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Community-Based Rehabilitation Following Brain Injury: Comparison of a Transitional Living Program and a Home-Based Program

Published online by Cambridge University Press:  14 June 2012

Kate Hopman
Liverpool Brain Injury Rehabilitation Unit, Sydney, Australia
Robyn L. Tate*
Rehabilitation Studies Unit, Northern Clinical School, Sydney Medical School, The University of Sydney, Australia
Annie McCluskey
Faculty of Health Sciences, The University of Sydney, Australia
Address for correspondence: Professor Robyn Tate Professorial Research Fellow Rehabilitation Studies Unit, Northern Clinical School, Sydney Medical SchoolThe University of SydneyPO Box 6, Ryde NSW 1680Australia E-mail:
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Background and aims: Community-based rehabilitation programs for people with a brain injury are diverse. Comparative program evaluation is required to identify optimal type, intensity and duration of programs. The aim of this study was to compare the effectiveness of two community-based rehabilitation programs using a set of standardised outcome measures.

Methods: The study used a quantitative, multicentre, longitudinal design. Persons with severe traumatic brain injury (TBI, n = 39) and acquired brain impairment (n = 2) were recruited from two residential, transitional living programs (TLU; n = 21) and two home-based community rehabilitation programs (CR; n = 20). Participants were assessed via interview at program entry, 2 months and 6 months later using a broad range of standardised measures. The quantity and types of intervention provided to study participants were recorded. Results: No significant differences were identified between the TLU and CR groups at baseline or 6-month follow-up. Two significant group-by-time interactions were identified on the Community Integration Questionnaire (CIQ). First, the CR group had significantly greater changes in productivity (p = .003; d = 1.0) compared to the TLU group over time; by contrast, the TLU group showed significantly greater improvements in social integration (p = .007; d = .86). The TLU participants received up to five times more intervention than the CR participants. This finding is significant considering the similar levels of improvement in function made by both TLU and CR participants.

Conclusions: Both TLU and CR groups improved on a range of measures. The TLU group however, received significantly more face-to-face interventions. Further examination of the relationship between participant contextual factors, such as coping style and self-esteem, and impairments such as challenging behaviour and decreased self-awareness, of people attending TLU and CR programs is required.

