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Article 1: A Practical Clinical Trial of Holistic Neuropsychologic Rehabilitation After Traumatic Brain Injury
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2007 ACRM Annual Conference Abstracts Provided here are the abstracts of scientific papers and posters presented at the joint 84th Annual Meeting of the American Congress of Rehabilitation Medicine (ACRM) and the 14th Annual Meeting of the American Society of Neurorehabilitation (ASNR), in Washington, DC, October 3ⴚ7, 2007. Papers and posters were chosen by the joint ACRMⴚASNR program committee. The abstracts have not been subjected to formal peer review by the Editorial Board of the Archives of Physical Medicine and Rehabilitation. Abstracts from the 2007 ACRMⴚASNR Joint Conference are published in both society journals: Archives of Physical Medicine and Rehabilitation 2007;88(10):E1-27, and Neurorehabilitation and Neural Repair 2007;21(6).
Paper Presentations Article 1 A Practical Clinical Trial of Holistic Neuropsychologic Rehabilitation After Traumatic Brain Injury. Keith Cicerone (JFK-Johnson Rehabilitation Institute, United States), Tasha Mott, Joanne Azulay, Mary Sharlow-Galella, Wendy Ellmo, John Friel, Susan Paradise. Disclosure: None declared. Objective: To evaluate the effectiveness of intensive-holistic cognitive rehabilitation (ICRP) and “standard” neurorehabilitation (SRP) for traumatic brain injury. Design: Randomized controlled trial with 6-month follow-up. Setting: Outpatient brain injury rehabilitation program. Participants: 68 participants randomly assigned to ICRP (n⫽34) or SRP (n⫽34). Interventions: ICRP consisted of individual and group interventions emphasizing self-regulation, interpersonal communication, functional problem solving, and self-efficacy for management of symptoms. SRP primarily consisted of individual physical therapy, occupational therapy, speech therapy. and neuropsychologic treatment. Both interventions lasted 17 weeks. Main Outcome Measures: Primary outcomes were community integration (Community Integration Questionnaire [CIQ]) and perceived quality of life (QOL). Neuropsychologic functioning was assessed before and after treatment. Results: Neuropsychologic functioning improved equally in both groups (P⬍.001). CIQ exhibited a significant interaction of treatment conditions with significant improvement after ICRP (P⫽.004), while SRP did not change. Perceived QOL showed a significant main effect (P⫽.011) and interaction on perceived QOL due to improvement of ICRP (P⫽.004) with no benefit of SRP. Benefits were maintained at 6-month follow-up. Conclusions: There are significant benefits from ICRP in community integration and life satisfaction compared with standard neurorehabilitation for traumatic brain injury. Key Words: Brain injuries; Rehabilitation. Article 2 The Psychologic Effects of Employment Following Traumatic Brain Injury: Objective and Subjective Indicators. Theodore Tsaousides (Mount Sinai School of Medicine, United States), Teresa Ashman, Colette Seter. Disclosure: Supported by NIDRR (grant no. H133b040033). Objective: To examine the differential effect of objective and subjective indicators of employment on psychologic well-being, quality of life (QOL), and depression following traumatic brain injury (TBI). Design: Quasi-experimental. Setting: Research and training center on TBI interventions, in a school of medicine, in New York City. Participants: 437 individuals with TBI (age range, 18⫺65y) living in the community independently. Interventions: Not applicable. Main Outcome Measures: Bigelow’s Psychological Well-Being Scale,
