| Author, Year
Country
Study Design
Sample Size |
Methods |
Outcome |
| Gerber & Gargaro (2015)
Canada
Pre-Post
Ninitial=78, Nfinal=61 |
Population: TBI=26, CVA=20, Anoxia=8, Tumor=7; Mean Age=44.97yr; Mean Time Post Injury=7.71yr; Severity: Mild=5, Moderate=48, Severe=9.
Intervention: Participants entered a multi-faceted day program with their caregivers (2 d/wk, 6mo).
Outcome Measures: Community Integration Questionnaire (CIQ), Overt Behaviour Scale (OBS), Burden Assessment Scale (BAS), Goal Attainment Scale (GAS). |
1. Mean CIQ was significantly higher after 6mo of intervention (10.02 to 12.25, p=0.000).
2. Mean BAS was significantly lower after 6mo of intervention (48.83 to 45.40, p=0.006).
3. Mean OBS was lower after 6mo of intervention (7.08 to 5.66) but the difference was not statistically significant.
4. OBS was positively correlated with BAS at baseline (r=0.381, p=0.006) and at 6mo (r=0.391, p=0.006).
5. BAS at baseline (r=-0.409, p=0.004) and at 6mo (r=-0.302, p=0.032) was negatively correlated with CIQ at 6 mo. |
| Sloan et al. (2012)
Australia
Cohort
N=43 |
Population: TBI=29, ABI=9, Stroke=5; Mean Age=28.42 yr; Gender: Male=25, Female=18; Mean Time Post Injury=6.73 yr.
Intervention: Participants attended the Community Approach to Participation rehabilitation program aimed at maximizing the level of participation in valued life roles. Participants were grouped by home-like (n=28) or disability-specific (n=12) accommodation setting. Outcomes were assessed at baseline, 1, 2, and 3 yr.
Outcome Measures: Care and Needs Scale (CANS), Functional independence Measure (FIM), Community Integration Questionnaire (CIQ), Part One of the Role Checklist (RC), number of hours of gratuitous care. |
1. The home-like accommodations group had significant improvement on the CANS (p=0.001), number of hours of gratuitous care per wk (p=0.001), FIM (p=0.03), CIQ and RC (p<0.001) across the 3-yr period.
2. The disability-specific accommodations group had significant improvement on the CIQ (p=0.001) and RC (p=0.02) across the 3-yr period.
3. The disability specific accommodations group, compared to the home-like accommodations group, required a significantly higher level of support (CANS) at all time points (p≤0.003). A significant change in the CANS was only seen in the home-like accommodations group post intervention. |
| Feeney et al. (2001)
USA
Case Series
N=80 |
Population: TBI; Mean Time Post Injury=7.33yr.
Intervention: Participants received an intervention program designed to provide living and community support.
Outcome Measures: Cost-Benefit Analysis, community living status. |
1. Three to four years after initiation of community support services, 82% of the first cohort and 89% of second cohort were still living in the community. The majority lived in a supported apartment setting.
2. Average daily costs decreased from $208 to $157 after the initiation of the program for the first cohort. In the second cohort, average daily costs decreased from $215 to $153. In this population of 80 individuals, the program enabled a savings of $1.75 million/yr. |
| Johnson & Davis (1998)
USA
Case Series
N=3 |
Population: TBI; Mean Age=30.3yr; Gender: Male=1, Female=2.
Intervention: Participants were matched with community participants to increase leisure activity weekly for 4wk (i.e. a supported relationships intervention).
Outcome Measure: Social Contact Survey. |
1. All participants increased the frequency of integrated social contact after the intervention and continued to experience integrated social contacts greater than baseline levels during the 8wk of follow-up. |
| Bulinski (2010)
Poland
PCT
NInitial=200, NFinal=200
|
Population: TBI=100, Spouses Of Individuals With TBI=100, Severity: Mild=0, Moderate=0, Severe=100. Group A (PTSD+TBI; n=101): Mean Age: Male= 24.10±11.02yr, Female=22.11±4.52yr; Gender: Male=61, Female=40; Time Post Injury=not reported. Group B (TBI only; n=99): Mean Age: Male= 25.10±12.37yr, Female=23.11±7.43yr; Gender: Male=57 Female=42; Mean Time Post Injury=not reported.
