ABI-aftercare in Motion: Multidisciplinary Aftercare in the Home Environment in Patients With Acquired Brain Injury

Rationale: Many people with acquired brain injury (ABI) experience difficulties in reintegration into their social life after discharge from the rehabilitation center. It is also known that people with ABI do not meet the physical activity guidelines; they have lower physical activity levels than healthy people and they have difficulty maintaining their physical fitness level reached during rehabilitation. An inactive lifestyle may lead to persistent complaints, such as fatigue, anxiety or depression, and may result in a poor health-related quality of life (HR-QoL).

Objective: To improve aftercare for patients with ABI receiving outpatient rehabilitation, aimed at promoting an active lifestyle to prevent persistent complaints after ABI and poor HR-QoL.

Study design: Care improvement study using a prospective mono-center cohort with a pre-post implementation study design.

Study population: Patients with ABI receiving outpatient rehabilitation therapy.

Intervention (if applicable): Implementation of an aftercare program that strengthens the cooperation between rehabilitation center and local patient support organisations in the community. The aftercare program integrates standard outpatient rehabilitation and community services, including: 1) brain education regarding long-term consequences of ABI, physical activity guidelines, and patient support organizations in the area; 2) a joint physical/ occupational/ movement therapy session with a buddy from a patient support organisation during outpatient rehabilitation; 3) buddy support (max 8 hrs) in the community towards an active lifestyle after rehabilitation discharge; 4) follow-up by the rehabilitation physician.

Main study parameters/endpoints: The proportion of participants with ABI participating in the community buddy program (target 60%) and feasibility (rating of satisfaction) of the program will be calculated. Secondary, objectively measured physical activity, physical fitness and cognitive functioning and patient reported outcomes (physical activity, fatigue, anxiety, depression, cognitive complaints, coping, community integration, HRQoL, physical fitness, health care use, return to work) using validated questionnaires will be collected before and at 3, 6, and 12 months after outpatient rehabilitation discharge.

• Change in total minutes of physical activity/week at 6 and 12 months compared with controls [Time frame: 0, 6, 12 months]
• Change in Montreal Cognitive Assessment (MoCA) score at 6 and 12 months compared with controls. [Time frame: 0, 6,12 months]
• Change in functional exercise capacity at 6 and 12 months compared with controls [Time frame: 0, 6, 12 months]
• Change in Walking Speed at 6 and 12 months compared with controls [Time frame: 0, 6, 12 months]
• Change in handgrip strength at 6 and 12 months compared with controls [Time frame: 0, 6, 12 months]
• Change in anxiety and depression at 3, 6, and 12 months compared with controls [Time frame: 0, 3, 6, and 12 months]
• Change in fatigue at 3, 6, and 12 months compared with controls [Time frame: 0, 3, 6, and 12 months]
• Change in cognitive failures at 3, 6, and 12 months compared with controls [Time frame: 0, 3, 6, and 12 months]
• Change in coping style at 3, 6, and 12 months compared with controls [Time frame: 0, 3, 6, and 12 months]
• Change in health-related quality of life at 3, 6, and 12 months compared with controls [Time frame: 0, 3, 6, 12 months]
• Change in physical and mental components of health-related quality of life at 3, 6, and 12 months compared with controls [Time frame: 0, 3, 6, 12 months]
• Change in physical activity at 3, 6,12 months compared with controls [Time frame: 0, 3, 6, 12 months]