Efficacy of activities of daily living retraining during posttraumatic amnesia: A randomised controlled trial

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.