Article Details

Research Database: Article Details

Citation:  Malec, J. F. (2001). Impact of comprehensive day treatment on societal participation for persons with acquired brain injury. Archives of Physical Medicine and Rehabilitation, 82 (7), 885-895.
Title:  Impact of comprehensive day treatment on societal participation for persons with acquired brain injury
Authors:  Malec, J. F.
Year:  2001
Journal/Publication:  Archives of Physical Medicine and Rehabilitation
Publisher:  Elsevier
Full text:   
Peer-reviewed?  Yes
NIDILRR-funded?  Yes
Research design:  Mixed methods

Structured abstract:

Background:  Comprehensive Day Treatment programs appear to enhance a persons' activity and societal participation post brain injury. More research is needed to evaluate the impact of CDT for individuals with brain injury and advance the way for randomized control trials of treatment components.
Purpose:  There were 2 hypotheses. The first was that vocational outcomes will meet or exceed those cited in prior research. Specifically, 75% of participants in community- based independent or supported community-based employment or education/training programs; and (b) 50% of individuals in independent community-based employment. The other hypothesis was vocational outcomes will be related to (1) severity of injury, (2) severity of impairment/disability, (3) ISA, (4) time since injury, (5) presence of additional injuries not related to the brain injury, and (6) preinjury educational/vocational status.
Setting:  The setting was a Rehabilitation Center.
Study sample:  One hundred and thirteen individuals with brain injury, who were consecutively admitted to the CDT program from 1988 to 1998. This included 96 individuals who completed the program and 17 who did not. Traumatic brain injury accounted for the majority or 72% of the participants who completed the program and 71% of the drop outs. The severity of the TBI sample was 82% and 92% respectively. The mean time since injury (TBI, CVA or other) among those who completed the program was 4.6 years. The subjects had myriad of problems in the following areas post injury: self awareness, cognitive, communication, social skills and emotional/behavioral. They were also either unemployed or facing failure at work. Participants had mobility, functional communication skills and exhibited some capacity for applying new knowledge. The average length of stay among participants in the CDT program was 189.5.
Intervention:  Participants attended a CDT that followed guidelines developed by prior research for post acute brain injury rehabilitation programs, along with the following changes: combination of physical therapy and recreation therapy into a Life Skills Group, family education and use of a vocational counselor to provide employer education and support.
Control or comparison condition:  There was no control or comparison condition.
Data collection and analysis:  Evaluation and outcome data were analyzed for each participant. For those who completed the program, work outcomes was measured using the Vocational Independence Scale at program end and 1-year follow-up and Rasch-analyzed Mayo-Portland Adaptability Inventory (MPAI-22) and goal attainment scaling (GAS) at program end. Data was collected from the Independent Living Scale, VIS, GAS and MPAI-22 when participants entered and exited the program to measure this factor. Logistic regression analysis was conducted for the ILS and VIS were for those who completed the program one year post completion with potential outcome predictors that included: age, education, severity of injury, type of injury, time post injury, degree of impairment prior to program participation.
Findings:  Significant goal achievement on GAS and improvement on MPAI-22; increased societal participation at 1-year follow-up for those treated postacutely and many years after injury: 72% of graduates living independently; 39% working independently, 10% in transitional placements, and 18% in supported or volunteer work. Long-term outcomes were modestly related linearly to preadmission MPAI-22 and nonlinearly to time since injury.
Conclusions:  Community Day Treatment program improves participation in society for individuals with brain injury. Next steps needed are randomized control trials of active treatment components. Relationships of predictors to outcomes are not sufficiently strong for patient selection. More effective interventions for vocational reintegration are needed for individuals with severe brain injury.

Disabilities served:  Cerebral vascular accident (stroke)
Traumatic brain injury (TBI)
Populations served:  Gender: Female and Male
Race: White / Caucasian
Interventions:  Vocational rehabilitation
Outcomes:  Employment acquisition
Return to work
Increase in tenure