Copyright © The Authors 2012

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Bell, K.R., Temkin, N.R., Esselman, P.C., Doctor, J.N., Bombardier, C.H., Fraser, R. T., . . . Dikmen, S. (2005). The effects of a scheduled telephone intervention on outcome after a moderate to severe traumatic brain injury: A randomised trial. Archives of Physical Medicine and Rehabilitation, 86 (5), 851856.CrossRefGoogle Scholar
Bowen, A., Tennant, A., Neumann, V., & Chamberlain, A. (1999). Evaluation of a community-based neuropsychological rehabilitation service for people with traumatic brain injury. Neurorehabilitation, 13, 147155.CrossRefGoogle Scholar
Chestnut, R., Carney, N., Maynard, H., Mann, C., Patterson, P., & Helfland, M. (1999). Summary report: Evidence for the effectiveness of rehabilitation for persons with traumatic brain injury. Journal of Head Trauma Rehabilitation, 14 (2), 176188.CrossRefGoogle Scholar
Cicerone, K.D., Mott, T., Azulay, J., & Friel, J.C. (2004). Community integration and satisfaction with functioning after intensive cognitive rehabilitation for traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 85, 943950.CrossRefGoogle ScholarPubMed
Cohen, J. (1988). Statistical power analysis for the behavioural sciences (2nd ed.). New York: Academic Press.Google Scholar
Glenn, M.B., Goldstein, R., Selleck, E.A., & Rotman, M. (2004). Characteristics of facility based community integration programs for people with brain injury. Journal of Head Trauma Rehabilitation, 19 (6), 482493.CrossRefGoogle ScholarPubMed
Goranson, T.E., Graves, R.E., Allison, D., & LaFreniere, R. (2003). Community integration following multidisciplinary rehabilitation for traumatic brain injury. Brain Injury, 17 (9), 759774.CrossRefGoogle ScholarPubMed
Hashimoto, K., Okamoto, T., Watanabe, S., & Ohashi, M. (2006). Effectiveness of a comprehensive day treatment program for rehabilitation of patients with acquired brain injury in Japan. Journal of Rehabilitation Medicine, 38 (1), 2025.CrossRefGoogle ScholarPubMed
Herbert, R., Carrier, R., & Biloddeau, A. (1988). The functional autonomy measurement system (SMAF): Description and validation of an instrument for the measurement of handicaps. Age and Aging, 17 (5), 293302.CrossRefGoogle Scholar
Knight, R.G., Devereux, R.C., & Godfrey, H.P. (1997). Psychosocial consequences of caring for a spouse with multiple sclerosis. Journal of Clinical and Experimental Neuropsychology, 19, 719.CrossRefGoogle ScholarPubMed
Malec, J.F., & Basford, J.S. (1996). Postacute brain injury rehabilitation. Archives of Physical Medicine and Rehabilitation, 77, 198207.CrossRefGoogle ScholarPubMed
Malec, J. (2005). The Mayo-Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. Retrieved from Scholar
Malec, J.F., & Degiorgio, M.S. (2002). Characteristics of successful and unsuccessful completers of 3 postacute brain injury rehabilitation pathways. Archives of Physical Medicine and Rehabilitation, 83, 17591764.CrossRefGoogle ScholarPubMed
Malec, J.F., Kragness, M., Evans, R.W., Finlay, K.L., Kent, A., & Lezak, M.D. (2000). Refining a measure of brain injury sequelae to predict post-acute outcome: Rating scale analysis of the Mayo-Portland Adaptability Inventory. Journal of Head Trauma Rehabilitation, 15 (1), 670682.CrossRefGoogle Scholar
Malec, J.F., & Thompson, J.M. (1994). Relationship of the Mayo-Portland Adaptability Inventory to functional outcome and cognitive performance measures. Journal of Head Trauma Rehabilitation, 9 (4), 115.CrossRefGoogle Scholar
McColl, M.A., Carlson, P., Johnston, J., Minnes, P., Shue, K., Davies, D., Karlovits, T. (1998). The definition of community integration: perspectives of people with brain injuries. Brain Injury, 12 (1), 1530.CrossRefGoogle ScholarPubMed
McColl, M.A., Davies, D., Carlson, P., Johnston, J., & Minnes, P. (2001). The Community Integration Measure: Development and preliminary validation. Archives of Physical Medicine and Rehabilitation, 82, 429434.CrossRefGoogle ScholarPubMed
Moseley, A.M., Herbert, R.D., Sherrington, C., & Maher, C.G. (2002). Evidence for physiotherapy practice: a survey of the Physiotherapy Evidence Database (PEDro). Australian Journal of Physiotherapy, 48, 4349.CrossRefGoogle Scholar
National Institute of Health. (1999). Rehabilitation of persons with traumatic brain injury: Consensus conference. The Journal of the American Medical Association, 282 (10), 974983.CrossRefGoogle Scholar
Olver, J., & Harrington, H. (1996). Functional outcomes after a transitional living programme for adults with traumatic brain injury. In Ponsford, J., Snow, P. & Anderson, V. (Eds.), International association for the study of traumatic brain injury. Conference (pp. 359361). Bowen Hills QLD: Australian Academic Press.Google Scholar
Pace, G.M., Schlund, M.W., Hazard-Haupt, T., Christensen, J.R., Lashno, M., McIver, J., . . . Morgan, K. A. (1999). Characteristics and outcomes of a home and community-based neurorehabilitation programme. Brain Injury, 13 (7), 535546.Google ScholarPubMed
