Investigation of community participation outcomes for adults with acquired brain injury after discharge from post-acute rehabilitation: A mixed-methods study

Site: The Brightwater ‘Oats Street’ Facility is an acquired brain injury rehabilitation facility that is based on a novel model of care called Staged-Community-Based-Brain Injury Rehabilitation. Community Participation is the ability of a person to participate in activities outside of the home environment. A prospective longitudinal cohort study design will be used. Community participation outcomes for Oats Street clients will be measured at four time points: At discharge (T0) and at 4 months (T1), 8 months (T2) and 12 months (T3) following discharge. Sample size calculation: Based on client discharge numbers from 2018-2020, we expect approximately 26 (range: 20-31) discharges per year, or 52 (range: 40-62) discharges over the 24-month study follow-up period. Factoring in an expected response/attrition rate of 20% based on similar studies in the literature, the total number of participants expected to fully complete the study is 41 (range: 32-50). After study enrolment, participants will be assessed at four time points over the study period: T0 (1-2 weeks prior to discharge), T1 (4 months), T2 (8 months) and T3 (12 months) post-discharge. At each time point, assessments will include administration of 1) core outcome measures: The Community Integration Questionnaire to measure community participation (approximate time commitment of 15 minutes), The UK Functional Independence Measure and Functional Assessment Measure (approximate time commitment of 35 minutes) as well as the Mayo-Portland Adaptability Inventory (approximate time commitment of 15 minutes) to measure functional independence and aspects of community participation, the Goal Attainment Scale (approximate time commitment of 30 minutes) to measure goal attainment related to community participation and the Quality of Life after Brain Injury instrument (approximate time commitment of 10 minutes) to measure quality of life; 2) any additional outcome measures identified in a previous phase of the study and 3) the structured survey developed in the previous phase of the study (approximate time commitment of 20 minutes). These will all be conducted with each participant during multiple 60 minute face-to-face sessions over a one-week period. Discharge (T0) Discharge assessments will take place at Oats Street 1-2 weeks prior to discharge. The core outcome measures will be completed by Oats Street staff members. Additional outcome measures identified from the systematic review and the structured survey will be completed by the researcher. The researcher was employed as an Occupational Therapist at Oats Street for 6 months in 2020, however it is unlikely that they will be known to participants unless there was some interaction during this period of employment. Follow-Ups (T1-T3) Follow-up assessments will be conducted over one week at the participant’s home. If the participant’s home is not suitable, they will be able to choose a location suitable to them. To reduce participant fatigue, assessments will be completed during multiple 60-minute meetings over the one-week period. All assessments will be completed by the researcher. The researcher will implement participant retention strategies to reduce attrition over the follow-up period. Participants will be contacted one month before each time point to prepare suitable times for assessment via phone and email. Once the dates have been confirmed, a reminder text and email will be sent two weeks before the start date. The researcher will maintain regular contact with participants throughout the follow-up period via phone and email. A series of multilevel mixed effect regression models will be used to analyse changes in community participation outcomes and to develop and test a community participation explanatory model.