Impact of comprehensive day treatment on societal participation for persons with acquired brain injury

Objectives: To evaluate comprehensive day treatment (CDT) for survivors of brain injury by time since injury and to identify outcome predictors. Design: Before and after. Setting: Rehabilitation center. Participants: Ninety-six program graduates; 17 dropouts with acquired brain injury. Interventions: Comprehensive Day Treatment Program: daily group sessions to build cognitive and behavioral skills through a transdisciplinary approach, supportive feedback, and a variety of therapeutic modalities. Obtained outcome measures before and after the program, and at 1-year follow-up. Main Outcome Measures: Outcome: Independent living status, 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. Predictors: age, education, severity of initial injury, time since injury, and preadmission MPAI-22. Results: 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: CDT improves societal participation even among persons with a long history of limited participation after brain injury. This de facto extended baseline analysis indicates the effectiveness of CDT and paves the way for 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 those most severely disabled after brain injury.