RESEARCH QUESTION: What is the impact of interdisciplinary rehabilitation on traumatic brain injury (TBI) survivor community participation and life satisfaction as well as family and caregiver burden?

RATIONALE: TBI is a leading cause of death and disability in young adults. Despite advances in medical technology and rehabilitation, the majority of survivors of TBI transition from hospital to community with some residual cognitive, psychosocial, behavioral, or physical impairment. Additionally, the significant strain placed on family members caring for injured relatives is well documented in the literature, negatively affecting their physical health and contributing to emotional distress and the likelihood of depression. As experts in functional rehabilitation, it is essential that occupational therapy practitioners not only understand the challenges of TBI rehabilitation but the complexity of factors affecting successful community participation.

DESIGN: Quasi-experimental, longitudinal

PARTICIPANTS: Consecutive admissions to an inpatient rehabilitation facility serving individuals with TBI and other neurological conditions. TBI survivors ages 18–65 yr were included in the study. Twenty-five participants were initially recruited into the study, 13 completed all forms at 1-yr follow-up.

METHOD: Determination of treatment program effectiveness is being established through assessment and discharge scores of the FIM^™ and the Satisfaction With Life Scale (SWLS).Community integration following treatment program discharge is being evaluated at 90-day and 1-yr follow-up via the FIM, Caregiver Burden Scale, Community Integration Questionnaire, and SWLS.

ANALYSIS: Nonparametric statistics used to determine differences in assessment scores between testing periods and correlations among variables. The Wilcoxon test was used to determine differences in scores between evaluation periods, and Spearman correlations were used to evaluate associations between variables.

RESULTS: Significant improvements in basic activities of daily living (ADLs) from initial evaluation through hospital discharge and again at 90-day follow-up. FIM scores did not change from 90-day to 1-yr periods. Mean community integration scores did not significantly change between 90-day and 1-yr follow-up. Caregiver needs decreased between follow-up periods, but overall caregiver burden did not significantly change over the course of the 1-yr follow-up periods. Mean satisfaction with life scores did not significantly change from baseline through the three evaluation periods. Longer inpatient admission, lower FIM scores, and lower community integration scale scores were associated with greater caregiver burden. Lower FIM scores at discharge were associated with greater caregiver burden and lower community integration at 1 yr.

DISCUSSION: The findings of the study highlight the value of inpatient rehabilitation in facilitating functional improvements along with the impact of those changes on long-term community participation, life satisfaction, and caregiver burden. Caregiver burden is a long-term issue that can significantly affect relationships and the recovery process.

IMPACT STATEMENT: This study highlights both the benefits of inpatient rehabilitation after TBI and the struggles that continue postdischarge for survivors and caregivers. With their expertise in functional rehabilitation and holistic focus, occupational therapists play a key role in the complexities of the TBI recovery process. Although independence in basic ADLs may create an important foundation for community participation and life satisfaction, this study indicates that more is needed to improve what has become a major societal issue.