Is there a relationship between patient perception of rehabilitation environment and patient outcome?

Research Objectives: This pilot study examined the relationship between patient perception of the therapeutic milieu at a residential rehabilitation program and clinician-rated functional adaptability scores in an acquired brain injury (ABI) sample of veterans and service members.

Design: At admission and discharge from the rehabilitation program, an adaptability inventory was completed by a professional consensus interdisciplinary team. Patients completed self-report measures their last week of treatment to capture perceptions of the residential milieu. Pearson correlation was completed to examine the relationship between patient perception of the milieu, professional consensus adaptability scores, and change in those adaptability scores.

Setting: Polytrauma Transitional Rehabilitation Program in San Antonio

Participants: This study enrolled fifteen service members and veterans with a history of acquired brain injury that include moderate/severe traumatic brain injury, stroke, and central nervous system infection.

Interventions: Patients completed residential rehabilitation to address community reintegration goals. Patients were evaluated and treated by an interdisciplinary team comprised of the following disciplines: neuropsychology, health psychology, physiatry, physical therapy, occupational therapy, speech therapy, vision therapy, recreational therapy, and acupuncture.

Main Outcome Measures: Mayo Portland Adaptability Inventory, Fourth Edition (MPAI), Good Milieu Index (GMI)

Results: Patients indicated that on average, the milieu was satisfactory (M=21.40, SD=2.82). Clinician-rated MPAI scores declined on average by 16.13 (SD=6.95), from baseline (M=37.87, SD=14.19) to discharge (M=21.73, SD=9.93). Patient GMI scores were not significantly associated with clinical consensus of patient ability on the MPAI at admission (r2= 0.30, p= 0.13) nor discharge (r2= 0.08, p= 0.39). However, patient-rated milieu scores were significantly and negatively correlated with change on MPAI from admission to discharge (r2= -0.51, p= 0.03).

Conclusions: The more positively the patient rated the milieu, the greater the improvement in adaptability was noted by clinical consensus on the MPAI. These findings indicate that perceptions of the rehabilitative milieu is an instrumental factor in the benefit that they derive from that care. The milieu should be assessed and optimized to facilitate the optimal clinical impact while in residential rehabilitation program for service members and veterans with ABI.

Author(s) Disclosures: None.