Structured Abstract
Brain Injury Structured Abstract - BI #5
Case coordination emphasizing early intervention and community support may reduce unemployment among clients with brain injury
CITATION: Malec, J. F., Buffington, A. L. H., Moessner, A. M., & Degiorgio, L. (2000). A medical/vocational case coordination system for persons with brain injury: An evaluation of employment outcomes. Archives of Physical Medicine and Rehabilitation, 81(8), 1007-1015.
LEVEL OF EVIDENCE: IIA (Validity not reported.)
Sampling information was completed both before and after undergoing a treatment program. This large group (N = 114) provided a IIA level of evidence with validity not reported.
RESEARCH OBJECTIVE/QUESTION
To evaluate initial placement and 1-year employment outcomes for persons with brain injury.
DESIGN
| |
RCT |
|
Single Case |
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Case Control |
| |
Cohort |
X |
Before-After |
|
Cross-Sectional |
This study design is used to evaluate a group of individuals who are undergoing the same treatment. Information regarding a group of people is collected both before and after treatment. This is a common design that is generally paralleled with a single case/individual study. A before-after design usually involves more than one person whereas a single case study may involve only one individual.
SAMPLING PROCEDURE
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Random |
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Consecutive |
|
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 = 114 |
M age = 37.4 |
Male = 70 |
Ethnicity = NR |
Female = 44 |
NR = Not reported
114 Minnesota residents (range in age 18 to 65 years) with acquired brain injury. Those with substance abuse problems, long-term placement, or who declined participation were excluded. 78% Had greater than 12 years of education.
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 to the home or job force or both.
OUTCOMES
Vocational Independent Scale
Preinjury Employment Status
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Measures |
Reliability |
Validity |
|
Glasgow Coma Scales |
NR |
NR |
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Mayo-Portland Adaptability Inventory |
NR |
NR |
|
Rasch Scale Analysis |
NR |
NR |
NR = Not Reported
Outcome - OT terminology
II. Performance Area
Work and Productive
Activities
4. Vocational Activities
Outcome - ICIDH-2 terminology
Participation Activities: Vocational
INTERVENTION
Initial counseling and placement into study with focus on: Vocational outcome with 1-year follow up and early intervention with medical center-based & community-based resources.
Description
Treatment/Rehabilitation
Who delivered
- Nurse case coordinator
- Vocational case coordinator
- Emergency room staff
- Social worker
- Clinicians
Setting
Medical/vocational case coordination system
Frequency
- Initial assessment and counseling
- After discharge, phone call post one month to assess further sequelae
- Follow up in 1-year after placement or left project
Duration
1-year follow up
RESULTS
At placement:
- 46% In independent work
- 25% In transitional placements
- 9% In long-term supported employment
- 10% In sheltered work
- 10% Not placed
At 1-year follow up:
- 53% In independent work
- 19% In transitional placement
- 9% In supported work
- 6% In sheltered work
- 13% Unemployed
Vocational Independence Scale (VIS) significantly predicted VIS scores at the 1-year follow-up time (t = .75 p < 0.0001)
CONCLUSIONS
Biases
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Attention |
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Masking/blinding |
X |
Drop outs |
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Contamination |
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Co-intervention |
|
- Time since injury and impairment/disability best predict vocational placement
- Level of initial placement predicted employment status at follow up. The greater the disability the more time and extensive the rehabilitation services needed before placement
- Reported 10% not placed; most withdrew from study after admission because of their decision not to work after reviewing options
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.