Ponsford, J., Harrington, H., Olver, J., & Roper, M. (2006). Evaluation of a community-based model of rehabilitation following traumatic brain injury. Neuropsychological Rehabilitation, 16 (3), 315328.CrossRefGoogle ScholarPubMed
Powell, J., Heslin, P., & Greenwood, R. (2002). Community based rehabilitation after severe traumatic brain injury: A randomised control trial. Journal of Neurology, Neurosurgery and Psychiatry, 72, 193202.CrossRefGoogle Scholar
Reistetter, T.A., & Abreu, B.C. (2005). Appraising evidence on community integration following brain injury: A systematic review. Occupational Therapy International, 12 (4), 196217.CrossRefGoogle ScholarPubMed
Salazar, A.M., Warden, D.L., Schwab, K., Braverman, S., Walter, J., Cole, R., . . . Ellenbogen, R. G. (2000). Cognitive rehabilitation for traumatic brain injury: a randomized trial. Journal of the American Medical Association, 283 (23), 30753081.CrossRefGoogle ScholarPubMed
Sander, A.M., Caroselli, J.S., High, W.M., Becker, C., Neese, L., & Scheibel, R. (2002). Relationship of family functioning to progress in a post-acute rehabilitation programme following traumatic brain injury. Brain Injury, 16 (8), 649657.CrossRefGoogle Scholar
Sarajuuri, J.M., Kaipio, M.L., Koskinen, S.K., Niemela, M.R., Servo, A.R., & Vilkki, J.S. (2005). Outcomes after a comprehensive neurorehabilitation program for patients with traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 86 (12), 22962302.CrossRefGoogle Scholar
Seale, G., Caroselli, J.S., High, W.M., Becker, C.L., Neese, L.E., & Scheibel, R. (2002). Use of the Community Integration Questionnaire (CIQ) to characterise changes in functioning for individuals with traumatic brain injury who participate in a post-acute rehabilitation programme. Brain Injury, 16 (11), 955967.CrossRefGoogle Scholar
Simpson, G., Secheny, T., Lane-Brown, A., Strettles, B., Ferry, K., & Phillips, J. (2004). Post-acute rehabilitation services for people with traumatic brain injury: A model description and evaluation of the Liverpool Hospital Transitional Living Program. Brain Impairment, 5 (1), 6780.CrossRefGoogle Scholar
Soo, C., Tate, R., Aird, V., Allaous, J., Browne, S., Carr, B., . . . Hummell, J. (2010). Validity and responsiveness of the Care and Needs Scale (CANS) for assessing support needs following traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 91 (6), 905912.CrossRefGoogle Scholar
Soo, C.A., Tate, R.L., Hopman, K., Forman, M., Sechney, T., Arid, V., . . . Coulston, C. (2007). Reliability of the Care and Needs Scale for assessing support needs after traumatic brain injury. Journal of Head Trauma Rehabilitation, 22 (5), 288295.CrossRefGoogle ScholarPubMed
Tate, R.L. (2004). Assessing support needs for people with traumatic brain injury: The care and needs scale (CANS). Brain Injury, 18 (5), 445460.CrossRefGoogle ScholarPubMed
Tate, R.L., Broe, A.B., Cameron, I.D., Hodgkinson, A.E., & Soo, C.A. (2005). Pre-injury, injury and early post-injury predictors of long-term functional and psychosocial recovery after severe traumatic brain injury. Brain Impairment, 6 (2), 7589.CrossRefGoogle Scholar
Tate, R.L., Hodgkinson, A., Veerabangsa, A., & Maggiotto, S. (1999). Measuring psychosocial recovery after traumatic brain injury: Psychometric properties of a new scale. Journal of Head Trauma Rehabilitation, 14, 543557.CrossRefGoogle ScholarPubMed
Tate, R.L., Simpson, G.K., Soo, C.A., & Lane-Brown, A.T. (2011). Participation after acquired brain injury: Clinical and psychometric considerations of the Sydney Psychosocial Reintegration Scale (SPRS). Journal of Rehabilitation Medicine, 43, 609618.CrossRefGoogle ScholarPubMed
Turner-Stokes, L., Disler, P.B., Nair, A., & Wade, D.T. (2005). Multi-disciplinary rehabilitation for acquired brain injury in adults of working age. Retrieved from Scholar
Wheeler, S.D. (2004). The effectiveness of a community based life skills training program for traumatic brain injury. Richmond, VA: Virginia Commonwealth University.Google Scholar
Willer, B., Button, J., & Rempel, R. (1999). Residential and home based post-acute rehabilitation of individuals with traumatic brain injury: A case control study. Archives of Physical Medicine and Rehabilitation, 80, 399406.CrossRefGoogle Scholar
Willer, B., Rosenthal, M., Kreutzer, J., Gordon, W., & Rempel, R. (1993). Assessment of community integration following rehabilitation for traumatic brain injury. Journal of Head Trauma Rehabilitation, 8, 587.CrossRefGoogle Scholar
Williams, J., Drinka, T., Greenberg, J., Farrell-Holtan, J., Euhardy, R., & Schram, M. (1991). Development and testing of the Assessment of Living Skills and Resources (ALSAR) in elderly community dwelling veterans. The Gerontologist, 31, 8491.CrossRefGoogle ScholarPubMed
Winkler, D., Unsworth, C., & Sloan, S. (2006). Factors that lead to successful community integration following severe traumatic brain injury. Journal of Head Trauma Rehabilitation, 21 (1), 821.CrossRefGoogle ScholarPubMed
World Health Organization. (2001). International Classification of Functioning, Disability and Health. Retrieved from Scholar