| Schmidt et al. (2013)
Australia
RCT
PEDro=8
Ninitial=54, Nfinal=32
|
Population: TBI. Group 1 (G1, n=18): Mean Age=42.7yr; Gender: Male=14, Female=4; Mean Time Post Injury=1.5yr; Mean GCS=8.1. Group 2 (G2, n=18): Mean Age=41.6yr; Gender: Male=14, Female=4; Mean Time Post Injury=4.7yr; Mean GCS=7.1. Group 3 (G3, n=18): Mean Age=37.5yr; Gender: Male=18, Female=0; Mean Time Post Injury=5.8yr; Mean GCS=7.0.
Intervention: Participants were randomly allocated to receive self-awareness training with verbal plus video (G1), verbal (G2), or experiential (G3) feedback on functional task performance before task repetition. Outcomes were assessed before and after intervention, and then at 8-10wk follow-up.
Outcome Measures: Online Awareness (OA, error frequency), Awareness Questionnaire (AQ), Self-perceptions in Rehabilitation Questionnaire (SPIRQ), Depression Anxiety Stress Scale (DASS). |
1. All groups showed significant improvement on OA and AQ after treatment, which were maintained at follow-up.
2. G1 showed significantly greater improvement on OA and AQ compared to G2 and G3 after treatment (p<0.001) and at follow-up (p<0.01). There was no significant difference in OA or AQ between G2 and G3.
3. G1 significantly improved on AQ (p<0.01) compared to G2 (MD=4.9) and G3 (MD=7.3). There was no significant difference in AQ between G2 and G3 (MD=2.4).
4. There was no significant difference in SPIRQ or DASS between groups after treatment or at follow-up.
5. All groups maintained a significant improvement in OA through the maintenance of a similar number of errors as initial follow-up.
6. The G1 group continued to improve in OA in comparison to G2 (MD=20.6) and G3 (MD=14.4). There was no significant difference in OA between G2 and G3. |
| Bell et al. (2011)
USA
RCT
PEDro=4
N=433 |
Population: TBI; Mean Age=39yr; Gender: Male=323, Female=110; Mean GCS=9.7
Intervention: Participants were randomly assigned to either scheduled telephone intervention (treatment group; n=210) or usual care (control group; n=223) in the community. The treatment group received telephone calls over 21mo consisting of education, problem-solving, and referrals. Outcomes were assessed at 1 and 2 yr.
Outcome Measures: Functional Independence Measure, Disability Rating Scale, Participation Assessment with Recombined Tools-Objective, Glasgow Outcome Scale-Extended, 12-Item Short Form Health Survey, Brief Symptom Inventory-18, EuroQOL, Perceived Quality of Life. |
1. There were no significant differences between groups on any of the outcome measures at 1 or 2 yr.
|
| Powell et al. (2002)
USA
RCT
PEDro=4
Ninitial=110, Nfinal=94 |
Population: TBI; Gender: Male=71, Female=23. Outreach Group (n=48): Mean Age=34yr; Mean Time Post Injury=4 yr. Information Group (n=46): Mean Age=35yr; Mean Time Post Injury=2.7 yr.
Intervention: Participants were randomly allocated to either an outreach treatment group provided by a multidisciplinary team (2-6 hr/wk, 6-12 wk) or an information treatment group which involved a therapist providing a booklet of resources at a single home visit.
Outcome Measures: Barthel Index (BI), Brain Injury Community Rehabilitation Outcome-39 scale (BICRO-39). |
1. The outreach group had greater change scores on the self-organization (p<0.025) and psychological wellbeing (p<0.05) subscales of the BICRO-39 than the information group.
2. The outreach group showed significantly greater change scores on the BI (p<0.05) and BICRO-39 (p<0.05) in comparison with the information group. |
|
Waehrens & Fisher (2007)
Denmark
Pre-Post
N=36
|
Population: ABI=22, Stroke=14; Age=48.1yr; Gender: Male=24, Female=12; Mean Time Post Injury=6.9 mo.
Intervention: A retrospective pre-post of patients attending an inpatient neuro-rehabilitation program. The program combined Affolter, Bobath, and Coombes approaches.
Outcome Measure: The assessment of motor and process skills (AMPS) tool. |
1. Following rehabilitation individuals showed improvement in their ability to perform motor activities of daily living (ADLs) and Process ADLs (p<0.001 for both) from baseline.
|
| Goranson et al. (2003)
Canada
Cohort
N=42 |
Population: TBI; Gender: Male=21, Female=21; Treatment Group (n=21): TBI; Mean Age=34.71yr; Mean Time Post Injury=12.1 mo. Control Group (n=21): TBI; Mean Age=36.57yr; Mean Time Post Injury=13.48 mo.
Intervention: Participants attended an intensive outpatient rehabilitation program from a multidisciplinary team focusing on cognition, attention, listening, and transitioning (treatment group, 5.5 hr/d, 4 d/wk, 4mo). Matched community dwelling individuals served as the control group.
Outcome Measure: Community Integration Questionnaire (CIQ). |
1. The treatment group showed significant improvement in home integration (p=0.035) and non-significant improvement in social integration (p=0.28) and productivity (p=0.09) scales of the CIQ.