Life⫺3, and Beck Depression Inventory⫺II. The objective indicator of employment included level of employment (no employment, part-time, full-time) and the subjective indicator included work discrepancy, which was defined as the discrepancy between the perceived importance of work and the degree to which work needs are met. Results: A substantial percentage of subjects with TBI reported large negative changes in level of employment. Psychologic well-being was not significantly related to any predictor variables. QOL was significantly related to level of employment level (.15), work discrepancy (⫺.29), and income (.23). Depression was significantly related to education (⫺.10), income (⫺.14), level of employment (⫺.17), and work discrepancy (.19). Hierarchical multiple regression showed that work discrepancy contributed significantly to QOL and depression variance above and beyond all other predictors. Conclusions: The results of this study highlight the importance of including subjective indicators of employment when assessing QOL and depression in persons with TBI. The benefits of TBI rehabilitation could be optimized when traditional goals of rehabilitation (ie, return to work) are combined with more subjective and personally meaningful goals. Understanding the importance ascribed to work and identifying appropriate ways to help people fulfill their employment needs is likely to contribute further to QOL and improved mood. Key Words: Brain injuries; Employment; Quality of life; Rehabilitation. Article 3 Responsiveness of the Utrecht Scale for Evaluation of Rehabilitation. Marcel Post (De Hoogstraat, Netherlands), Rebecca Baines, Ingrid van de Port, Renee Peeters, Steven Berdenis van Berlekom. Disclosure: None declared. Objective: To examine the validity and responsiveness of the Utrecht Scale for Evaluation of Rehabilitation (USER), a generic measure covering mobility, self-care, cognition, pain, fatigue, and mood. Design: Longitudinal study with measurements at admission and at discharge from clinical rehabilitation, with a maximum period between measurements of 4 months. Setting: 3 rehabilitation facilities in The Netherlands. Participants: Rehabilitation inpatients with different diagnoses (N⫽319). Interventions: Not applicable. Main Outcome Measures: Effect sizes of the USER were compared with those of the Barthel Index, FIM instrument, and 36-Item Short-Form Health Survey (SF-36). Results: Strong correlations were found between the motor scores of USER, Barthel Index, and FIM (range, .91⫺.96), and the cognitive scores of USER and FIM (.88). Correlations between USER mood scores and SF-36 mental health scores were .67 to .69. Effect sizes of the motor scores were .97 (USER), .90 (Barthel Index), and .83 (FIM). In patients with spinal cord injuries (n⫽44), effect sizes of the Arch Phys Med Rehabil Vol 88, October 2007
2007 ACRM Annual Conference Abstracts Provided here are the abstracts of scientific papers and posters presented at the joint 84th Annual Meeting of the American Congress of Rehabilitation Medicine (ACRM) and the 14th Annual Meeting of the American Society of Neurorehabilitation (ASNR), in Washington, DC, October 3ⴚ7, 2007. Papers and posters were chosen by the joint ACRMⴚASNR program committee. The abstracts have not been subjected to formal peer review by the Editorial Board of the Archives of Physical Medicine and Rehabilitation. Abstracts from the 2007 ACRMⴚASNR Joint Conference are published in both society journals: Archives of Physical Medicine and Rehabilitation 2007;88(10):E1-27, and Neurorehabilitation and Neural Repair 2007;21(6).
