JBBS  Vol.9 No.12 , December 2019
Prediction of Functional Outcome in Post-Hospital Brain Injury Rehabilitation
Abstract: Post-hospital brain injury rehabilitation programs are afforded limited time to reduce chronic disability resulting from acquired brain injury. Therefore, the purpose of this study was to identify deficit areas resulting from acquired brain injury that have the greatest impact on functional outcomes to enable greater efficiency in rehabilitation programming. Study participants were 1717 persons with acquired brain injury treated in residential post-hospital rehabilitation programs. Participants were assessed at admission and discharge on the MPAI-4. Functional status at discharge was evaluated based on T-scores derived from MPAI-4 discharge participation index items: Initiation, self-care and residence. The data base of 1717 was randomly divided into two subsets. Items from admission Abilities Index and select person variables were entered into stepwise multiple regression on subset one and then in a hierarchical multiple regression on subset two. Rash analysis demonstrated satisfactory construct validity and internal consistency of admission and discharge MPAI-4 evaluations (Person reliability > 0.90, Item reliability = 0.99). Both regression analyses revealed that Mobility and Novel Problem Solving accounted for 40% of the variance in functional outcome, p < 0.001. Acquired brain injury results in a myriad of cognitive and physical impairments. Of the many possible deficits, the greatest gains in overall functional outcomes may be achieved by allocating additional treatments aimed at reducing disability in mobility and novel problem solving.
Cite this paper: Lewis, F. and Horn, G. (2019) Prediction of Functional Outcome in Post-Hospital Brain Injury Rehabilitation. Journal of Behavioral and Brain Science, 9, 406-416. doi: 10.4236/jbbs.2019.912031.

[1]   Masel, B.E. and DeWitt, D.S. (2010) Traumatic Brain Injury: A Disease Process, Not an Event. Journal of Neurotrauma, 27, 1529-1540.

[2]   Hayden, M.E., Plenger, P. and Bison, K.L. (2013) Treatment Effect versus Pretreatment Recovery in Persons with Acquired Brain Injury: A Study Regarding the Effectiveness of Post-Acute Rehabilitation. American Academy of Physical Medicine and Rehabilitation, 5, 319-327.

[3]   Altman, I.M., Swick, S., Parrot, D. and Malec, J.F. (2010) Effectiveness of Community-Based Rehabilitation after Traumatic Brain Injury for 489 Program Completers Compared with Those Precipitously Discharged. Archives of Physical Medicine and Rehabilitation, 91, 1697-1704.

[4]   Langlosis, J.A., Rutland-Brown, W. and Wald, M. (2006) The Epidemiology and Impact of Acquired Brain Injury: A Brief Overview. The Journal of Head Trauma Rehabilitation, 21, 375-378.

[5]   Lewis, F. and Horn, G. (2015) Neurologic Continuum of Care: Evidence-Based Model of a Post-Hospital System of Care. Neurorehabilitation, 36, 243-251.

[6]   Lewis, F., Horn, G. and Russell, R. (2017) Impact of Chronicity on Outcomes Following Post-Hospital Residential Brain Injury Rehabilitation: Application of Multivariate Statistics and Rasch Analysis. Open Journal of Statistics, 7, 254-263.

[7]   Horn, G.J. and Lewis, F.D. (2014) A Model of Care for Neurological Rehabilitation. Journal of Nurse Life Care Planning, 14, 681-692.

[8]   Malec, J.F. and Lezak, M.D. (2008) The Mayo-Portland Adaptability Inventory (MPAI-4) for Adults. Child Adolescence Manual, 1-84.

[9]   Kean, J., Malec, J., Altman, I. and Swick, S. (2011) Rasch Measurement Analysis of the Mayo-Portland Adaptability Inventory (MPAI-4) in a Community-Based Rehabilitation Sample. Journal of Neurotrauma, 28, 745-753.

[10]   Malec, J., Kragness, M., Evans, R., Finlay, K., Kent, A. and Lezak, M. (2003) Further Psychometric Evaluation and Revision of the Mayo-Portland Adaptability Inventory in a National Sample. The Journal of Head Trauma Rehabilitation, 18, 479-492.

[11]   Linacre, J. (2002) What Do Infit, Outfit, Mean-Square, and Standardization Mean? Archives of Rasch Measurement, 16, 871-882.

[12]   Andrich, D. (1978) A Rating Formulation for Ordered Response Categories. Psychometrika, 43, 561-573.

[13]   Tennant, A. and Conaghan, P.G. (2007) The Rasch Measurement Model in Rheumatology: What Is It and Why Use It? When Should It Be Applied and What Should One Look for in a Rasch Paper? Arthritis Care & Research, 57, 1358-1362.

[14]   Godefroy, O. (2003) Frontal Syndrome and Disorders of Executive Functions. Journal of Neurology, 250, 1-6.

[15]   McDonald, B.C., Flashman, L.A. and Saykin, A.J. (2002) Executive Dysfunction Following Traumatic Brain Injury: Neural Substrates and Treatment Strategies. NeuroRehabilitation, 17, 333-344.

[16]   Hawkins, M.L., Lewis, F.D. and Medeiros, R. (1996) Serious Traumatic Brain Injury: An Evaluation of Functional Outcomes. The Journal of Trauma: Injury and Critical Care, 41, 257-283.

[17]   Reeder, K., Rosenthal, M., Lichtenberg, P. and Wood, D. (1996) Impact of Age on Functional Outcome Following Traumatic Brain Injury. Journal of Head Trauma Rehabilitation, 11, 22-31.

[18]   Cohen, J. and Cohen, P. (1975) Applied Multiple Regression/Correlation Analysis for the Behavioural Sciences. Lawrence Erlbaum, Hillsdale.

[19]   Cope, N.D., Cole, J.R., Hall, K.M. and Barkans, H. (1991) Brain Injury: Analysis of Outcome in a Post-Acute Rehabilitation System. Part I: General Analysis. Brain Injury, 5, 111-125.

[20]   Horn, G.J., Lewis, F.D., Russell, R. and Kemp, D. (2017) Anxiety Following Traumatic Brain Injury: Impact on Post-Hospital Rehabilitation Outcomes. Physical Medicine & Rehabilitation Research, 2, 1-6.

[21]   Lewis, F. and Horn, G. (2017) Rasch Analysis and Functional Measurement in Post-Hospital Brain Injury Rehabilitation. International Journal of Statistics and Probability, 6, 50-59.

[22]   Malec, J.E. and Brasford, J.S. (1996) Post-Acute Brain Injury Rehabilitation. Archives of Physical Medicine and Rehabilitation, 77, 198-207.