Point of entry and functional outcomes after comprehensive day treatment participation

Abstract

Objectives: To explore the relationship between point of entry into a comprehensive day treatment (CDT) program and outcomes after acquired brain injury (ABI). We hypothesized that participants entering our program 0 to 6 months postinjury would demonstrate greater declines in neurobehavioral sequelae and improvements in residential/vocational independence than those entering >6 to 12 and >12 to 24 months postinjury.

Design: Retrospective examination of admission, discharge, and 1-year follow-up data from a CDT program.

Setting: A large Midwestern academic medical center.

Participants: Adult CDT participants with traumatic brain injuries (TBI) (n=54) or cerebrovascular accidents (CVAs) (n=29).

Interventions: A CDT rehabilitation program.

Main outcome measures: Portland Adaptability Inventory/Mayo-Portland Adaptability Inventory (percent change scores between admission and discharge) and the Independent Living and Vocational Independence Scales.

Results: Time since injury was categorically coded into the 3 aforementioned point of entry groups. A 2 (injury type) × 3 (point of entry) between subjects analysis of covariance revealed a significant main effect for the point of entry (P<.001). Post hoc tests indicated that individuals entering the program 0 to 6 months postinjury demonstrated significantly greater treatment gains than those entering 6 to 12 or 12 to 24 months postinjury. Within group chi-square analyses revealed that a significantly higher percentage of the early entry participants were living and working independently at discharge and 1-year follow-up.

Conclusions: Entry into a CDT program (0-6mo postinjury) is associated with significantly greater declines in neurobehavioral sequelae and improvements in residential and vocational independence in participants with TBI or CVA. Sustainable modest treatment gains were also observed in the late entry groups, suggesting that these individuals also benefit significantly from CDT program participation.