Ps. Klonoff et al., OUTCOME ASSESSMENT AFTER MILIEU-ORIENTED REHABILITATION - NEW CONSIDERATIONS, Archives of physical medicine and rehabilitation, 79(6), 1998, pp. 684-690
Objective: This study incorporated level of functional impairment rati
ngs at program admission into rehabilitation outcome (return to work/s
chool) at the time of program discharge. Hypotheses: (1) Patients and
families with better working alliance ratings will show better adjuste
d outcome; (2) patients seeking compensation will have poorer outcome
than those not seeking compensation or receiving benefits; (3) speed o
f information processing and memory will relate to the level of adjust
ed outcome. Design: Consecutive neurorehabilitation admissions from Ma
rch 1992 to May 1996. Setting: Outpatient milieu-based interdisciplina
ry day treatment program. Subjects: Sixty-four patients with heterogen
eous brain injury etiologies. Main Outcome Measures: Adjusted outcome,
defined as level of discharge productivity adjusted by staff ratings
of functional severity of impairment at program admission; work readin
ess and work eagerness, based on average staff ratings. Results: At di
scharge, 89.5% of patients showed fair or good adjusted outcome; 62% w
ere gainfully employed/full-time students; 15.6% resumed preinjury sta
tus. Better working alliance predicted better adjusted outcome. Patien
ts seeking compensation showed significantly lower work eagerness rati
ngs. Poorer outcome was associated with better neuropsychological stat
us. Conclusions: Efficacy of neurorehabilitation was demonstrated for
patients with better working alliance who were not seeking compensatio
n. Adjusted outcome demonstrated greater sensitivity and utility by in
corporating the variable of functional severity of impairment at progr
am admission, Inclusion of ''process'' variables addressing working al
liance, motivation, and capacity to work provide important contributio
ns to understanding rehabilitation outcome. (C) 1998 by the American C
ongress of Rehabilitation Medicine and the American Academy of Physica
l Medicine and Rehabilitation.