Pilot Study: Are there benefits to persons with TBI participating in a work program?

By Nichole Garcia, OTR/L, CBIST, CKTP, and Brittney Tuck, MOTS

Michigan is known for its established roots and beliefs in the mental health clubhouse community, boasting 40 clubhouses as of 2024 – more than any other state in the country. These community-based services are dedicated to supporting and empowering individuals with specific needs, such as mental illness. However, although Michigan has nearly 40 mental health clubhouses statewide as of 2024, there are no clubhouse communities dedicated to people living with brain injury. With auto no-fault reforms in Michigan, and concerns for meeting the long-term needs of those with a traumatic brain injury (TBI), brain injury clubhouses are critically needed.

MARC Therapies in Novi, Michigan has been proactive in starting this movement. Insurance companies need to recognize the value of work programs and support their reimbursement. As there is minimal research on the benefits of work programs in the brain injury community, MARC Therapies is informing others about how to implement the social practice of clubhouses in work programs and their value to the community.

Our current research aimed to evaluate the impact of participation in MARC Therapies’ clubhouse work program on pain, work tolerance, quality of life, mental health, and independence among survivors of TBI. We recruited participants from MARC Therapies, all of whom are TBI survivors due to motor vehicle accidents. Our sample consisted of 30 members, 30 to 80 years of age, who sustained injuries between four and 45 years ago. The length of time since their injury averaged 24 years.

Upon admission, members complete the Functional Independence Measure and Functional Assessment Measure (FIM/FAM) to identify daily living skills and challenges. These measures are repeated every six months. We analyzed the initial FIM/FAM scores and compared them with the most recent scores to determine the program’s effectiveness in key areas. We focused on the FIM/FAM domains of Work/Education, Use of Leisure Time, Social Interaction, Emotional Status, Adjustment to Limitations, and Housework. The FIM/FAM responses are scored on a 7-point scale, with 1 indicating dependence, and 7 indicating independence in a task. Notable improvement occurred in the Work/Education domain, with an average score increase of 1.45 points among participants. Additionally, we observed gains in the Use of Leisure Time (1.17 points) and Housework (0.7 points) domains, reflecting greater independence and reduced need for assistance in these areas.

To further investigate the program’s impact on our TBI survivors, we administered the WHO Quality of Life-BREF (WHOQOL-BREF) assessment, which measures perceived quality of life across four domains: physical health, psychological health, social relationships, and environment. Participants rated their experiences on a 1-5 scale. The environment domain received the highest average score of 81.6 out of 100, reflecting a strong sense of satisfaction with their surroundings. In the physical health domain, an average score of 73 indicated a generally positive view of their physical well-being. While scores on the psychological health and social relationships domains were lower, with averages of 68 and 55 points, these still indicate moderate satisfaction in these areas among our participants. In comparison to a normative sample of individuals without injuries or disabilities, members of MARC Therapies scored higher in two of the four domains (physical health and environment). Scores in the psychological health and social relationships domains scored lower, however, remained in the normative standard deviation range which is significant when comparing survivors of a TBI to the typical population. 

Overall, our research demonstrated important benefits for individuals with TBI participating in a clubhouse social practice work program. Using the outcome measure of the FIM/FAM in this work program demonstrated increased levels of independence with work, leisure, and household management. More research is needed to demonstrate the impact it has on employment longevity, and overall satisfaction. In our study, 100 percent of the 30 individuals were employed as compared to the 10-40 percent employment rates of the national brain injury population rates (Brain Injury Association of America, 2016). Future research will explore differences from a sample of those attempting work without a supportive work program compared to those participating in a clubhouse work program.

References

Clubhouse International. (2024). https://clubhouse-intl.org/

Essential Brain Injury Guide 5.0. (2016). The Brain Association of America.