Structured Abstract
Brain Injury Structured Abstract - BI #4
Cognitive rehabilitation at home may have therapeutic benefits for clients with brain injury
CITATION: Salazar, A., Warden, D. L., Schwab, K., Spector, J., Braverman, S., Walter, J., Cole, R., Rosner, M., Martin, E., Ecklund, J., & Ellenbogen, R. G. (2000). Cognitive rehabilitation for traumatic brain injury: A randomized trial. JAMA, 283(23), 3075-3081.
LEVEL OF EVIDENCE: IA2b
This randomized control trial 2 group comparison design study, sample size above 20 per condition (n = 120; n = 67, n = 53) with moderate - low internal validity and moderate - low external validity provided a IA level of evidence.
RESEARCH OBJECTIVE/QUESTION
To evaluate the efficacy of inpatient cognitive rehabilitation for clients with traumatic brain injury.
DESIGN
|
X |
RCT |
|
Single Case |
|
Case Control |
| |
Cohort |
|
Before-After |
|
Cross-Sectional |
Randomized Controlled Trial or Randomized Clinical Trial. This type of study is generally referred to as a Type 1 study. An RCT is usually composed of a set of persons who are chosen or have volunteered for the study. Volunteers are then divided into two or more groups that are similar in characteristics. In this study, one group receives treatment and the other group(s) does not. Therefore, different treatment methods can be compared during one study. Single-center, parallel group randomized trial.
SAMPLING PROCEDURE
|
X |
Random |
|
Consecutive |
| |
Controlled |
|
Convenience |
- Individuals involved in the study are selected at random from a larger population of candidates
- Participants were randomly assigned to an 8-week in-hospital cognitive rehabilitation program (n = 67) or a limited home rehabilitation program (n = 53).
SAMPLE
|
N = 67; 53 |
M age =
25 hosp,
26 home |
Male =
93 hosp,
53 home |
Ethnicity = white
69 hosp,
70 home |
Female = NR |
NR = Not reported
Inclusion criteria very specific. Severity of injury was determined according to length of loss of consciousness, admission Glasgow Coma Scale scores, Posttraumatic Amnesia scores (PTA), MRI, and Rancho Level of 7.
PARTICIPANT CHARACTERISTICS
Moderate to severe TBI
MEDICAL DIAGNOSIS/CLINICAL DISORDER
Traumatic Brain Injury
OT TREATMENT DIAGNOSIS
Environmental (sociocultural) problems
OUTCOMES
Return to work
|
Measures |
Reliability |
Validity |
|
Multidisciplinary evaluations |
NR |
NR |
|
Return to Work |
|
|
|
Full Time > = 35 h/wk |
NR |
NR |
|
Part Time < = 35 h/wk |
|
|
NR = Not reported
Outcome - OT terminology
B-Environmental Aspects: 2 social, 3 cultural
Outcome - ICIDH-2 terminology
Participation
Environmental and cultural aspects - prevention
INTERVENTION
- Intensive in-hospital cognitive rehabilitation
- Limited home rehabilitation
Description
1. In-hospital Rehabilitation
- Interdisciplinary Cognitive Rehabilitation - modeled after Prigatano
- Structure (daily routines)
- OT/SP/Cognitive/Coping Skills (individual & group)
- Integrated Work Therapy modeled after Ben-Yishay, et al. & Burke et al.
- Work setting placements - coordinated by an occupational therapist
2. Home Rehabilitation:
- Traumatic brain injury education
- Counseling from a psychiatric nurse
Who delivered
1. In-hospital Rehabilitation
- Cognitive program physiatrist - Medical doctor trained
- Neuropsychologist - PhD trained
- OTR - Bachelor trained
- Speech pathologist - Master trained
- 2 Rehab assistants
2. Home Rehabilitation:
- Psychiatric Nurse - College trained
Setting
Walter Reed Army Medical Center, Washington, DC
Frequency
In-hospital: Not clear
Home: 30-minute phone consultation once a week
Duration
In-hospital: 8 Weeks
Home: 8 Weeks
Follow-up
1 Year evaluated 6, 12, & 24 months
RESULTS
- The in-hospital and home treatment groups were compared using the Fischer Exact Test; 95% confidence intervals (CIs) were separately calculated for differences in the percentage of individuals who had returned to work or who were fit for duty. Fisher Exact Test or t tests were used
- There was no significant difference between clients who had received the intensive in-hospital cognitive program versus the limited rehabilitation program in return to employment at 1-year follow-up
- Return to work was 90% for hospital group and 94% for the home group (p = .51, difference 4%; 95% CI; -5% - 14%). Among the participants working at one year, 91% of the hospital group and 93% of the home group were working full time (p > .99)
CONCLUSIONS
Biases
| |
Attention |
|
Masking/blinding |
|
Drop outs |
| |
Contamination |
|
Co-intervention |
|
The overall benefit of in-hospital cognitive program for clients with moderate to severe TBI was similar to that of home rehabilitation. The results highlight the potential therapeutic benefits of the home setting.
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.
