Community integration and satisfaction with functioning after intensive cognitive rehabilitation for traumatic brain injury

doi:10.1016/j.apmr.2003.07.019

Archives of Physical Medicine and Rehabilitation

Volume 85, Issue 6, June 2004, Pages 943-950

https://doi.org/10.1016/j.apmr.2003.07.019 Get rights and content

Abstract

Cicerone KD, Mott T, Azulay J, Friel JC. Community integration and satisfaction with functioning after intensive cognitive rehabilitation for traumatic brain injury. Arch Phys Med Rehabil 2004;85:943–50.

Objective

To evaluate the effectiveness of an intensive cognitive rehabilitation program (ICRP) compared with standard neurorehabilitation (SRP) for persons with traumatic brain injury (TBI).

Design

Nonrandomized controlled intervention trial.

Setting

Community-based, postacute outpatient brain injury rehabilitation program.

Participants

Fifty-six persons with TBI.

Interventions

Participants in ICRP (n=27) received an intensive, highly structured program of integrated cognitive and psychosocial interventions based on principles of holistic neuropsychologic rehabilitation. Participants in SRP (n=29) received comprehensive neurorehabilitation consisting primarily of physical therapy, occupational therapy, speech therapy, and neuropsychologic treatment. Duration of treatment was approximately 4 months for both interventions.

Main outcome measures

Community Integration Questionnaire (CIQ); and Quality of Community Integration Questionnaire assessing satisfaction with community functioning and satisfaction with cognitive functioning. Neuropsychologic functioning was evaluated for the ICRP participants.

Results

Both groups showed significant improvement on the CIQ, with the ICRP group exhibiting a significant treatment effect compared with the SRP group. Analysis of clinically significant improvement indicated that ICRP participants were over twice as likely to show clinical benefit on the CIQ (odds ratio=2.41; 95% confidence interval, 0.8–7.2). ICRP participants showed significant improvement in overall neuropsychologic functioning; participants with clinically significant improvement on the CIQ also showed greater improvement of neuropsychologic functioning. Satisfaction with community functioning was not related to community integration after treatment. Satisfaction with cognitive functioning made a significant contribution to posttreatment community integration; this finding may reflect the mediating effects of perceived self-efficacy on functional outcome.

Conclusions

Intensive, holistic, cognitive rehabilitation is an effective form of rehabilitation, particularly for persons with TBI who have previously been unable to resume community functioning. Perceived self-efficacy may have significant impact on functional outcomes after TBI rehabilitation. Measures of social participation and subjective well-being appear to represent distinct and separable rehabilitation outcomes after TBI.

Section snippets

Participants

We examined treatment effectiveness for people with TBI who participated in a comprehensive, postacute, outpatient, brain injury rehabilitation program. Criteria for participation in this program include being medically stable at the time of admission; independent in basic self-care skills, such as feeding and toileting; and having the cognitive ability to participate in treatment. Additional inclusion criteria for participants in the current study included medical documentation of TBI, age of

Effectiveness of intervention

We found a significant main effect for time on total CIQ scores (F_1,54=40.49, P<.001) with both ICRP and SRP groups improving from before to after treatment (table 2). There was also a significant program by time interaction effect (F_1,54=5.66, P=.021), suggesting that the participants in the ICRP showed greater improvement from before to after treatment (table 3). The ICRP group exhibited over twice the magnitude of treatment effect on total CIQ than the participants receiving SRP did (ES,

Discussion

Results of this prospective, observational study support the effectiveness of an intensive, holistic, postacute program of cognitive rehabilitation compared with an alternative program of neurorehabilitation for persons with TBI. Although both groups improved with treatment, the participants receiving ICRP showed significantly greater improvements in community integration than participants receiving standard rehabilitation. Over half the ICRP participants showed clinically significant

Conclusions

The results of our controlled, observational study indicate significant clinical benefit of ICRP for persons with TBI. Although both groups improved, the participants receiving ICRP were over twice as likely to show clinically significant improvement in community integration as those receiving SRP, despite being longer after injury and having slightly worse community functioning before treatment. Participants’ QOL, assessed by their satisfaction with community functioning, was not related to

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The articles included in this systematic review essentially studied the effect of different interventions aimed at the rehabilitation of SC in patients with chronic TBIs. The analysis showed adequate methodological quality and an acceptable level of evidence. Future research should analyse the effect of these interventions in patients with TBIs in the sub- and post-acute phases.
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^☆: Supported by the National Institute on Disability and Rehabilitation Research (grant no. H133A020518).

¹: No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the author(s) or on any organization with which the author(s) is/are associated.

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ArticleCommunity integration and satisfaction with functioning after intensive cognitive rehabilitation for traumatic brain injury1☆,

Abstract

Objective

Design

Setting

Participants

Interventions

Main outcome measures

Results

Conclusions

Section snippets

Participants

Effectiveness of intervention

Discussion

Conclusions

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Arch Phys Med Rehabil

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Arch Clin Neuropsychol

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Article
Community integration and satisfaction with functioning after intensive cognitive rehabilitation for traumatic brain injury¹☆,