Residential Rehabilitation: Return on investment one year after discharge.

Research Objectives: To investigate the durability of outcomes in residential neurorehabilitation programming after discharge.
To investigate outcome durability in traumatic brain injury and cerebrovascular accidents.

Design: The total sample (N=108; 1x4 repeated measures design) was combined to include TBI, CVA, and Mixed neurological groups focusing on four measurement periods. Additional analysis included repeated measures 2x4 design addressing TBI and CVA by the four measurement periods.

Setting: Participants received physical therapy, occupational therapy, speech therapy, recreation, counseling, case management, and physical medicine physician intervention.

Participants: Subjects (N=108) were selected from 2,177 neurologically impaired adults with consecutive discharges from 18 post-hospital programs in 12 states from 2011 through 2019. Inclusion criteria: ages 18-75, acquired brain injury, completed post-hospital residential neurorehabilitation, and outcomes completed at admission, discharge, three-month, and twelve-month follow-up. Exclusion criteria: < 18 or >75 years of age, diagnosed with a congenital neurological disorder, failed to complete rehabilitation, and/or unable to be reached at three- and twelve-month follow-ups.

Interventions: Participants were evaluated upon admission and discharge by a multidisciplinary team consensus. Similarly, the discharge outcome was completed within the final week of the participant’s program. Three- and twelve-month follow-ups were conducted via telephone by a trained coordinator. Most respondents were family members (80%); 20% were participants.

Main Outcome Measures: Mayo Portland Adaptability Inventory-4 (and subset M2PI which is the Participation Index of the full measure.

Results: The total sample demonstrated a significant main effect for assessment interval, Greenhouse-Geisser F (2.37) = 76.87, p < 0.001, partial eta2 = 0.418, power to detect = 0.99. No difference was noted from 3 to 12 months post-discharge. Repeated Measures mixed ANOVA (2 x 4) for TBI and CVA participants differed over assessment intervals, Greenhouse-Geisser F(2.4) = 67.93, p < 0.001, partial eta2 = 0.41, power to detect = 0.99.

Conclusions: Post-hospital residential neurorehabilitation programs provide a return on investment. Gains are realized from admission to discharge and maintained after discharge for up to 1-year.

Author(s) Disclosures: Gordon J. Horn, Ph.D. - NeuroRestorative employee.
Frank D. Lewis, Ph.D. - NeuroRestorative employee.