Paper Presentations Article 1 A Practical Clinical Trial of Holistic Neuropsychologic Rehabilitation After Traumatic Brain Injury. Keith Cicerone (JFK-Johnson Rehabilitation Institute, United States), Tasha Mott, Joanne Azulay, Mary Sharlow-Galella, Wendy Ellmo, John Friel, Susan Paradise. Disclosure: None declared. Objective: To evaluate the effectiveness of intensive-holistic cognitive rehabilitation (ICRP) and “standard” neurorehabilitation (SRP) for traumatic brain injury. Design: Randomized controlled trial with 6-month follow-up. Setting: Outpatient brain injury rehabilitation program. Participants: 68 participants randomly assigned to ICRP (n⫽34) or SRP (n⫽34). Interventions: ICRP consisted of individual and group interventions emphasizing self-regulation, interpersonal communication, functional problem solving, and self-efficacy for management of symptoms. SRP primarily consisted of individual physical therapy, occupational therapy, speech therapy. and neuropsychologic treatment. Both interventions lasted 17 weeks. Main Outcome Measures: Primary outcomes were community integration (Community Integration Questionnaire [CIQ]) and perceived quality of life (QOL). Neuropsychologic functioning was assessed before and after treatment. Results: Neuropsychologic functioning improved equally in both groups (P⬍.001). CIQ exhibited a significant interaction of treatment conditions with significant improvement after ICRP (P⫽.004), while SRP did not change. Perceived QOL showed a significant main effect (P⫽.011) and interaction on perceived QOL due to improvement of ICRP (P⫽.004) with no benefit of SRP. Benefits were maintained at 6-month follow-up. Conclusions: There are significant benefits from ICRP in community integration and life satisfaction compared with standard neurorehabilitation for traumatic brain injury. Key Words: Brain injuries; Rehabilitation. Article 2 The Psychologic Effects of Employment Following Traumatic Brain Injury: Objective and Subjective Indicators. Theodore Tsaousides (Mount Sinai School of Medicine, United States), Teresa Ashman, Colette Seter. Disclosure: Supported by NIDRR (grant no. H133b040033). Objective: To examine the differential effect of objective and subjective indicators of employment on psychologic well-being, quality of life (QOL), and depression following traumatic brain injury (TBI). Design: Quasi-experimental. Setting: Research and training center on TBI interventions, in a school of medicine, in New York City. Participants: 437 individuals with TBI (age range, 18⫺65y) living in the community independently. Interventions: Not applicable. Main Outcome Measures: Bigelow’s Psychological Well-Being Scale,
Life⫺3, and Beck Depression Inventory⫺II. The objective indicator of employment included level of employment (no employment, part-time, full-time) and the subjective indicator included work discrepancy, which was defined as the discrepancy between the perceived importance of work and the degree to which work needs are met. Results: A substantial percentage of subjects with TBI reported large negative changes in level of employment. Psychologic well-being was not significantly related to any predictor variables. QOL was significantly related to level of employment level (.15), work discrepancy (⫺.29), and income (.23). Depression was significantly related to education (⫺.10), income (⫺.14), level of employment (⫺.17), and work discrepancy (.19). Hierarchical multiple regression showed that work discrepancy contributed significantly to QOL and depression variance above and beyond all other predictors. Conclusions: The results of this study highlight the importance of including subjective indicators of employment when assessing QOL and depression in persons with TBI. The benefits of TBI rehabilitation could be optimized when traditional goals of rehabilitation (ie, return to work) are combined with more subjective and personally meaningful goals. Understanding the importance ascribed to work and identifying appropriate ways to help people fulfill their employment needs is likely to contribute further to QOL and improved mood. Key Words: Brain injuries; Employment; Quality of life; Rehabilitation. Article 3 Responsiveness of the Utrecht Scale for Evaluation of Rehabilitation. Marcel Post (De Hoogstraat, Netherlands), Rebecca Baines, Ingrid van de Port, Renee Peeters, Steven Berdenis van Berlekom. Disclosure: None declared. Objective: To examine the validity and responsiveness of the Utrecht Scale for Evaluation of Rehabilitation (USER), a generic measure covering mobility, self-care, cognition, pain, fatigue, and mood. Design: Longitudinal study with measurements at admission and at discharge from clinical rehabilitation, with a maximum period between measurements of 4 months. Setting: 3 rehabilitation facilities in The Netherlands. Participants: Rehabilitation inpatients with different diagnoses (N⫽319). Interventions: Not applicable. Main Outcome Measures: Effect sizes of the USER were compared with those of the Barthel Index, FIM instrument, and 36-Item Short-Form Health Survey (SF-36). Results: Strong correlations were found between the motor scores of USER, Barthel Index, and FIM (range, .91⫺.96), and the cognitive scores of USER and FIM (.88). Correlations between USER mood scores and SF-36 mental health scores were .67 to .69. Effect sizes of the motor scores were .97 (USER), .90 (Barthel Index), and .83 (FIM). In patients with spinal cord injuries (n⫽44), effect sizes of the Arch Phys Med Rehabil Vol 88, October 2007