2. Participation in rehabilitation, age at injury, level of education, length of post-traumatic amnesia, and gender (female) were all predictors of a better outcome.
|
| Geurtsen, Van Heugten, Martina, & Geurts (2012)
Netherlands
Pre-Post
NInitial=70, NFinal=67 |
Population: TBI=47, stroke=7, brain tumor=10, encephalitis=4, hypoxia=2; Mean Age: 25.1±7.9yr; Gender: Male=46, Female=24; Mean Time Post Injury=5.2y; Severity: Mean GCS=7.5
Intervention: Participants attended a structured residential treatment program consisting of three modules: the independent living module (100h per person), the social-emotional module (110h per person), and the vocational module (44h per person). Outcome measures were assessed at inclusion (T0), the start of the treatment 3mo later (T1), the end of the treatment (T2) and 1yr follow-up after the end of treatment (T3)
Outcome Measures: Community Integration Questionnaire (CIQ), Employability Rating Scale (ERS), living situation, school, work situation, work hours, Center for Epidemiological Studies Depression Scale (CES-D), EuroQOL quality of life scale (EQ-5D), World Health Organization Quality of Life Scale Abbreviated (WHOQOL-BREF; 5 scales), Global Assessment of Functioning (GAF) scale |
1. Participants’ societal participation improved significantly immediately after treatment (CIQ; p<.001).
2. Living independently rose from 25.4% before treatment to 72.4% after treatment and was still 65.7% at follow up. |
| Geurtsen, Van Heugten, Martina, Rietveld, et al. (2012)
Netherlands
Post-Test
NInitial=67, NFinal=63
*Follow-up study of Geurtsen, Van Heugten, Martina, & Geurts (2012) |
Population: TBI=42, stroke=6, brain tumor=9, encephalitis=4, hypoxia=2, Mean Age= 24.7±7.2yr, Gender: Male=42, Female=21, Mean Time Post Injury=5.1±5.3yr, Severity: Mean GCS=7.8
Intervention: Participants attended a structured residential treatment program consisting of three modules: the independent living module (100h per person), the social-emotional module (110h per person), and the vocational module (44h per person). Outcome measures were assessed 1 and 3yr post treatment.
Outcome Measures: Community Integration Questionnaire (CIQ), Employability Rating Scale (ERS), living situation, school, work situation, work hours, Center for Epidemiological Studies Depression Scale (CES-D), World Health Organization Quality of Life Scale Abbreviated (WHOQOL-BREF; 5 scales) |
1. There were no significant differences for any of the outcome measures between the 1yr and 3yr follow-up assessment (p>.05), indicating that the pos-intervention gains at 1yr were maintained at 3yr follow-up. |
| Malec (2001)
USA
Pre-Post
NInitial=113, NFinal=96 |
Population: ABI=113 Program Graduates (n=96): TBI=72%, CVA=19%, Other (e.g., anoxia)=9%; Mean Age=34.2±12.2yr; Gender: Male=73%, Female=27%; Mean Time Post Injury=4.6±6.6yr; Severity: Mild=7%, Moderate=7%, Severe=82%, Undetermined=4%
Dropouts (n=17): TBI=71%, CVA=6%, Other (e.g., anoxia)=23%; Mean Age=29.4±12.4yr; Gender: Male=71%, Female=29%; Mean Time Post Injury=1.3±1.5yr; Severity: Mild=8%, Severe=92%
Intervention: Participants attended a comprehensive day treatment (CTD) program involving daily group sessions and individual therapy as needed, for an average of 189.5d. The CTD program utilized a transdisciplinary approach, supportive feedback, and a variety of therapeutic modalities (peer, staff, videotape). The program sessions aimed to improve:
· Self-awareness of strengths and weaknesses
· Coping and compensation skills
· Personal organization
· Social skills and effectiveness;
· Emotional and behavioral self-management participation in social, work, and leisure activities
· Health maintenance
Outcome measures were assessed before and after the program, and at 1yr follow-up
Outcome Measures: Independent living status, vocational independence scale, Mayo-Portland Adaptability Inventory (MPAI-22), Goal Attainment Scaling (GAS) |
1. Of the 552 goals set for graduates of the program and scaled using GAS, 81% were met at an expected level of outcome or better.
2. A significant improvement on the overall level of disability was observed at program completion (MPAI-22; p<.001).
3. At 1yr follow-up, 72% of graduates were living independently, 39% were working independently, 10% were in transitional placements, and 18% were in supported or volunteer work. |
| Perumparaichallai et al. (2020)
USA
Pre-Post
NInitial=107, NFinal=107 |
Population: TBI=62, CVA=27, Other (Anoxia, Tumor, & infection)=14; Mean Age=35.81yr; Gender: Male=62, Female=45; Mean Time Post Injury=3.02yr; Severity: Mild=3, Moderate-to-Severe=36, Severe=18, Unknown=3
Intervention: Participants attended holistic milieu-oriented neurorehabilitation between 1996 and 2016. Participants completed one or more of the intervention programs that aimed to facilitate:
· Home and community independence
· Social relationships and quality of life
· Work and/or school re-entry
The intervention programs incorporated individual and group therapies (intervention length=3-5d/wk, 4-6h/d). Primary outcome measures were assessed at program admission, discharge, and follow-up in 2016. Secondary outcome measures were assessed at follow-up in 2016.
Outcome Measures: Primary Outcome measures: Productivity status (e.g., return-to-work/school), driving status.
Secondary Outcome Measures: Mayo-Portland Adaptability Inventory-4 (MPAI-4) and a long-term outcome questionnaire (LOQ) specifically developed for this study. |
1. When categorized based on their MPAI-4 Total score, most participants reported good functioning independence (no limitations=25%, mild limitations=20%, mild to moderate limitations=42%).
2. Psychosocial data from the LOQ revealed positive findings regarding patients’ marital status (Married/engaged/relationship=47.7%), living situation (living independently with or without others=97.2%), and quality of social life (has a friend to confide=75.7%, participation in social activities at least once/wk=57%, no challenges engaging in social activities=69.2%). |
