OBJECTIVES: Evaluate a Comprehensive Day Treatment (CDT) program for survivors of brain injury (BI) by time since injury; identify outcome predictors.
PARTICIPANTS: 96 program graduates; 17 dropouts with acquired BI.
OUTCOME MEASURES: Outcome: Independent Living Status, Vocational Independence Scale at program end and 1-year follow-up; Rasch-analyzed Mayo-Portland Adaptability Inventory (MPAI-22) and Goal Attainment Scaling (GAS) at program end; Predictor: age, education, severity of initial injury, time since injury, preadmission MPAI-22.
RESULTS: Significant goal achievement on GAS and improvement on MPAI-22; increased societal participation at 1 year follow-up for both those treated postacutely and many years after injury: 72% of graduates living independently; 39% working independently, 10% in transitional placements, 18% in supported or volunteer work. Long-term outcomes were modestly related linearly to preadmission MPAI-22 and nonlinearly to time since injury.
CONCLUSIONS: CDT improves societal participation even among persons with a long history of limited participation after BI. This de facto extended baseline analysis indicates the effectiveness of CDT and paves the way for randomized control trials of active treatment components. Relationships of predictors to outcomes are not sufficiently strong for patient selection. More effective interventions for vocational re-integration are needed for those most severely disabled after BI.