The effectiveness of a community based life skills training program for traumatic brain injury.

摘要

This study examines clinical outcomes associated with a community based, transitional living program for individuals with traumatic brain injury (TBI) that utilizes a Life Coach Model of rehabilitation. While community based rehabilitation is frequently cited as ideal for managing the cognitive and behavioral symptoms associated with TBI, research based evidence for such models is lacking. The intent of this research was to advance knowledge of community based TBI rehabilitation and specifically, the effectiveness of the Life Coach Model, through evaluating the impact of life coaching on community integration and self reported satisfaction with life. Background. TBI is a leading cause of death and disability in young adults. Trends in inpatient TBI rehabilitation suggest decreasing lengths of inpatient hospital stay. Additionally, the transition from the structured hospital based setting to home and community settings have historically been difficult for many survivors of TBI, placing excessive demands on caregivers and social service agencies. Identifying successful models of rehabilitation for reducing disability through increased societal participation is a frequently cited priority TBI research need. The World Health Organization's International Classification of Functioning, Disability, and Health (ICF) provides a framework for the construct of disability and illustrates the interaction between person and environment. With its emphasis on societal participation, the ICF is well suited to conceptualizing the complexities of TBI rehabilitation and outcomes as well as a model for evaluating clinical outcomes at the community level. Satisfaction with life is considered an important measure of rehabilitation outcome and was included in the study to facilitate comprehensive program evaluation. Method. A quasi-experimental design was employed to compare individuals with TBI participating in a community based rehabilitation program with other persons with TBI residing in the community. In addition to having had a TBI of moderate or greater severity, treatment and comparison subjects were matched for gender, age, education, and time since injury. Both within and between group comparisons were made after a 90 day follow-up period using the Community Integration Questionnaire (CIQ) and the Satisfaction with Life Scale (SWLS). Subjects. A sample of 18 treatment and 18 comparison subjects aged 18--55 were included in the study. Subjects in the experimental condition represented a convenience sample of consecutive admissions to a community based life skills training program using the Life Coach model of rehabilitation. Comparison subjects were recruited from neurological and neuropsychological practices, outpatient rehabilitation clinics, and community based services for the TBI population. Results. Significant improvements in community integration were found on two of three CIQ subscales at follow-up for the Life Skills Coaching participants while no change was found for the comparison subjects. There were no between-group differences at follow-up on community integration, a finding possibly attributable to pre-treatment differences on CIQ scores. No significant within or between group differences were found on life satisfaction scores. However, pre-treatment differences were also present on SWLS scores. Conclusions . Findings of the study tentatively support life coaching as a means of improving community integration. Further research is needed with to more decisively determine the effectiveness of life skills coaching and the relationship between community integration and life satisfaction using groups matched for baseline levels of community integration and life satisfaction.