Intensive Multi-Disciplinary Outpatient Rehabilitation for Facilitating Return-to-Work after Acquired Brain Injury: A Case-Control Study.
Gabriela Moreno Legast, Amandine Durand, Tatiana Aboulafia Brakha and 2 others
PMID 35861581WHAT IT FOUND
Patients in a coordinated daytime hospital programme were more likely to return to over half their previous work level than those in standard outpatient care.
However, neither the primary outcome nor the overall return-to-work rate reached statistical significance, so this is a promising trend rather than proof of benefit.
Key findings
01The primary outcome, the proportion of patients returning to more than 50% of their pre-morbid work level, was higher in the coordinated group (55%) than the control group (41%), but this difference was not statistically significant (p = 0.076).
02The median final return-to-work rate increased from 45% of pre-morbid level in the control period to 80% in the coordinated period, but this also failed to reach statistical significance (p = 0.187) due to high variability between patients.
03The coordinated programme involved significantly higher treatment intensity and costs compared to the control period, but because multiple therapies were delivered together, the contribution of any single component cannot be separated.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study was underpowered to detect significant differences due to high variability between patients. It is a retrospective case-control study with a historic control group, which introduces potential biases. Multiple therapies (physical, cognitive, occupational, psychological) were delivered simultaneously in the coordinated group, making it impossible to determine which specific intervention or component drove the observed trends. Data on treatments received outside the hospital in private practices were not registered, so the true intensity difference between groups may be overestimated. The study was not registered in a clinical trial registry.
Declared interests
The authors declare no conflicts of interest. The study was approved by the ethics committee of the canton of Geneva.
The easy way to misread this
Do not interpret the higher percentages in the coordinated group as proof that this specific daytime hospital model works. Both the primary outcome (p = 0.076) and the secondary return-to-work rate (p = 0.187) failed to reach statistical significance. Additionally, because patients received a bundle of intensive therapies, you cannot attribute the trend to any single discipline or intervention component.