Glintborg et al.

(2016)

Denmark

PCT

N=82

Population: ABI; KORE group (n=27): Mean Age=53.6yr; Gender: Male=16, Female=11; Diagnosis: Apoplexia=21, TBI=6. ALT group (n=18): Mean Age=52yr; Gender: Male=14, Female=4; Diagnosis: Apoplexia=16, TBI=2. SR group (n=37): Mean Age=53.4yr; Gender: Male=17, Female=20; Diagnosis: Apoplexia=25, Stroke=12.

Intervention:  Participants who received the coordinated rehabilitation program (KORE) were compared with participants receiving standard treatment (SR group) and alternative treatment (ALT group).

Outcome Measure: Functional Independence Measure (FIM), Major Depression Inventory (MDI), WHO-Quality of Life-BREF (WHOQOL-BREF), Impact on Autonomy and Independence Questionnaire (IPAQQ-DK).

1.        FIM improved significantly in all groups from hospitalization after ABI to discharge (KORE: p<0.001, r=0.56; ALT: p<0.001, r=0.62; SR: p<0.001, r=0.58). At 1yr post discharge, only the ALT group had a significant increase in total FIM score (p<0.001, r=0.48). There were significant differences between groups in total FIM score at discharge (p<0.001). Post hoc analysis showed the ALT groups FIM score was significantly lower than the KORE group (p<0.01, r=0.36).

2.        Signs of clinical depression at discharge were observed in 30% of clients in the KORE group and 22% of those in the ALT group. MDI scores increased non-significantly from discharge to 1-2yr post discharge. Depression rates did not differ significantly between groups at any time point.

3.        No significant change in any of the QOL scores from discharge to 1-2yr post discharge was recorded. In the KORE and ALT groups, 74% and 77% of clients respectively, reported being dissatisfied with their physical QOL.

4.        Indoor autonomy significantly improved from discharge to 1-2yr post discharge in both the KORE group (p<0.001, r=0.43) and the ALT group (p<0.001, r=0.49). The ALT group also reported significantly negative changes in family roles (p<0.05, r=0.38) and a reduction in outdoor problems (p<0.001, r=0.50).

Andelic et al. (2014)

Norway

Case Control

N=59

Population: TBI; Continuous Group (n=30): Gender: Male=23, Female=7. Broken-Chain Group (n=29): Gender: Male=22, Female=7.

Intervention: Two rehabilitation trajectories were explored: continuous and broken-chain. Clinical data on patients who had been admitted to rehabilitation between 2005 and 2007, and had received 6wk, 1yr and 5yr follow-ups post-injury was analyzed.

Outcome Measure: Disability Rating Scale (DRS) and costs of treatment.

1.        Patients in the continuous chain group experienced an additional 4.06 points gain in DRS compared to the Broken-chain group (19.40 versus 23.46).

2.        The cost for the continuous group from acute care through to rehabilitation was 37,000 NOK (approx. $6,075.5 USD) less than the broken chain group.

Harradine et al. (2004)

Australia

Cohort

N=198

Population: TBI; Urban (n=147): Mean Age=32.1yr; Gender: Male=117, Female=30. Rural (n=51): Mean Age=32.1yr; Gender: Male=38, Female=13.

Intervention: Questionnaires were administered to patients at rehabilitation admission then again at 18mo follow-up. Patients were compared based on where they lived (urban or rural).

Outcome Measure: Disability Rating Scale (DRS), Mayo–Portland Adaptability Inventory (MPAI), General Health Questionnaire 28-item version (GHQ-28), and Medical Outcomes Short Form Health Survey (SF-36).

1.        There were no significant differences between the two groups for scores on the DRS, MPAI, GHQ-28, and SF-36 questionnaires at 18mo follow-up.

2.        There were no significant differences between the two groups in return to work rate or functional outcomes at follow-up.

3.        In both groups, fewer patients were living alone compared to pre-injury; more were living with parents post injury but this did not reach statistical significance.

McLaughlin & Peters (1993)

USA

Cohort

N=31

Population: ABI; Step-Up Group (n=19): Mean Age=26.6yr; Gender: Male=18, Female=13; Mean Time Post injury=16.68 mo. Inpatient Group (n=12): Mean Age-26.6yr, Gender: Male=18, Female=13; Mean Time Post Injury=18.3 mo.

Intervention: Patients in the Step-Up Group participated in a transitional living setting inpatient rehabilitation program and were compared with patients receiving inpatient rehabilitation alone. Data collected over 18mo through a post discharge survey.

Outcome Measure: Rancho Los Amigos Levels of Cognitive Functioning Scale (RLAS), Barthel Index (BI), and surveys on independent living and performance post-discharge.

1.        Patients in the Step-Up Group reported greater functional independence on the BI than patients who received inpatient rehabilitation alone.

2.        Although patients in the Step-Up group reported better independent skills, they did not differ with the inpatient group on employment rates, participation in volunteer work or in RLAS scores.