Measuring outcome in community-based rehabilitation services for people who have suffered traumatic brain injury: the Community Outcome Scale

Abstract

Objective: To develop a way of measuring long-term outcomes after traumatic brain injury (TBI) that takes account of individual circumstances. Design: Reports by head-injured people and their families about problems and coping strategies were elicited via semi-structured interviews. Specially designed computer software was used to record problems and strengths and to measure their impact for the individual on four handicap dimensions. Setting: Interviews took place in the respondents' homes. Subjects: Between 1992 and 1997 the services at 10 rehabilitation centres in England were evaluated. Subjects were men and women aged between 16 and 65 who had suffered TBI and who had been referred for treatment to one of the centres under study. Interventions: Head-injured people and their families were interviewed three months, 18 months and in some cases 36 months after recruitment. Main outcome measures: The Hospital Anxiety and Depression Scale (HAD) and the Functional Independence/Assessment Measure (FIM/FAM) were used to validate relevant dimensions of the new scale. Results: A measure of long-term outcome was developed and called the Community Outcome Scale. Relevant dimensions of the scale showed significant correlation with the HAD and with items of the FIM/FAM. Conclusion: The scale captures information which no other instrument does, and merits further validation.