Original article| Volume 88, ISSUE 7, P877-884, July 2007

The Hopkins Rehabilitation Engagement Rating Scale: Development and Psychometric Properties


      Kortte KB, Falk LD, Castillo RC, Johnson-Greene D, Wegener ST. The Hopkins Rehabilitation Engagement Rating Scale: development and psychometric properties.


      To conduct an initial investigation of the psychometric properties of the Hopkins Rehabilitation Engagement Rating Scale (HRERS), a 5-item, clinician-rated measure developed to quantify engagement in acute rehabilitation services.


      We used a cross-sectional design to conduct correlational and multivariate analyses to establish the measure’s internal consistency, interrater reliability, construct validity, and criterion validity.


      Acute inpatient rehabilitation in 3 metropolitan hospitals.


      A total of 206 subjects with spinal cord injury, ischemic or hemorrhagic stroke, amputation, or hip or knee replacement.


      Not applicable.

      Main Outcome Measures

      The HRERS, Positive and Negative Affect Schedule, Brief Symptom Inventory, Levine’s Denial of Illness Scale, Craig Handicap Assessment and Reporting Technique, and FIM instrument.


      The HRERS has good internal consistency (α=.91) and interrater reliability (intraclass correlation coefficient, .73) and represents a unidimensional construct. It correlated negatively with symptoms of depression (r=−.24, P<.01), higher ratings of denial of illness (r=−.30, P<.001), and self-rated negative affect (r=−.23, P<.01), and correlated positively with self-rated positive affect (r=.36, P<.001) and level of functioning 3 months postdischarge (r=.22, P<.01).


      The HRERS is a valid and reliable measure of rehabilitation engagement that relates to intermediate-term functional outcomes.

