Article

OBJECTIVES: To (1) assess the effectiveness of home- and community-based
rehabilitation (HCBR) in a large cohort of individuals with disabilities
secondary to cerebrovascular accident (CVA); and (2) evaluate the responsiveness
to treatment of the Mayo-Portland Adaptability Inventory (MPAI-4) to changes
resulting from HCBR in this patient group. DESIGN: Retrospective analysis of
program evaluation data for treatment completers and noncompleters. SETTING:
HCBR conducted in 7 geographically distinct U.S. cities. PARTICIPANTS: Individuals
with CVA (n=738) who completed the prescribed course of rehabilitation (completed
course of treatment [CCT]) compared with 150 individuals who were precipitously
discharged (PD) before program completion. INTERVENTION: HCBR delivered by
certified professional staff on an individualized basis. MAIN OUTCOME MEASURES:
Mayo-Portland Adaptability Inventory (MPAI-4) completed by professional consensus
on admission and at discharge. RESULTS: With the use of analysis of covariance,
MPAI-4 total scores at discharge for CCT participants were compared with those of
PD participants, with admission MPAI-4, age, length of stay, and time since event
as covariates. CCT participants showed greater improvement than PD participants
(F=99.48, P<.001) with a moderate effect size (partial eta(2)=.10). Group
differences and effect sizes were similar for the 3 index scores: Ability
(F=75.96, P<.001; partial eta(2)=.08), Adjustment (F=99.67, P<.001; partial
eta(2)=.10), and Participation (F=69.15, P<.001; partial eta(2)=.07).
CONCLUSIONS: Individuals in the CCT group who received the entire planned course
of HCBR showed greater improvement on all MPAI-4 indexes than those in the PD
group who were discharged before completing the prescribed program. This
dose-response relationship provides evidence of a causal relationship between
treatment and outcome.
CI - Copyright (c) 2013 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS