Comparison of TBI and CVA outcomes: Durability of gains following post-hospital neurological rehabilitation

• Published in: NeuroRehabilitation (Reading, Mass.) Vol. 52; no. 3; pp. 425 - 433
• Main Authors: Lewis, Frank D., Horn, Gordon J.
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.01.2023; Sage Publications Ltd
• Subjects: Adaptability; Adolescent; Adult; Aftercare; Aged; Brain Injuries; Brain Injuries, Traumatic - rehabilitation; Brain injury; Female; Hospitals; Humans; Length of stay; Male; Middle Aged; Neurological Rehabilitation; Neurology; Patient Discharge; Rehabilitation; Statistical analysis; Traumatic brain injury; Treatment Outcome; long-term outcome; MPAI-4; TBI; post-hospital rehabilitation; CVA
• ISSN: 1053-8135; 1878-6448; 1878-6448
• DOI: 10.3233/NRE-220261

BACKGROUND: With the effectiveness of post-hospital brain injury rehabilitation clearly demonstrated, research focus has shifted to durability of treatment gains over time. OBJECTIVE: Study objectives were threefold: (1) examined the stability of outcomes following post-hospital rehabilitation for persons with acquired brain injury, (2) compare differences in short and long-term outcome for TBI and CVA groups, and (3) identify predictors of long-term outcomes. METHODS: Subjects (n = 108) were selected from 2,177 neurologically impaired adults with consecutive discharges from 18 post-hospital programs in 12 states from 2011 through 2019. The study sample included TBI, CVA, and Mixed neurological groups. All persons were evaluated using the Mayo Portland Adaptability Inventory –4 Participation Index at four assessment intervals: admission, discharge, and 3 and 12 month follow-up. Additional analyses included repeated measures 2x4 design addressing TBI and CVA by the four measurement periods, and hierarchical multiple regression to identify outcome predictors. RESULTS: The total sample demonstrated a reduction in Participation T-scores (indicating less disability) from admission to discharge. Reductions in disability were maintained at the 3 and 12 month follow-up assessments (Greenhouse-Geisser F (2.37) = 76.87, p < 0.001, partial eta2 = 0.418, power to detect = 0.99). The CVA group demonstrated greater disability at each assessment interval, however, those differences were not statistically significant. Significant predictors of outcome at 12 months post-discharge were length of stay in program and type of injury. TBIs with longer length of stay experienced better outcome at 12 months than non-TBIs with shorter length of stays (hierarchical multiple regression adjusted R2 = 0.085, p < 0.05). CONCLUSION: Post-hospital residential neurorehabilitation programs provide a return on investment. Gains are realized from admission to discharge, and maintained one year following discharge from rehabilitation.