Poncet et al. (2018)

France

Pre-post

N= 7

Population:  ABI Group (N= 7): Mean Age=38yr (10.1); Gender: Male=43%, Female=57%; Mean time post injury= n/a, at least 2 months discharged to home; GCS= n/a.

Intervention: Participants underwent a multidisciplinary ABI outpatient rehabilitation program 5 days a week for 7 weeks. Assessed at pre, post, 3 months, and 6 months after program

Outcomes: The Cooking Task, Instrumental Activities of Daily Living Profile (IADL Profile), Assessment of Life Habits (LIFE H), Berg Balance Scale (BBS), Six-minute Walk Test (6MWT), 10m Walk Test (10MWT), Box and Blocks Test (BBT), Montgomery Asberg Depression Rating Scale (MADRS), Hamilton Depression Rating Scale (HDRS), The Evaluation Test of Attention (ETA), Auditory Verbal Learning Test.

1.        Non-overlap of all pairs (NAP) scores and two standard deviation method (SDB) was used to determine significance.

2.        Strong improvement was seen on the Cooking Task for 6/7 participants from pre to post, with four showing improvement at 3 and 6 months.

3.        Strong improvement was seen on the IADL Profile for 6/7 participants, with four improving from post to 6 months.

4.        Strong improvement was seen on the LIFE H for 4/7 participants from pre to post.

5.        No improvements seen on other measures.

Peirone et al. (2014)

Italy

RCT

PEDro=8

N=16

Population: ABI; Intervention Group (n=8): Mean Age=39.62yr; Gender: Male=4, Female=4; Mean Time Post Injury-14 mo. Control Group (n=8): Mean Age=40.5yr; Gender: Male=5, Female=3; Mean Time Post Injury=14.5 mo.

Intervention: All patients received 50 min of physiotherapy 3x/wk for 7 wk. The intervention group also received additional dual-task exercises 6x/wk including balance and body stability whilst performing a motor task (throw/catch a ball) or a cognitive test.

Outcome Measure: Balance Evaluation System Test (BEST), Activities-specific Balance Confidence Scale (ABC), and Goal Attainment Scaling (GAS).

1.        Both the Intervention group and the control group improved significantly on the BEST (p=0.014 and p=0.02 respectively) but when comparing the two, the Intervention group displayed significantly greater improvements (p=0.008).

2.        On the ABC, the intervention group made significant improvements from baseline (p=0.01). There was no significant difference between the groups at the end of the study.

3.        Both intervention and control groups experienced significant improvements on the GAS (p=0.02 and p=0.01 respectively) but no significant difference was found between the two groups.

Eicher et al. (2012)

USA

Cohort

N=604

Population: ABI; Group 1 (n=235): Mean Age=41.65yr; Gender: Male=136, Female=99. Group 2 (n=78): Mean Age=38.95yr; Gender: Male=62, Female=16. Group 3 (n=246): Mean Age=35.42yr; Gender: Male=185, Female=61. Long-term Group 4 (n=45): Mean Age=35.78yr; Gender: Male=33, Female=12.

Intervention: Four rehabilitation programs were assessed: Group 1 received Intensive Outpatient & Community-based Rehabilitation, Group 2 received Intensive Residential Rehabilitation, Group 3 received Long-term Residential Supported Living, and Group 4 received Long-term Community-based Supported Living. Mean follow-up time was 5-6mo for Groups 1, 2 and 4, and 8mo for Group 3.

Outcome Measure: Mayo-Portland Adaptability Inventory (MPAI-4).

1.        Programs with an intense rehabilitation program (Groups 1 and 2) demonstrated significant improvements on the MPAI-4 compared to Groups 3 and 4 (p=0.002).

2.        At baseline assessment, patients in Groups 1 and 2 scored significantly lower than patients in Groups 3 and 4 in adjustment (p<0.001) and ability (p<0.05).

3.        At the second assessment, patients in Groups 1 and 2 scored significantly better on ability (p<0.006) and participation (p<0.001) than patients in Groups 3 and 4.

4.        There was no statistical difference on adjustment at second assessment.

Braunling-McMorrow et al. (2010)

USA

PCT

N=205

Population: TBI; Neurorehabilitation Group (NR; n=129): Mean Age=36.6 yr; Gender: Male=89, Female=40; Mean Time Post Injury=15 mo. Neurobehavioural Group (NB; n=76): Mean Age=32yr; Gender: Male=63, Female=13; Mean Time Post Injury=56 mo.

Intervention: Individuals were divided into 2 groups: those receiving NR services and those requiring specialized NB services due to behavioural or psychiatric issues. Both groups participated in behavioural and cognitive therapy programs. Assessments were completed at pre-admission, admission, discharge, and 3mo, 6mo and 12mo post-discharge.

Outcome Measure: Functional Area Outcome Menu.

