Early versus later admission to postacute rehabilitation: impact on functional outcome after traumatic brain injury

OBJECTIVE: To examine the impact of participation in a postacute community reentry program on functional outcome after traumatic brain injury (TBI). DESIGN: Cohort, nonrandomized, intervention study. Pretest-posttest, follow-up design. SETTING: Nonprofit outpatient community reentry program affiliated with an inpatient rehabilitation hospital. PARTICIPANTS: Three groups of persons with moderate to severe TBI differing in length of time between injury and admission. The first group entered postacute rehabilitation within 6 months of injury (n=115); the second group, between 6 and 12 months (n=23); and the third group, greater than 12 months (n=29). INTERVENTIONS: Persons with TBI participated in a postacute community reentry program (average, 4.3mo) that emphasized (1) teaching compensatory strategies to address residual cognitive deficits; (2) arranging environmental supports to maximize functioning; (3) counseling and education to address personal and family adjustment and to improve accurate self-awareness; and (4) transition from simulated activities in the clinic to productive activities in the community. MAIN OUTCOME MEASURES: Disability Rating Scale, Supervision Rating Scale, and the Community Integration Questionnaire. RESULTS: All groups showed improvements between admission and discharge on measures of overall disability, independence, home competency, and productivity, and these gains were maintained at follow-up. For the group beginning postacute rehabilitation the earliest (<6mo postinjury) independence continued to improve after discharge. Community integration total score and home competency also continued to improve even after discharge. CONCLUSIONS: The results point toward the effectiveness of postacute rehabilitation in improving functional outcome after TBI even for persons who have reached stable neurologic recovery at 12 or more months postinjury.