Intervention: Participants took part in the Academy of Life program for 6mo. They received training and information concerning the nature and consequences of brain injury, as well as concerning the types of support and strategies available for handling communication barriers between patients and families. Outcome measures were assessed before and after the completion of the program.
Outcome Measures: Document analysis, clinical interviews with caregivers, Family Bonds Scale, Social Isolation Scale, Social Functions subscale from a battery used to evaluate QOL after TBI. |
1. Prior to the intervention:
· Family bonds were severely weakened
· Participants felt socially isolated, lonely, sad, surrounded by hostility and felt they had no purposeful social activity
· The most common form of support from significant others was pity, unwanted interference, lack of understanding and social ostracism
2. Following the intervention, there was selective improvement on all parameters, particularly in patients without PTSD symptoms:
· Desynchronization of cognitive, emotional and social bonds decreased(p>.05)
· Participants reported more positive support and less negative support (p<.05), as well as decreased loneliness as a result of social ostracism (p<.05)
3. The best effects were achieved in the reduction of social dysfunctions, growth of purposeful social activity, improvement in type of support received, and reduction of selected parameters of social isolation. |
| Sloan et al. (2009a)
Australia
Pre-Post
NInitial=43, NFinal=43 |
Population: ABI=43 (TBI=67%, hypoxic brain injury=21%, cerebrovascular
accident or infection=12%); Age at Injury=28.42yr; Gender: Male=25, Female=18; Mean Time Post Injury=6.73yr; Severity: Mild=0, Moderate=0, Severe=43
Intervention: Participants received a 3yr Community Approach to Participation (CAP) occupational therapy (OT) intervention. The CAP OT is a community-based rehabilitation program aimed at maximizing the level of participation in valued life roles. Outcome measures were assessed at four time points: January 2004 (Baseline), January 2005 (T1), January 2006 (T2), and January 2007 (T3).
Outcome Measures: Care and Needs Scale (CANS); number of hours of paid and gratuitous weekly support; Functional Independence Measure (FIM), Community Integration Questionnaire (CIQ), Role Checklist (RC Part 1) |
1. Participants’ support needs decreased significantly from Baseline to T1 (CANS; p=.005), and from T1 to T2 (CANS; p=.02).
2. There was a significant decrease in total care hours per week from baseline to T2 (p =.003), from Baseline to T3 (p =.003), and from T1 to T2 (p=.006).
3. The mean hours of gratuitous care per week reduced significantly over the intervention period (p=.02)
4. Participants showed a significant improvement in the FIM from Baseline to T1 (p<.001).
5. Participants showed a significant improvement in the CIQ between Baseline and T1 (p<.001) and T1 and T2 (p=.004).
6. Participants showed a significant improvement in the RC Part 1 between Baseline and T1 (p< .001) and between T2 and T3 (p<.02). |
| Sloan et al. (2009b)
Australia
PCT
NInitial=85, NFinal=85 |
Population: ABI=85. Early Group (n=26): Age at Injury= 35.7±18.85yr; Gender: Male=73%, Female=27%; Mean Time Post Injury=343d, Severity: Mild=0, Moderate=0, Severe=26
Late Group (n=59): Age at Injury= 24.71±12.72yr; Gender: Male=56%, Female=44%; Mean Time Post Injury=10.2yr; Severity: Mild=0, Moderate=0, Severe=59
Intervention: Participants received an average of 51.01hr of CAP OT intervention for up to 12mo. The CAP OT is a community-based rehabilitation program aimed at maximizing the level of participation in valued life roles. Outcome measures were assessed prior to the intervention (Baseline) and after a 12-mo period or at discharge (TI).
Outcome Measures: Functional Independence Measure (FIM), Community Integration Questionnaire (CIQ), Role Checklist (RC Part 1) |
1. Both groups showed a significant improvement in the FIM from Baseline to T1 (p<.001).
2. Both groups showed a significant improvement in the CIQ from Baseline to T1 (p<.001).
3. Both groups showed a significant improvement in the RC Part 1 from Baseline to T1 (p<.001).
4. Participation in the roles of volunteer (RC; p<.05), home maintainer (RC; p<.001), hobbyist (RC; p<.01), and participation in organizations (RC; p<.01) increased significantly for both groups from Baseline to T1. |
