A. Shiel et al., The effects of increased rehabilitation therapy after brain injury: results of a prospective controlled trial, CLIN REHAB, 15(5), 2001, pp. 501-514
Objective: The objective was to investigate the effect of increased intensi
ty of rehabilitation therapy provided to brain-injured subjects on the rate
at which independence was regained and the duration of hospital admission.
Design: A two-centre, prospective, controlled study with random allocation
to groups.
Setting: Two district general hospitals on the south coast of England.
Subjects: Fifty-six people with moderate and severe head injury consecutive
ly admitted to Southampton and Poole hospitals between June 1995 and Septem
ber 1997.
Interventions: Increased intensity of rehabilitation therapy input without
change in content.
Results: Subjects receiving more intensive therapy made more rapid progress
and were discharged home sooner. The different intensities of therapy empl
oyed in this study showed no evidence of a 'ceiling' effect and the 'interv
ention group' made significantly more rapid progress on tests of dependency
during the period of admission. A clear response to increased therapy inpu
t was seen in one of the centres with more rapid functional improvement and
a shorter length of hospital stay. This centre already had more therapy an
d better community facilities. No such benefits were seen at the other cent
re where the intervention group had a longer hospital stay than the routine
group.
Conclusion: Increasing the hours per week of therapy given to adults recove
ring from brain injury in hospital can accelerate the rate of recovery of p
ersonal independence and result in their being discharged from hospital soo
ner. Increased rehabilitation therapy after brain injury is associated with
enhanced functional recovery and shorter hospital stay if provided in the
context of an integrated service that can provide ongoing community support
. There is no evidence of any ceiling effect of therapeutic intensity beyon
d which no further response is observed.