Participation as an Outcome of Traumatic Brain Injury Rehabilitation

Past Studies

Past Studies suggest that improvements in participation and community integration are results of TBI rehabilitation. They further suggest that rehabilitation may prevent a decline in community functioning (activities of daily living). Most studies have not addressed outcomes of improvement in the quality of life and of well-being. These two areas may be of importance when reflecting patients’ values and preferences in evaluating the effectiveness of their rehabilitation and should be considered as distinct outcomes of TBI rehabilitation.Previous studies have evaluated treatment outcomes in terms of improvement on neurological test scores and ability to return to work. While consensus has been that rehabilitation relates to overall improvements, few studies have actually addressed the effects of rehabilitation on social participation and community integration. 

This Study

This Study seeks to determine whether TBI rehabilitation produces improvements in social participation, measured by the improvement on ( CIQ) Community Integration Questionnaire, clinically meaningful change, and meaningful patterns of community integration (independence in everyday home activities and social participation). The author reviews the literature and then combines and re-analyzes data from three of the studies to address these questions. He further examines the relationship of social participation to subjective well-being and whether greater participation produces positive feelings of well-being and satisfaction with functioning.Used collectively, these three studies suggest that a comprehensive, post-acute rehabilitation treatment program can produce significant improvements in social participation and community integration. It also suggests that rehabilitation may have a different impact on other aspects of participation as several studies showed benefits were most apparent on performance of everyday activities in the home, but less effective on participation in social activities and interpersonal relationships.There is evidence that rehabilitation not only improves functional outcome but reduces the probability that patients will demonstrate a decline in functioning over time.

Who May Be Affected By These Findings

People with brain injury and their families, caregivers, researchers, community providers and health professionals.

Caveats

Limitations to this study included the small literature sample selected and lack of sufficient data to examine regarding the effectiveness of rehabilitation as measured by participation and community integration. Future studies should address these issues, especially the clinically significant improvements in community functioning, additional interventions and potential implications for funding and health policy decisions. Attention should be given to patients’ preferences and values throughout recovery.

Bottom Line

This study suggested that TBI rehabilitation improves an individual’s functioning and meaningful participation in social and daily living activities and shows successful re-entry into the community. It addresses the importance of patients’ feelings about their rehabilitation and its effectiveness and shows the importance of looking at well-being and quality of life as distinctive outcomes for this population.

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