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Table 3.3 Models of Inpatient Rehabilitation for ABI

Author Year

Country

Research Design

PEDro

Sample Size

Methods

Outcomes

Cullen et al.

(2013)

Canada

Case Control

Ninitial=138, Nfinal=130

Population: TBI; Streamed Group (n=65): Mean Age=44.02yr; Gender: Male=49, Female=16. Control (n=65): Mean Age=44.46yr; Gender: Male=40, Female=25.

Intervention: Retrospective review of patients who received treatment according to either a traditional neurorehabilitation model or a functionally-based streamed model. In the streamed model patients were divided into a neurocognitive (NC) stream for predominantly cognitive/behavioural deficits, or a neurophysical (NP) stream for predominantly physical deficits.

Outcome Measure: Length of stay, Functional Independence Measure (FIM), and Disability Rating Scale.

1.        The NP group had higher FIM motor subscale efficiency than controls (0.41 versus 0.29; p=0.01).

2.        The NC group had less disability (Disability Rating Scale) compared to controls (3.63 versus 5.05, p=0.01).

3.        Groups did not differ significantly on length of stay, FIM discharge scores, total FIM gain, or total FIM efficiency.

 

Semlyen et al.

(1998)

UK

PCT

N=51

Population: TBI; Group 1 (n=33): Mean Age=36yr; Gender: Male=28, Female=5; Mean Time Post Injury=49.37 days; Mean GCS=5.03. Group 2 (n=18): Mean Age=30yr; Gender: Male=15, Female=3; Mean Time Post Injury=17.94 days; Mean GCS=5.39.

Intervention: Two groups were observed. Group 1 received a coordinated multidisciplinary rehabilitation program in a regional rehabilitation center and Group 2 received single-discipline rehabilitation provided in local hospitals. Assessments were completed at 4wk, 8wk, 12wk, 6mo, 12mo and 24mo post-treatment. Caregivers were assessed at 12wk, 6mo and 12mo after patient’s admission.

Outcome Measure: Functional Independence Measure (FIM), Barthel Index (BI), Newcastle Independence Assessment Form (NIAF), and General Health Questionnaire.

1.        Within the first 6mo of treatment, Group 1 made rapid gains on the BI (p<0.001), NIAF (p<0.0001), FIM Motor (p<0.01) and FIM Cognitive (p<0.05). Group 2 made improvements only up to 12wk post injury on the NIAF (p<0.05) and FIM Cognitive (p<0.05), but not on BI or FIM motor.

2.        Group 1 demonstrated functional gains over the 12 to 24mo period, making significant gains on the BI and the NIAF (both p<0.05).

3.        Caregivers of those in the Group 2 reported significantly higher levels of distress for somatic symptoms (p=0.001). Social dysfunction, whilst non-significant, was also much higher for the Group 2 caregivers (p=0.057).