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Title: Efficacy of activities of daily living retraining during posttraumatic amnesia: A randomised controlled trial
Authors: Ponsford, Jennie
Trevena-Peters, Jessica
McKay, Adam
Spitz, Gershon
Rachel, Suda Bach
Renison, Belinda
Keywords: Activities of Daily Living
Post Traumatic Amnesia
Treatment As Usual
Functional Independence Measure
Community Integration Questionnaire
Agitated Behavior Scale
Traumatic Brain Injury
Speech Therapy
Occupational Therapy
PTA Emergence
PTA Duration
Post Traumatic Amnesia Emergence
Post Traumatic Amnesia Duration
Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia
Issue Date: Sep-2017
Publisher: Elsevier
Citation: Arch Phys Med Rehabil. 2018 Feb; 99(2): 329-337.e2
Abstract: OBJECTIVE: To assess the efficacy of Activities of Daily Living (ADL) retraining during posttraumatic amnesia (PTA), compared with ADL retraining commencing after emergence from PTA. DESIGN: Randomised controlled trial. SETTING: Inpatient rehabilitation centre. PARTICIPANTS: 104 participants with severe TBI, admitted to rehabilitation and remaining in PTA for > 7 days, were randomised to receive either treatment as usual (TAU) with daily ADL retraining (Treatment), or TAU alone (physiotherapy, necessary speech therapy), during PTA. INTERVENTION: ADL retraining was manualised, followed errorless and procedural learning principles, and included individualised goals. Both groups received occupational therapy as usual following PTA. OUTCOME MEASURES: Primary outcome was the Functional Independence Measure (FIM) completed at admission, PTA emergence, discharge, and 2-month follow-up. Secondary outcomes included length of rehabilitation inpatient stay, PTA duration, Agitated Behavior Scale scores, and Community Integration Questionnaire (CIQ) scores at follow-up. Groups did not significantly differ in baseline characteristics. RESULTS: On the primary outcome, FIM total change, random effects regression revealed a significant interaction of group and time (p<0.01). The treatment group had greater improvement in FIM scores from baseline to PTA emergence, maintained at discharge, although not at follow-up. Twenty-seven percent more of the treatment group reliably changed on FIM scores at PTA emergence. Group differences in length of stay, PTA duration, agitation, and CIQ scores were not significant; however, TAU trended toward longer length of stay and PTA duration. CONCLUSION: Individuals in PTA can benefit from skill retraining.
DOI: doi: 10.1016/j.apmr.2017.08.486
PubMed URL:
ISSN: 0003-9993
Journal Title: Archives of Physical Medicine and Rehabilitation
Type: Journal Article
Affiliated Organisations: Monash Institute of Cognitive & Clinical Neurosciences and School of Psychological Sciences Monash University, Clayton VIC, Australia
Type of Clinical Study or Trial: Randomized Controlled Clinical Trial
Appears in Collections:Neurosciences

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