5.4 Community Based Rehabilitation Programs for ABI

Case Study (continued)

The patient was eventually discharged home, fully ambulatory but still with short-term memory difficulties, some trouble with higher level ADL tasks, irritability and complaining of some anxiety about leaving the hospital.  A community based rehabilitation program is recommended but the insurer questions the benefit of a community based rehabilitation program for this patient.

What is the impact of community based rehabilitation programs for patients with acquired brain injury?

  1. There is Level 2 evidence that rehabilitation, whether hospital-based (outpatient) or community-based, improves the level of independence for persons with an acquired brain injury. These effects were maintained one to three years later.
     
  2. There is Level 4 evidence for the positive effects of community-based rehabilitation programs that use a peer or supported relationship model of intervention.
     
  3. The data supporting community based rehabilitation for ABI patients is by no means definitive and there is some question as to its benefit for a physical mobility and cognitive independence.
  • Rehabilitation care provided in the community is often proposed as an attractive and cost effective alternative to residential or hospital-based rehabilitation programs.
     
  • Overall, the evidence for community-based rehabilitation is not better than that for institutional care; however, there is some benefit in focusing on psychosocial and community reintegration issues although the data supporting community based rehabilitation for ABI patients is by no means definitive and there is some question as to its benefit in physical mobility and cognitive independence issues.

For a more detailed discussion please see ERABI/Community Reintegration Post ABI/Productivity.