Occupational therapy and achievement of self-identified goals by adults with acquired brain injury: phase II.

OBJECTIVE The purpose of this study was to investigate the association between participation in goal-specific outpatient occupational therapy and improvement in self-identified goals in adults with acquired brain injury. METHOD Thirty-one persons with traumatic brain injury of mixed chronicity participated at three sites located in different regions of the United States. Using a repeated-measures design, therapy that usually was offered at each site to achieve specific goals was followed by a no-treatment period. Participants completed the Canadian Occupational PerFormance Measure Performance subscale (COPM-P) and Satisfaction subscale (COPM-S), and the Community Integration Questionnaire (CIQ) at admission, discharge, and 1 to 18 weeks after discharge. Goal attainment scales were developed at admission and scored at discharge; the differences for each site were tested, using dependent t tests. Gains for the treatment period (admission to discharge) in COPM subscales and the CIQ were compared with gains during the no-treatment period (discharge to follow-up) for each site, using dependent t tests. The results were synthesized meta-analytically across the sites. RESULTS The participants identified a total of 149 goals, 81% of which were achieved. Goal attainment T scores improved significantly (Z = 7.52, p < .001), and the combined effect size was large (r = .94). The COPM-P (Z = 4.13, p < .001) and COPM-S (Z = 4.25, p < .001) showed significantly greater gains during the treatment (average 15.3 weeks) versus the no-treatment (average 9.9 weeks) period. Effect size estimates were large: .71 and .76, respectively. Gain scores of the CIQ did not differ significantly (Z = .75, p = .22, r = .29) between periods. CONCLUSION Participation in goal-specific outpatient occupational therapy that focused on teaching compensatory strategies was strongly associated with achievement of self-identified goals and reduction of disability in adults with mild to moderate brain injury.