Responsiveness of the Activity Participation Outcome Measure in adult patients with Traumatic Brain Injury in an acute private neurological rehabilitation setting in South Africa

Abstract

Introduction: Acute neurological rehabilitation aims to reduce the burden of care of patients with traumatic brain injury (TBI) 
and increase their activity participation. Tracking change throughout the rehabilitation is essential for funders of the service as 
well as the patient. Valid, reliable and responsive outcome measures are thus needed for accurate measurement of change.
This study compared the responsiveness to change of the Functional Independence Measureâ„¢+ Functional Assessment 
Measure (FIMâ„¢+FAM) with the Activity Participation Outcomes Measure (APOM). This was administered TBI patients in the 
acute neurological rehabilitation phase in a private health care facility in South Africa.
Method: A quantitative, prospective, longitudinal cohort design was used. A sample of 24 in-patients over 12 months was 
scored weekly on both outcome measures. The responsiveness between the APOM and FIMâ„¢+FAM was tested using the 
dependent t-test for paired samples and the effect size from admission to discharge was calculated with the standardised response mean.
Results: Both measures were responsive to change and tracked improvement in activity participation (APOM) and reduction of 
burden of care (FIMâ„¢+FAM). No significant statistical difference was found between the responsiveness of the two measures, however positive changes were reported in each individual patient.
Conclusion: Although both measures are responsive to track change in TBI patients, the APOM includes more specific items 
that occupational therapists address in rehabilitation. The lack of a measure of physical components in the APOM makes it a 
difficult to be the only one to use in an environment where there is a high physical burden of care in patients. However, the 
APOM could be used in conjunction with other impairment-based scales that target physical components. It is recommended that more occupational therapists use the APOM with TBI populations.

Key words: Activity participation outcome measure, Traumatic Brain Injuries, Acute neurological rehabilitation, responsiveness