Category: Brain Injury; Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development)
Objective : Evaluate characteristics of Activity Measure for Post-Acute Care (AM-PAC) as an outcome measure of activity limitations in individuals with TBI and apply it to evaluate changes in activity limitations in individuals receiving specialized brain injury rehabilitation.
Design : This longitudinal evaluation of the applicability of a functional activity limitations measure to evaluate changes among individuals with TBI across the rehabilitation continuum involves: 1) validation of AM-PAC in individuals with TBI; 2) application of AM-PAC in a before-after trial to determine changes in activity limitations following specialized outpatient brain injury rehabilitation.
Setting : Community hospital outpatient brain injury rehabilitaion program
Participants (or Animals, Specimens, Cadavers) : 38 individuals (mean age=46+/-13.7) with a documented history of TBI (time since injury 5-231 weeks, mean=60 weeks) enrolled in specialized post-acute rehabilitation able to provide informed consent and have a proxy who can complete AM-PAC. Exclusion criteria: current cognitive complaints or neurological history preceded the TBI; active psychosis or substance abuse.
Interventions : Specialized individualized multidisciplinary cognitive rehabilitation.
Main Outcome Measure(s) : AM-PAC (Basic Mobility, Daily Living, Applied Cognitive indices) administered to patients and proxies; Neuropsychological Assessment Battery Daily Living Scales; Texas Functional Living Scale; Dynamic Gait Index; Berg Balance Scale.
Results : Everyone completed AM-PAC. Awareness was not significantly correlated with any outcomes, suggesting this was not a significant factor in this population. As predicted, AM-PAC mobility scales correlated with traditional measures of mobility. AM-PAC daily living scales correlated with neuropsychological cognitive scales but not with the traditional measure of functional daily living. AM-PAC applied cognitive scales correlated with traditional measure of cognitive driving skills and traditional measure of functional daily living. There were significant patient-proxy agreements for all AM-PAC scales, suggesting this aspect of the measure extends to individuals with TBI. Pre-post analyses controlling for age, age at injury, time since injury and injury severity revealed significant post-treatment improvements in all functional areas assessed by AM-PAC.
Conclusions : AM-PAC is a functional assessment tool capable of capturing the occurrence of and changes in functional limitations over time to accurately assess patient needs that meets current legislative rehabilitation setting requirements. Preliminary data from this study suggest that it is likely to be a valid and applicable measure in individuals with TBI, with a need to clarify the specific functions assessed by its indices. Findings suggest significant improvements in important functional activities of daily living following outpatient rehabilitation.
Yelena Goldin– Clinical and Research Neuropsychologist, JFK Johnson Rehabilitation Institute, Edison, New Jersey
Keith Cicerone– Director of Neuropsychology / Rehabilitation Psychology / Cognitive Rehabilitation, JFK Johnson Rehabilitation Insitute, Edison, New Jersey