Residential and home-based postacute rehabilitation of individuals with traumatic brain injury: A case control study

Objectives: To compare the outcomes of severely brain-injured individuals treated in a postacute residential rehabilitation program with a matched sample of individuals receiving limited services in their homes or on an outpatient basis. Design: Controlled study using a matched design in a before-and-after trial and a 1-year follow-up trial. Setting: A postacute community-based residential rehabilitation program or in the homes of patients. Patients and Other Participants: The treatment group included all persons admitted consecutively for rehabilitation to the postacute residential program over a 3-year period (n = 23). All subjects had severe traumatic brain injury, The comparison group was selected from the roster of a support group on the basis of a systematic matching procedure. Matching variables included gender, age, length of coma, time since injury, and level of disability. Subjects of the two groups were matched on an individual basis. Main Outcome Measures: A functional assessment instrument (modified Health and Activity Limitations Survey [HALS]) and the Community Integration Questionnaire (CIQ). Results: Individuals with traumatic brain injury who received residential-based postacute rehabilitation displayed a statistically significant increase in functional abilities when compared with a traditional (home-based) service group. More specifically, treatment subjects showed significantly greater improvement in motor skills and cognitive abilities, Treatment subjects also showed greater improvement in community integration, although this may have been accounted for by initial,group differences. Conclusions: Postacute rehabilitation appears to be effective in improving function for individuals with severe brain injury. Residential-based services appear to produce greater functional improvement, whereas home-based services are more effective at maintaining community integration. (C) 1999 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.