{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T21:00:03Z","timestamp":1763499603467,"version":"3.41.2"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2020,11,30]],"date-time":"2020-11-30T00:00:00Z","timestamp":1606694400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"Introduction:<\/jats:bold> Early Supported Discharge (ESD) is a clinical flow management service offering interdisciplinary rehabilitation, wherein patients are provided supported in-home rehabilitation treatment; in comparison to conventional hospital-based rehabilitation model of service delivery. There has been little research into the functional outcomes for other types of acquired brain injury (ABI).<\/jats:p>Methods:<\/jats:bold> In this prospective cohort study, ABI patients presenting at a level I trauma center in Calgary, Canada were placed in either an ESD program or conventional inpatient rehabilitation (IPR) program based on their medical history and presentation. A small number of patients completed both programs (ESD+IPR group). ESD therapies were designed to emulate IPR. Participants completed professionally-rated Mayo-Portland Adaptability Index-4 (MPAI), Quality of Life after Brain Injury (QOLIBRI), Generalized Anxiety Questionnaire-7 (GAD7), Montreal Cognitive Assessment (MoCA), and Patient Health Questionnaire-9 (PHQ9) surveys at 1, 3, and 6 months following initial assessment pre-rehabilitation. Caregivers completed the Zarit Burden Interview (ZBI) at the same time points. The Supervision Rating Scale (SRS) and Disability Rating Scale (DRS) were completed at admission to rehabilitation and all follow-ups. Generalized estimate equations models were used to describe the three groups over time, including age as a covariate.<\/jats:p>Results:<\/jats:bold> Significant effects of time were reported in the MPAI participant sub-score in the ESD and IPR groups (\u03c7<\/mml:mi><\/mml:mrow>(<\/mml:mo>2<\/mml:mn><\/mml:mrow>)<\/mml:mo><\/mml:mrow><\/mml:mrow>2<\/mml:mn><\/mml:mrow><\/mml:msubsup><\/mml:math><\/jats:inline-formula> = 42.429, p<\/jats:italic> &lt; 0.000; \u03c7<\/mml:mi><\/mml:mrow>(<\/mml:mo>2<\/mml:mn><\/mml:mrow>)<\/mml:mo><\/mml:mrow><\/mml:mrow>2<\/mml:mn><\/mml:mrow><\/mml:msubsup><\/mml:math><\/jats:inline-formula> = 9.773, p<\/jats:italic> = 0.008), showing significantly higher scores between 1 and 3 month timepoints for both groups. ZBI scores were significantly lower in the ESD group at 1 month compared to 3 and 6 months (\u03c7<\/mml:mi><\/mml:mrow>(<\/mml:mo>2<\/mml:mn><\/mml:mrow>)<\/mml:mo><\/mml:mrow><\/mml:mrow>2<\/mml:mn><\/mml:mrow><\/mml:msubsup><\/mml:math><\/jats:inline-formula> = 31.252, p<\/jats:italic> &lt; 0.001). The proportion of patients with medical complications during rehabilitation was 25.3% in ESD compared to 74.7% patients in IPR.<\/jats:p>Conclusions:<\/jats:bold> Improvements in functional outcomes were evident in patients participating in ESD and IPR, with more medical complications reported in the IPR group. Caregiver burden lessened over time in the ESD group but not in the IPR group. Both ESD and ESD+IPR groups can be considered viable alternatives to traditional inpatient rehabilitation. A randomized control trial would be required to properly compare rehabilitation streams. Further investigation into affective and lifestyle elements of ABI recovery would also improve our understanding of targeted neurorehabilitation in this population.<\/jats:p>","DOI":"10.3389\/fneur.2020.596526","type":"journal-article","created":{"date-parts":[[2020,11,30]],"date-time":"2020-11-30T06:40:00Z","timestamp":1606718400000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Early Supported Discharge for Neurorehabilitation Following Acquired Brain Injury"],"prefix":"10.3389","volume":"11","author":[{"given":"Regan","family":"King","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Trevor","family":"Seeger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meng","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rodney","family":"Li Pi Shan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine","family":"McGovern","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason","family":"Knox","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa","family":"Patel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tak","family":"Fung","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tolulope","family":"Sajobi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chantel","family":"Debert","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2020,11,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"329241","DOI":"10.1155\/2015\/329241","article-title":"Life after adolescent and adult moderate and severe traumatic brain injury: self-reported executive, emotional, and behavioural function 2-5 years after injury","volume":"2015","author":"Finnanger","year":"2015","journal-title":"Behav Neurol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"2691","DOI":"10.1089\/neu.2017.5486","article-title":"Prediction of persistent post-concussion symptoms after mild traumatic brain injury","volume":"35","author":"Cnossen","year":"2018","journal-title":"J Neurotrauma."},{"key":"B3","doi-asserted-by":"publisher","first-page":"281","DOI":"10.2147\/CEOR.S44625","article-title":"The costs of traumatic brain injury: a literature review","volume":"5","author":"Humphreys","year":"2013","journal-title":"Clinicoecon Outcomes Res."},{"key":"B4","doi-asserted-by":"publisher","first-page":"370","DOI":"10.1177\/0269215513502212","article-title":"Implementing evidence-based stroke Early Supported Discharge services: a qualitative study of challenges, facilitators and impact","volume":"28","author":"Chouliara","year":"2014","journal-title":"Clin Rehab."},{"key":"B5","doi-asserted-by":"publisher","first-page":"2198","DOI":"10.1161\/STROKEAHA.111.646091","article-title":"Cost avoidance associated with optimal stroke care in Canada","volume":"43","author":"Krueger","year":"2012","journal-title":"Stroke."},{"key":"B6","doi-asserted-by":"publisher","first-page":"750","DOI":"10.1177\/0269215512474030","article-title":"A qualitative study exploring patients' and carers' experiences of Early Supported Discharge services after stroke","volume":"27","author":"Cobley","year":"2013","journal-title":"Clin Rehab."