Ownsworth et al. (2008)

Australia

RCT

PEDro=8

N=35

Population: TBI=21, Stroke=12, Tumor=2; Mean Age=43.89yr; Gender: Male=19, Female=16; Mean Time Post Injury=5.29 yr.

Intervention: Patients were randomly allocated to one of six intervention groups: group-based support, individual occupation-based support or a combination of the two (each of these three interventions had its own waitlist which served as a control group). Relatives and patients completed questionnaires at baseline, post intervention and at 3mo follow-up.

Outcome Measure: Canadian Occupational Performance Measure (COPM), Brain Injury Community Rehabilitation Outcome-39 (BICRO-39), and Patient Competency Rating Scale (PCRS).

1.        COPM performance self-ratings improved significantly from pre- to post-assessment following the individual and combined interventions (both p<0.01), but not the group intervention (p=0.029). A similar pattern was seen for relatives’ ratings (p<0.01, p<0.025, p=0.028).

2.        COPM performance self-ratings improved significantly from pre-assessment to 3mo follow-up in the individual (p<0.025), group and combined (both p<0.01) intervention groups. A similar pattern was seen for COPM relatives’ ratings (p<0.01, p<0.01, p<0.025).

3.        Psychological improvements measured by the BICRO-39 were demonstrated from pre- to post-assessment by the patients in the group-based support intervention (p<0.01) and between pre-assessment and follow-up (p=0.025). The individual-based support intervention also demonstrated improvement between pre-assessment and follow-up (p<0.025).

4.        Relatives of the patients in the individual-based intervention reported significant improvements on the PCRS from pre- to post-assessment (p<0.025). Significant improvement was also reported by relatives of group-based patients at 3mo follow-up (p<0.025).

Malec & Degiorgio (2002)

USA

Secondary Analysis of PCT

N=114

Population: TBI=73, Other=41; Mean Age=37.4yr; Gender: Male=70, Female=44; Mean Time Post Injury=65.5mo; Severity: Severe=64, Moderate=8, Mild=24, Undetermined=18.

Intervention: Patients in three rehabilitation pathways were observed: Specialized Vocational Services (SVS) only (n=49), SVS and a 3 hr/wk Community Reintegration Outpatient Group (CROG; n=21), and SVS and a 6 hr/day comprehensive day treatment (CDT; n=44). Assessments were completed by patients and staff at  yr follow-up.

Outcome Measure: Mayo-Portland Adaptability Inventory (MPAI), Vocational Independence Scale, and community-based employment status (CBE).

1.        No significant differences in CBE rates between all three groups: SVS=77%, CROG=85%, CDT=84% (p>0.1).

2.        There were no significant differences between patient MPAI scores across all three groups, except for driving (p<0.001) with 71% of the SVS group and 60% of the CROG group receiving no driving concerns from others compared to only 26% for the CDT group.

3.        There were significant differences in staff MPAI scores with the SVS group experiencing fewer memory (p<0.01) and problem-solving (p<0.001) impairments, and greater attention and concentration abilities (both p<0.001) compared to the other groups.

4.        Patients in the CROG group were more likely to live independently than those in the SVS or CDT groups (p<0.001).