1.        Individuals in both groups showed significant functional gains from admission to discharge (p<0.001).

2.        Functional gains were also made from admission to 1yr follow up (p<0.001).

3.        The NR group made greater overall gains than those in the NB group (p<0.001).

4.        Gains made by both groups were noted at the 1yr follow up; whereas NB group continued to make significant gains from discharge to follow-up (2.93 to 3.23; p<0.05), the NR group maintained their gains (3.68 to 3.60; p>0.05).

5.        Results also found that NR patients admitted within 6mo of injury made the greatest improvement (p<0.001). There was no significant effect of time post injury for the NB group.

Hassett et al. (2009)

Australia

RCT

PEDro=8

N=62

Population: TBI; Fitness Group (n=32): Mean Age=35.4yr; Gender: Male=27, Female=5; Severity: Very Severe=9, Extremely Severe=23. Home Group (n=30): Mean Age=33yr; Gender: Male=26, Female=4; Severity: Very Severe=11, Extremely Severe=19.

Intervention: Patients were randomly assigned to receive either a supervised fitness center-based therapy program or an unsupervised home-based program. Assessments were completed at baseline, at completion of the intervention and at 3mo follow-up.

Outcome Measure: Goals, 20 m Shuttle Test, Body Mass Index, Waist-to-Hip-ratio, and Sydney Psychosocial Reintegration Scale (SPRS).

1.        Patients in both groups improved in cardio-respiratory fitness but there were no significant differences between groups.

2.        At the end of the intervention, the fitness group reported significantly greater total scores on SPRS (p=0.033) but the difference was not significant at follow-up.

3.        The fitness group also reported significantly more goals achieved at the end of the intervention (p=0.005) but this also became non-significant at follow-up.

Ponsford et al. (2006)

Australia

Cohort

N=154

Population: TBI; Community Group (n=77): Mean Age=35.43yr; Gender: Male=56, Female=21; Mean GCS=8.22. Outpatient Group (n=77): Mean Age=33.78yr; Gender: Male=56, Female=21; Mean GCS=7.76.

Intervention: Patients treated in a community based rehabilitation program were matched with patients who attended the hospital for outpatient rehabilitation. Assessments were completed every 3mo during treatment then at 1 and 2yr follow-ups.

Outcome Measure: Craig Handicap Assessment and Reporting Technique, and Structured Outcome Questionnaire.

1.        Patients treated in the community were significantly more dependent on support from close others (p=0.008), less independent in mobility (p=0.005), had greater difficulty with motor speech (p=0.005) and following conversations (p=0.001), and displayed more inappropriate social behaviours (p=0.009) than the outpatient group.

2.        Patients treated in the community demonstrated increased physical independence (p=0.004) compared to patients in the outpatient group.

Powell et al. (2002)

UK

RCT

PEDro=8

N=94

Population: TBI; Outreach Group (n=48): Mean Age=34yr; Gender: Male=37, Female=11; Mean Time Post Injury=4yr. Information Group (n=46): Mean Age=35yr; Gender: Male=34, Female=12; Mean Time Post Injury=2.7 yr.

Intervention: Patients were randomly allocated to one of two groups. The Outreach group received multi-disciplinary therapy for 2 hr/wk for a mean of 27.3wk in a community setting and the information (control) group received a specially collated booklet with resources. Patients were assessed at 18mo and 40 mo.

Outcome Measure: Barthel Index (BI), Functional Independence Measure + Functional Assessment Measure (FIM+FAM), and Brain Injury Community Rehabilitation Outcome-39 (BICRO-39).

1.        Of the 92 subjects who completed the study, 35% of the Outreach group improved their scores on the BI compared to 20% of the Information group (p<0.05).

2.        Improvements for FIM+FAM scores approached statistical significance when measuring level of personal care (p<0.06) and cognition (p<0.09) for the Outreach group compared to the information group. All other FIM+FAM subscales were non-significant.

3.        The Outreach group demonstrated significantly greater improvement on the BICRO-39 than the Information group (p<0.05).

Willer et al. (1999)

USA/Canada

Case Control

N=46

Population: TBI; Treatment Group (n=23): Mean Age=33.42yr; Gender: Male= 20, Female=3; Mean Time Post Injury=3.05yr. Control Group (n=23): Mean Age=34.76yr; Gender: Male=20, Female=3; Mean Time Post-Injury=4.66yr.

Intervention: Patients admitted to a community-based residential rehabilitation treatment center were compared to a matched control group receiving rehabilitation at home or in a nursing facility. Assessments were completed at admission, discharge and at 1yr follow-up by staff or relatives.

Outcome Measure: Health Activity Limitation Survey and Community Integration Questionnaire (CIQ).

1.        Patients in the treatment facility showed significant improvement in motor and cognitive functioning at 1yr follow-up compared to the controls (p<0.05).

2.        The two groups did not differ significantly on the CIQ at discharge or at follow-up, but the treatment group demonstrated significantly greater improvement from admission to discharge than the control group (p<0.001).