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1016","DOI":"10.1161\/01.STR.31.5.1016","article-title":"There's no place like home: an evaluation of early supported discharge for stroke","volume":"31","author":"Mayo","year":"2000","journal-title":"Stroke."},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD000443.pub3","article-title":"Services for reducing duration of hospital care for acute stroke patients","author":"Fearon","year":"2012","journal-title":"Cochrane Database Syst Rev"},{"key":"B9","doi-asserted-by":"publisher","first-page":"2989","DOI":"10.1161\/01.STR.31.12.2989","article-title":"Benefit of an extended stroke unit service with early supported discharge: a randomized, controlled trial","volume":"31","author":"Indredavik","year":"2000","journal-title":"Stroke."},{"key":"B10","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1161\/01.STR.0000152288.42701.a6","article-title":"L. A randomized controlled trial of early supported discharge and continued rehabilitation at home after stroke: five-year follow-up of patient outcome","volume":"36","author":"Thors\u00e9n","year":"2005","journal-title":"Stroke."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1203","DOI":"10.3109\/09638288.2010.525286","article-title":"Comparing the experience of outpatient therapy in home and day hospital settings after traumatic brain injury: patient, significant other and therapist perspectives","volume":"33","author":"Doig","year":"2011","journal-title":"Disabil Rehab."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1114","DOI":"10.3109\/02699052.2011.607788","article-title":"Goal-directed outpatient rehabilitation following TBI: a pilot study of programme effectiveness and comparison of outcomes in home and day hospital settings","volume":"25","author":"Doig","year":"2011","journal-title":"Brain Injury."},{"key":"B13","doi-asserted-by":"publisher","first-page":"765","DOI":"10.1016\/S0003-9993(96)90254-3","article-title":"Supervision Rating Scale: a measure of functional outcome from brain injury","volume":"77","author":"Boake","year":"1996","journal-title":"Arch Phys Med Rehab."},{"key":"B14","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1111\/j.1532-5415.2005.53221.x","article-title":"The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment","volume":"53","author":"Nasreddine","year":"2005","journal-title":"J Am Geriatr Soc."},{"key":"B15","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1037\/t29015-000","article-title":"Disability rating scale for severe head trauma: coma to community","volume":"63","author":"Rappaport","year":"1982","journal-title":"Arch Phys Med Rehab."},{"key":"B16","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1007\/3-211-27577-0_6","article-title":"Assessment of health-related quality of life in persons after traumatic brain injury-development of the Qolibri, a specific measure. In: von Wild K.R.H, editor","volume-title":"Re-Engineering of the Damaged Brain and Spinal Cord","author":"von Steinbuechel","year":"2005"},{"key":"B17","doi-asserted-by":"crossref","DOI":"10.1037\/t29117-000","volume-title":"The Mayo Portland Adaptability Inventory","author":"Malec","year":"2014"},{"key":"B18","doi-asserted-by":"publisher","first-page":"302","DOI":"10.2340\/16501977-0511","article-title":"Factor analysis and Rasch analysis of the Zarit Burden Interview for acquired brain injury carer research","volume":"42","author":"Siegert","year":"2010","journal-title":"J Rehab Med."},{"key":"B19","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1080\/02699050310001646134","article-title":"Comparability of Mayo-Portland Adaptability Inventory ratings by staff, significant others and people with acquired brain injury","volume":"18","author":"Malec","year":"2004","journal-title":"Brain Injury."},{"key":"B20","doi-asserted-by":"publisher","first-page":"663","DOI":"10.1080\/09602011.2015.1013139","article-title":"Outcome prediction in home-and community-based brain injury rehabilitation using the Mayo-Portland Adaptability Inventory","volume":"25","author":"Malec","year":"2015","journal-title":"Neuropsychol Rehab."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"A brief measure for assessing generalized anxiety disorder: the GAD-7","volume":"166","author":"Spitzer","year":"2006","journal-title":"Arch Intern Med."},{"key":"B22","doi-asserted-by":"publisher","first-page":"509","DOI":"10.3928\/0048-5713-20020901-06","article-title":"The PHQ-9: a new depression diagnostic and severity measure","volume":"32","author":"Kroenke","year":"2002","journal-title":"Psychiatr Ann."},{"key":"B23","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)-a metadata-driven methodology and workflow process for providing translational research informatics support","volume":"42","author":"Harris","year":"2009","journal-title":"J Biomed inform."},{"key":"B24","doi-asserted-by":"publisher","first-page":"414","DOI":"10.1161\/STROKEAHA.107.489294","article-title":"Medical complications in a comprehensive stroke unit and an early supported discharge service","volume":"39","author":"Indredavik","year":"2008","journal-title":"Stroke."},{"key":"B25","doi-asserted-by":"publisher","first-page":"3 p","DOI":"10.1016\/S0270-6644(11)70444-1","article-title":"Aggression May Follow Moderate to Severe TBI","author":"Osterweil","year":"2011","journal-title":"Clinical Psychiatry News Digital Network"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2020.596526\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,11,30]],"date-time":"2020-11-30T06:40:02Z","timestamp":1606718402000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2020.596526\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,30]]},"references-count":25,"alternative-id":["10.3389\/fneur.2020.596526"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2020.596526","relation":{},"ISSN":["1664-2295"],"issn-type":[{"type":"electronic","value":"1664-2295"}],"subject":[],"published":{"date-parts":[[2020,11,30]]},"article-number":"596526"}}