Occupational performance priorities and outcomes in long-term transitional rehabilitation for young adults with acquired brain injury.

There was no comparison group and everyone received the same programme, so the improvements cannot be attributed to the rehabilitation. The authors state that the study cannot draw a direct conclusion about treatment effects for this group of patients. Participants were 18 to 25 and were followed for up to seven years, an age when social, study and work skills change anyway; the study cannot separate the programme from ordinary growing up. Only 46 people from the service's larger clinical collection had data at both admission and discharge. The rest were still in the programme and were not included, and it is not clear how they differed. The data cover the team's first nine years, during which clinical experience grew and methods changed, including the general introduction of evidence-based working in the department. The cohort mixes people injured in childhood with people injured in their late teens, so nothing can be concluded about the effect of age at injury. The GOSE ratings were made mostly by one physician. The authors note that differences between raters are a known disadvantage of that measure. Both COPM scores are the patient's own rating of goals they chose themselves, so they measure what each patient felt had changed, with no independent assessment.

The authors declare no conflicts of interest. The study was funded by the rehabilitation department and Karolinska Institutet unit that ran the service, plus two patient organisations (the Swedish association for people with polio, accident and injury, and the brain injury association Hjärnkraft). No commercial or industry sponsor.

The improvements are not proof that the transitional rehabilitation programme works. There was no comparison group, everyone received the same programme, and the participants were 18 to 25 and could have kept improving as they got older. The authors themselves say the study cannot draw a direct conclusion about treatment effects.