Outcome in Community Rehabilitation: Measuring the Social Impact of Disability

An organizational perspective on goal setting in community-based brain injury rehabilitation

PURPOSE

To use a taxonomy of goal content, developed in community-based brain injury rehabilitation to examine and compare the content of goals set within two different service settings; and to further examine the potential of the taxonomy to be a reliable and comprehensive framework for classifying goals.

METHOD

Qualitative analysis and categorization of 1492 goal statements extracted from a community-based brain injury rehabilitation service over two time periods (1996--97, 1998--99), and cross-organizational comparison of ratings of goal classifications using a random sample of 100 goal statements drawn from this data set and the original 1765 goal statements used in developing the taxonomy.

RESULTS

Application of the taxonomy beyond the original service setting in which it was developed indicated a strong inter-rater reliability, with a high test-retest agreement reported over time. For both services, a small number of categories accounted for a substantial proportion of goals set within the two time periods, while considerable change was evident in goals between the two periods for one service. Further, both placed emphasis on individually focused goals rather than relationship or family-related goals.

CONCLUSION

The taxonomy provides a reliable means for classifying goals and is a useful tool for exploration of the multiple influences on goal setting. Further application of the taxonomy to examine the relative influence on goal setting of client factors versus a range of organizational factors would be beneficial.

Cost-benefits associated with social outcome from neurobehavioural rehabilitation

PRIMARY OBJECTIVE

To carry out a clinical and cost-outcome evaluation of a neurobehavioural post-acute rehabilitation programme in the UK.

RESEARCH DESIGN

The study was a multi-centre prospective cohort study of adults with acquired brain injury admitted for residential rehabilitation. Comprehensive data were collected on type of residence, amount and type of care, functional independence, engagement in constructive occupation and participation in social roles.

PROCEDURES

Data were gathered on admission relating to individuals' levels of care and functioning, both pre-morbidly and at the time of admission (pre-rehabilitation). Additional information about functioning was collected upon discharge (post-rehabilitation). Follow-up data was collated in person, by telephone or by post after an average of 18 months by a researcher who was blind to the rehabilitation outcomes. The data were analysed in terms of clinical outcomes and support costs. Savings in costs of care or support were calculated on the basis of difference between pre-rehabilitation and follow-up support costs minus the costs of rehabilitation.

RESULTS

Significant gains were evident at discharge and follow-up in virtually all indices of social outcome. Improvements were recorded in type of accommodation, levels of care, functional ability, productive occupation and performance of social roles. Patients admitted within 1 year of injury made the most progress, but improvements were made regardless of time since injury. Patients continued to benefit from rehabilitation well beyond the period when most natural recovery would take place. Economic calculations suggested that the initial costs of rehabilitation are generally offset by savings in care costs within 2 years. Sensitivity analysis on estimated savings in care costs yielded projected lifetime savings of between Pounds 1.1-0.8 M for persons admitted for rehabilitation within 12 months of injury, Pounds 0.7- Pounds 0.5 M within 2 years of injury and Pounds 0.5-0.36 M for admissions after 2 years.

CONCLUSIONS

Specialist rehabilitation for neurobehavioural disability produces comprehensive and sustainable improvements in the life of individuals with brain injury. The initial costs associated with neurobehavioural rehabilitation are offset by savings in costs of support in the medium and longer term.

Outcome of Memory Rehabilitation in Traumatic Brain Injury Assessed by Neuropsychological Tests and Questionnaires

OBJECTIVES

To evaluate the effectiveness of a memory rehabilitation program. To compare different outcome measures.

PARTICIPANTS

Twelve patients with severe traumatic brain injury.

SETTING

Outpatient rehabilitation service.

MAIN OUTCOME MEASURES

Rey-Osterrieth Complex Figure Test (REY), California Verbal Learning Test (CVLT), Rivermead Behavioural Memory Test (RBMT), and the Memory Failures in Everyday Memory Questionnaire (MFE).

STATISTICAL ANALYSIS

Exact nonparametric procedures.

RESULTS

All patients achieved meaningful functional gains. Modest improvements were found in some of the scales of the CVLT but not in the REY, RBMT, or MFE.

CONCLUSION

Functional gains did not correlate with improvement in memory processes. Measurement of changes in independence in activities of daily living mediated by compensatory aids and educational intervention plans with relatives are proposed.