et al, 2010;Echlin et al, 2010;Penn, Rose, & Johnson, 2009;Rivara et al, 2011). For long-term therapy (>3 months), community-based rehabilitation programs are cost-effective and produce effect sizes on measures of quality of life and functional independence that are comparable to those of integrative rehabilitation programs (Evans & Brewis, 2008). Of particular relevance to the issue of delivery of services, telephone counseling (30 -45 minutes, bimonthly) lead to sustained improvements in quality of life, psychosocial functioning, and independence (Bell et al, 2005).…”

Comparison of rehabilitation outcomes in day hospital and home settings for people with acquired brain injury – a systematic review

“…These reviews have focussed on evaluating interventions enabling community integration [3], assessing the effects of multi-disciplinary rehabilitation [4] and exploring the efficacy of rehabilitation interventions delivered in community settings [5]. Turner Stokes et al [4] concluded that people with ABI should have access to outpatient or community-based services appropriate to their needs.…”