Neurologic continuum of care: Evidence-based model of a post-hospital system of care

BACKGROUND: There is increasing need for a well-organized continuum of post-hospital rehabilitative care to reduce long term disability resulting from acquired brain injury. OBJECTIVE: This study examined the effectiveness of four levels of post-hospital care (active neurorehabilitation, neurobehavioral intensive, day treatment, and supported living) and the functional variables most important to their success. METHODS: Participants were 1276 adults with acquired brain injury who were being treated in one of the four program levels. A Repeated Measures MANOVA was used to evaluate change from admission to discharge on the Mayo Portland Adaptability Inventory-4 T-scores. Regression analyses were used to identify predictors of outcome. RESULTS: Statistical improvement on the MPAI-4 was observed at each program level. Self-care and Initiation were the strongest predictors of outcome. CONCLUSION: The results support the effectiveness of a continuum of care for acquired brain injury individuals beyond hospitalization and acute in-hospital rehabilitation. It is particularly noteworthy that reduction in disability was achieved for all levels of programming even with participants whose onset to admission exceeded 7 years post-injury.