Community rehabilitation beneficial after severe traumatic brain injury

NEW YORK (Reuters Health) – Years after severe traumatic brain injury, multidisciplinary community-based rehabilitation can produce durable benefits, according to a report in the February issue of the Journal of Neurology, Neurosurgery, and Psychiatry.

Dr. J. Powell, of Goldsmiths College, London, and colleagues conducted what they believe is the first randomized controlled trial to assess the value of outreach rehabilitation in a community setting after severe traumatic brain injury (TBI). They a multidisciplinary intervention, which included a mean of two sessions a week for 27.3 weeks in homes, workplaces or day centers, with provision of written information outlining alternative resources.

Participants had sustained TBI between 3 months and 20 years before the trial and were free of other neurological conditions. Forty-eight outreach patients and 46 information patients were followed for a mean of 24.8 months.

Primary outcomes focused on levels of activity and participation, measured by the Barthel index (BI) and the brain injury community rehabilitation outcome-39 (BICRO-39). Secondary outcome measures included the functional independence measure and functional assessment measure (FIM+FAM) and hospital anxiety and depression scales.

Compared with information patients, those in the outreach arm showed significant gains on the BI and BICRO-39 total scores, and the self-organization and psychological well-being subscales. They also had greater gains on the BICRO personal care and mobility scales and on the FIM+FAM personal care and cognitive functions.

"Differential improvements were not seen for indices of socializing, productive employment, anxiety, or depression," the team notes. "Median changes on individual subscales were small, reflecting the diversity of the clinical population; however, 40% of outreach but only 20% of information participants made a clinically significant improvement of 2+ points on at least one BICRO-39 scale."

Dr. Powell and colleagues report that the magnitude of gains was not associated with time since injury.

J Neurol Neurosurg Psychiatry 2002;72:193-202.

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