      Key Words

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        • Cifu D.
        • Stewart D.
        Factors affecting functional outcome after stroke: a critical review of rehabilitation interventions.
        Arch Phys Med Rehabil. 1999; 80: S35-S39
        • Moffet H.
        • Collet J.P.
        • Shapiro S.H.
        • Paradis G.
        • Marquis F.
        • Roy L.
        Effectiveness of intensive rehabilitation on functional ability and quality of life after first total knee arthroplasty: a single-blind randomized controlled trial.
        Arch Phys Med Rehabil. 2004; 85: 546-556
        • Munin M.C.
        • Seligman K.
        • Dew M.A.
        • et al.
        Effect of rehabilitation site on functional recovery after hip fracture.
        Arch Phys Med Rehabil. 2005; 86: 367-372
        • Yagura H.
        • Miyai I.
        • Seike Y.
        • Suzuki T.
        • Yanagihara T.
        Benefit of inpatient multidisciplinary rehabilitation up to 1 year after stroke.
        Arch Phys Med Rehabil. 2003; 84: 1687-1691
        • Freburger J.K.
        An analysis of the relationship between the utilization of physical therapy services and outcomes for patients with acute stroke.
        Phys Ther. 1999; 79: 906-918
        • Freburger J.K.
        Analysis of the relationship between the utilization of physical therapy services and outcomes of care for patients after total hip arthroplasty.
        Phys Ther. 2000; 80: 448-458
        • Fiedler R.C.
        • Granger C.V.
        • Russell C.F.
        UDSmrsm: follow-up data on patients discharged in 1994-1996.
        Am J Phys Med Rehabil. 2000; 79: 184-192
        • Resnick B.
        • Zimmerman S.
        • Magaziner J.
        • Adelman A.
        Use of the Apathy Evaluation Scale as a measure of motivation in elderly people.
        Rehabil Nurs. 1998; 23: 141-147
        • Lenze E.J.
        • Munin M.C.
        • Dew M.A.
        • et al.
        Adverse effects of depression and cognitive impairment on rehabilitation participation and recovery from hip fracture.
        Int J Geriatr Psychiatry. 2004; 19: 472-478
        • Geelen R.
        • Soons P.
        Rehabilitation: an ‘everyday’ motivation model.
        Patient Educ Couns. 1996; 28: 69-77
        • Maclean N.
        • Pound P.
        • Wolfe C.
        • Rudd A.
        Qualitative analysis of stroke patients’ motivation for rehabilitation.
        BMJ. 2000; 321: 1051-1054
        • Faller H.
        Rehabilitation (Stuttg). 2003; 42 ([Shared decision making: an approach to strengthening patient participation in rehabilitation] [German]): 129-135
        • Jeffrey D.
        Cognitive clarity: key to motivation in rehabilitation.
        J Rehabil. 1981; 47: 33-35
        • Kortte K.B.
        • Wegener S.T.
        Denial of illness in medical rehabilitation populations: theory, research, and definition.
        Rehabil Psychol. 2004; 49: 187-199
        • Lenze E.J.
        • Munin M.C.
        • Quear T.
        • et al.
        The Pittsburgh Rehabilitation Participation Scale: reliability and validity of a clinician-rated measure of participation in acute rehabilitation.
        Arch Phys Med Rehabil. 2004; 85: 380-384
        • Folstein M.F.
        • Folstein S.E.
        • McHugh P.R.
        • Fanjiang G.
        Mini-Mental State Examination: user’s guide. Psychological Assessment Resources, Odessa2001
        • Linacre J.M.
        • Heinemann A.W.
        • Wright B.D.
        • Granger C.V.
        • Hamilton B.B.
        The structure and stability of the Functional Independence Measure.
        Arch Phys Med Rehabil. 1994; 75: 127-132
        • Hamilton B.B.
        • Laughlin J.A.
        • Fiedler R.C.
        • Granger C.V.
        Interrater reliability of the 7-level functional independence measure (FIM).
        Scand J Rehabil Med. 1994; 26: 115-119
        • Ottenbacher K.J.
        • Hsu Y.
        • Granger C.V.
        • Fiedler R.C.
        The reliability of the Functional Independence Measure: a quantitative review.
        Arch Phys Med Rehabil. 1996; 77: 1226-1232
        • Bottemiller K.L.
        • Bieber P.L.
        • Basford J.R.
        • Harris M.
        FIM score, FIM efficiency, and discharge disposition following inpatient stroke rehabilitation.
        Rehabil Nurs. 2006; 31: 22-25
        • Chae J.
        • Zorowitz R.
        • Johnston M.
        Functional outcome of hemorrhagic and nonhemorrhagic stroke patients after in patient rehabilitation: a matched comparison.
        Am J Phys Med Rehabil. 1996; 75: 177-182
        • Derogatis L.
        The Brief Symptom Inventory (BSI): administration, scoring and procedures manual. 3rd ed. National Computer Systems, Minneapolis1993
        • Derogatis L.R.
        • Melisaratos N.
        The Brief Symptom Inventory: an introductory report.
        Psychol Med. 1983; 13: 595-605
        • MacNeill S.E.
        • Lichtenberg P.A.
        Predictors for functional outcome in older rehabilitation patients.
        Rehabil Psychol. 1998; 43: 246-257
        • Mast B.T.
        • MacNeill S.E.
        • Lichtenberg P.A.
        Geropsychological problems in medical rehabilitation: dementia and depression among stroke and lower extremity fracture patients.
        J Gerontol Biol Sci Med Sci. 1999; 54: M607-M612
        • Watson D.
        • Clark L.A.
        • Tellegen A.
        Development and validation of brief measures of positive and negative affect: the PANAS scales.
        J Pers Soc Psychol. 1988; 54: 1063-1070
        • Levine J.
        • Warrenburg S.
        • Kerns R.
        • et al.
        The role of denial in recovery from coronary heart disease.
        Psychosom Med. 1987; 49: 109-117
        • Jacobsen B.
        • Lowery B.
        Further analysis of the psychometric properties of the Levine Denial of Illness Scale.
        Psychosom Med. 1992; 54: 372-381
        • Whiteneck G.G.
        • Charlifue S.W.
        • Gerhart K.A.
        • Overholser J.D.
        • Richardson G.N.
        Quantifying handicap: a new measure of long term rehabilitation outcomes.
        Arch Phys Med Rehabil. 1992; 73: 519-525
        • Bradley J.V.
        The insidious L-shaped distribution.
        Bull Psychonomic Soc. 1982; 20: 85-88
        • Rossner B.
        Fundamentals of biostatistics. 5th ed. Duxbury Pr, Pacific Grove2000
        • Nunnally J.
        Psychometric theory. McGraw-Hill, New York1978
        • Shrout P.E.
        • Fleiss J.L.
        Intraclass correlations: uses in assessing rater reliability.
        Psychol Bull. 1979; 2: 420-428
        • Andresen E.M.
        • Catlin T.K.
        • Wyrwich K.W.
        • Jackson-Thompson J.
        Retest reliability of surveillance questions on health related quality of life.
        J Epidemiol Community Health. 2003; 57: 339-343
        • Raat H.
        • Botterweck A.
        • Landgraf J.M.
        • Hoogeveen W.C.
        • Essink-Bot M.L.
        Reliability and validity of the short form of the child health questionnaire for parents (CHQ-PF28) in large random school based and general population samples.
        J Epidemiol Community Health. 2005; 59: 75-82
        • Kachigan S.
        Statistical analysis: an interdisciplinary introduction to univariate and multivariate methods. Radius Pr, New York1986
        • Miller R.G.
        Simultaneous statistical inference. 2nd ed. Springer Verlag, New York1981
        • Rubak S.
        • Sandbaek A.
        • Lauritzen T.
        • Christensen B.
        Motivational interviewing: a systematic review and meta-analysis.
        Br J Gen Pract. 2005; 55: 305-312