OUTCOME ASSESSMENT AFTER MILIEU-ORIENTED REHABILITATION - NEW CONSIDERATIONS

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.