Structured Abstract
Brain Injury Stuctured Abstract - BI #6
Early intervention and provision of vocational services may improve vocational outcomes for clients with brain injury
CITATION: Malec, J. F., Buffington, A. L. H., Moessner, A. M., & Thompson, J. M. (1995). Subspeciality clinics: Physical medicine and rehabilitation: Maximizing vocational outcome after brain injury: Integration of medical and vocational hospital-based services. Mayo Clinic Proceedings, 70(12), 1165-1171.
LEVEL OF EVIDENCE: IIA (Validity not reported.)
In this large study, N = 147, clients were sampled twice, and each sampling could be considered a separate group (1 month, and then 1-year post follow-up) providing a IIA level of evidence with validity not reported.
RESEARCH OBJECTIVE/QUESTION
To describe a medical and vocational case management system implemented to decrease time between onset of brain injury and successful community reintegration.
DESIGN
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RCT |
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Single Case |
X |
Case Control |
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Cohort |
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Before-After |
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Cross-Sectional |
This study is also known as a retrospective study or a case comparison study. A case control study is generally performed to view in retrospect to see how a certain issue affected a group of clients involved in the study. Therefore, one can find out what makes these clients different from each other. The group of clients exposed to the issue in question is compared to a similar control group that was not exposed to the issue.
SAMPLING PROCEDURE
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Random |
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Consecutive |
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X |
Controlled |
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Convenience |
Individuals for the study are selected according to criteria that have been pre-selected for that certain study. This sampling procedure is not necessarily composed of volunteers but people who fit the criteria.
SAMPLE
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N = 147 |
M age = NR |
Male = NR |
Ethnicity = NR |
Female = NR |
NR = Not reported
147 Clients participated in the study. Clients eligible were Minnesota residents between ages of 18-35 diagnosed with brain injury.
PARTICIPANT CHARACTERISTICS
Brain Injury (BI)
MEDICAL DIAGNOSIS/CLINICAL DISORDER
Brain Injury (BI)
OT TREATMENT DIAGNOSIS
Cognitive problems, giving way to the creation of a vocational program to integrate clients back into the home or job force or both.
OUTCOMES
Vocational Rating Scales
Disability Scales
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Measures |
Reliability |
Validity |
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Glasgow Coma Scales |
NR |
NR |
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Mayo-Portland Adaptability Inventory |
NR |
NR |
NR = Not Reported
Outcome - OT terminology
II. Performance Area
C. Work and Productive Activities
4. Vocational Activities
Outcome - ICIDH-2 terminology
Participation Activities: Vocational
INTERVENTION
Early and appropriate integrated medical & vocational case management system to maximize vocational and independent living outcomes.
Description
- Treatment
- Reintegration into the community
Who delivered
- Nurse case coordinator
- Vocational case coordinator
- Emergency trauma unit
- Neuropsychologist
Setting
Mayo Medical Center, Rochester, Minnesota
Frequency
- Early diagnosis, intervention and education at admission
- 1-Month follow-up to determine status
- Referrals if appropriate and design plan
- Meetings quarterly to monitor/feedback
Duration
Measures obtained at 1-month and 1-year follow-up
RESULTS
- 67% With brain injury began receiving vocational services in the first year
- 34% Were in community based non-sheltered work or training programs
- Goal for 2nd year is 70% placement within 9 months after admission
Follow up - 37% had one or more residual symptoms; only half of the clients thought symptoms were severe enough to be referred.
CONCLUSIONS
Biases
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Attention |
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Masking/blinding |
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Drop outs |
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Contamination |
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Co-intervention |
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- Preliminary data are encouraging. Decreased amount of time between injury and initiation of vocational and rehabilitation services
- Core element of program is to improve interagency linkage
Terminology used in this document is based on two systems of classification current at the time the evidence-based literature reviews were completed: Uniform Terminology for Occupational Therapy Practice - Third Edition (AOTA, 1994) and International Classification of Functioning, Disability and Health (ICIDH-2) (World Health Organization [WHO], 1999). More recently, the Uniform Terminology document was replaced by Occupational Therapy Practice Framework: Domain and Process (AOTA, 2002), and modifications to ICIDH-2 were finalized in the International Classification of Functioning, Disability and Health (WHO, 2001).
This work is based on the evidence-based literature review completed by Beatriz C. Abreu, PhD, OTR, FAOTA, and colleagues. For more information about the Evidence-Based Literature Review Project, contact the Practice Department at the American Occupational Therapy Association, 301-652-6611, x 2040.
Copyright 2003 American Occupational Therapy Association, Inc. All rights reserved. This material may be reproduced and distributed without prior written consent.
